Author: "sara bennett" / Topic: business.industry - Searchworks@Jio Institute Digital Library Search Results

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1. Safety, immunogenicity, and efficacy of a COVID-19 vaccine (NVX-CoV2373) co-administered with seasonal influenza vaccines: an exploratory substudy of a randomised, observer-blinded, placebo-controlled, phase 3 trial

Author: Seth Toback, Eva Galiza, Catherine Cosgrove, James Galloway, Anna L Goodman, Pauline A Swift, Sankarasubramanian Rajaram, Alison Graves-Jones, Jonathan Edelman, Fiona Burns, Angela M Minassian, Iksung Cho, Lakshmi Kumar, Joyce S Plested, E Joy Rivers, Andreana Robertson, Filip Dubovsky, Greg Glenn, Paul T Heath, Roy L. Soiza, Robin Brittain-Long, Chiara Scicluna, Carole Edwards, Lynn Mackay, Mariella D'Allesandro, Amy Nicol, Karen Norris, Sandra Mann, Heather Lawrence, Ruth Valentine, Marianne Elizabeth Viljoen, Carol H. Pretswell, Helen Nicholls, Imrozia Munsoor, Agnieszka Meyrick, Christina Kyriakidou, Shalini Iyengar, Arham Jamal, Nick Richards, Helen Price, Bridie Rowbotham, Danielle Bird, Karen Smith, Olga Littler, Kirsty Fielding, Anna Townsend-Rose, Karen Miller, Jessica Davis, Alison Elliot-Garwood, Lauren Trottier, Paul Edwards, Margaret McFarland, Orod Osanlou, Laura Longshaw, Jane Stockport, Lynne Grundy, Katharine Lucy Broad, Karen Regan, Kim Storton, Declan Ryan-Wakeling, Brad Wilson, Malathy Munisamy, John Wright, Anil Shenoy, Beverley English, Lucy Brear, Paola Cicconi, Marta Boffito, Ana Milinkovic, Ruth Byrne, Roya Movahedi, Rosalie Housman, Naveed Kara, Ellen Brown, Andrea Cipriani, Mary-Jane Attenburrow, Katharine A. Smith, Jonathan Packham, Geoff Sparrow, Richard Smith, Josephine M. Rosier, Khalid Saja, Nyasha Nago, Brian Camilleri, Anita Immanuel, Mike Hamblin, Rawlings Osagie, Mahalakshmi Mohan, Hilary Floyd, Suzanne Goddard, Sanjay Mutgi, John Evans, Sean McKeon, Neringa Vilimiene, Rosavic Chicano, Rachel Hayre, Alice Pandaan, Catherine Henshall, Sonia Serrano, Andrea Mazzella, Thurkka Rajeswaran, Moncy Mathew, Karen Bisnauthsing, Laura Bremner, Henry Fok, Franca Morselli, Paola Cinardo, Blair Merrick, Lucy Sowole, Samantha Broadhead, Natalie Palmer, Jessica Cordle, Jaimie Wilson Goldsmith, Enya Cooney, Beth Jackson, Thilina Jayatilleke, Zelda Cheng, Toby Helliwell, Adrian Chudyk, Rafaela Giemza, John Lord Villajin, Noah Yogo, Esther Makanju, Pearl Dulawan, Deepak Nagra, April Buazon, Alice Russell, Georgie Bird, Amardeep Heer, Rex Sarmiento, Balraj Sanghera, Melanie Mullin, Adam Champion, Aisling Bevan, Kinzah Iqbal, Alshia Johnson, Rebecca Clark, Sarah Shaw, Steven Shaw, Amanda Chalk, Martin Lovatt, Caroline Lillicrap, Angela Parker, Jan Hansel, Zhi Wong, Galvin Gan, Eyad Tuma, Jane Minton, Jennifer Murira, Razan Saman, Alistair Hall, Kyra Holliday, Zara Khan, James Calderwood, George Twigg, Helena Baker, Julie Corrigan, Katy Houseman, Subhra Raguvanshi, Dominic Heining, Jake Weddell, Liz Glaves, Kim Thompson, Francis Davies, Ruth Lambley Burke, Emma C. Thomson, Dinesh Saralaya, Lisa Berry, Nancy Hopewell, Leigh Gerdes, Mihaela Pacurar, Saul N. Faust, Jeremy Turner, Christopher Jeanes, Adele Cooper, Jocelyn Keshet-Price, Lou Coke, Melissa Cambell-Kelly, Ketan Dhatariya, Claire Williams, Georgina Marks, James Sudbury, Lisa Rodolico, Judy Bradley, Sharon Carr, Roisin Martin, Angelina Madden, Paul Biagioni, Sonia McKenna, Alison Clinton, Maurice O'Kane, Justin Carter, Matthew Dewhurst, Bill Wetherill, Thandiwe Hoggarth, Katrina Lennon Collins, Marie Chowdhury, Adil Nathoo, Anna Heinen, Orla MacDonald, Claudia Hurducas, Liliana Cifuentes, Harjeevan Gill, Andy Gibson, Raha West, Jane Ewing, Rachel Blacow, John Haughney, Jonathan MacDonald, John Paul Seenan, Stewart Webb, Colin O'Leary, Scott Muir, Beth White, Neil Ritchie, Daniel F. McAuley, Jonathan Stewart, Mariella D'Alessandro, Nicki Lakeman, Laura Purandare, Duncan Browne, David Tucker, Peter Luck, Angharad Everden, Lisa Trembath, Michael Visick, Nick Morley, Laura Reid, Helen Chenoweth, Kirsty Maclean, Ray P. Sheridan, Tom Burden, Craig Francis Lunt, Shirley Todd, Stephanie Estcourt, Jasmine Marie Pearce, Suzanne Wilkins, Cathryn Love-Rouse, Eva Torok-Pollok, Mike Youle, Sara Madge, Danielle Solomon, Aarti Nandani, Janet M. North, Nargis Hemat, Rachel Newport, Philip A. Kalra, Chukwuma Chukwu, Olivia Wickens, Vikki O'Loughlin, Hema Mistry, Louise Harrison, Robert Oliver, Anne-Marie Peers, Jess Zadik, Katie Doyle, David R. Chadwick, Kerry Colling, Caroline Wroe, Marie Branch, Alison Chilvers, Sarah Essex, Mark Stone, Alberto San Francisco Ramos, Emily Beales, Olivia Bird, Zsofia Danos, Hazel Fofie, Cecilia Hultin, Sabina Ikram, Fran Mabesa, Aoife Mescall, Josyanne Pereira, Jennifer Pearce, Natalina Sutton, Emma Snashall, David Neil Baxter, Sara Bennett, Debbie Suggitt, Kerry Hughes, Wiesia Woodyatt, Lynsey Beacon, Alissa Kent, Chris Cooper, Milan Rudic, Simon Tunstall, Matthew Jackson, Claire Hombersley, Patrick Moore, Rebecca Cutts, Andrew Higham, Marwan Bukhari, Mohamed Elnaggar, Michelle Glover, Fiona Richardson, Alexandra Dent, Shahzeb Mirza, Rajiv Ark, Jennie Han, Suzy V. Hope, Philip J. Mitchelmore, Rostam Osanlou, Andrew Freedman, Alison Cooper, Katherine Burton, Kashyap Katechia, Michael Barrett, Jo Salkeld, Natalie Hill, Nathaniel Lee, Jon Perkins, and Polly Fox
Subjects: Adult, Pulmonary and Respiratory Medicine, Trivalent influenza vaccine, medicine.medical_specialty, COVID-19 Vaccines, Adolescent, Influenza vaccine, Population, Placebo, Young Adult, Immunogenicity, Vaccine, Double-Blind Method, Internal medicine, Humans, Medicine, education, Adverse effect, Aged, education.field_of_study, Reactogenicity, SARS-CoV-2, business.industry, COVID-19, Articles, Middle Aged, Vaccine efficacy, Vaccination, Influenza Vaccines, Seasons, business
Abstract: Background The safety and immunogenicity profile of COVID-19 vaccines when administered concomitantly with seasonal influenza vaccines have not yet been reported. We therefore aimed to report the results of a substudy within a phase 3 UK trial, by evaluating the safety, immunogenicity, and efficacy of NVX-CoV2373 when co-administered with licensed seasonal influenza vaccines. Methods We did a planned exploratory substudy as part of the randomised, observer-blinded, placebo-controlled, phase 3 trial of the safety and efficacy of the COVID-19 vaccine (NVX-CoV2373) by co-administrating the influenza vaccine at four study hospitals in the UK. Approximately, the first 400 participants meeting the main study entry criteria—with no contraindications to influenza vaccination—were invited to join the substudy. Participants of the main study were randomly assigned (1:1) to receive two intramuscular injections of either NVX-CoV2373 (5 μg) or placebo (normal saline) 21 days apart; participants enrolled into the substudy were co-vaccinated with a single (0·5 mL) intramuscular, age-appropriate (quadrivalent influenza cell-based vaccine [Flucelvax Quadrivalent; Seqirus UK, Maidenhead] for those aged 18–64 years and adjuvanted trivalent influenza vaccine [Fluad; Seqirus UK, Maidenhead] for those ≥65 years), licensed, influenza vaccine on the opposite deltoid to that of the first study vaccine dose or placebo. The influenza vaccine was administered in an open-label manner and at the same time as the first study injection. Reactogenicity was evaluated via an electronic diary for 7 days after vaccination in addition to monitoring for unsolicited adverse events, medically attended adverse events, and serious adverse events. Immunogenicity was assessed with influenza haemagglutination inhibition and SARS-CoV-2 anti-spike protein IgG assays. Vaccine efficacy against PCR-confirmed, symptomatic COVID-19 was assessed in participants who were seronegative at baseline, received both doses of study vaccine or placebo, had no major protocol deviations affecting the primary endpoint, and had no confirmed cases of symptomatic COVID-19 from the first dose until 6 days after the second dose (per-protocol efficacy population). Immunogenicity was assessed in participants who received scheduled two doses of study vaccine, had a baseline sample and at least one post-vaccination sample, and had no major protocol violations before unmasking (per-protocol immunogenicity population). Reactogenicity was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo and had data collected for reactogenicity events. Safety was analysed in all participants who received at least one dose of NVX-CoV2373 or placebo. Comparisons were made between participants of the substudy and the main study (who were not co-vaccinated for influenza). This study is registered with ClinicalTrials.gov, number NCT04583995. Findings Between Sept 28, 2020, and Nov 28, 2020, a total of 15 187 participants were randomised into the main phase 3 trial, of whom 15 139 received treatment (7569 received dose one of NVX-CoV2373 and 7570 received dose one of placebo). 431 participants were co-vaccinated with a seasonal influenza vaccine in the substudy (217 received NVX-CoV2373 plus the influenza vaccine and 214 received placebo plus the influenza vaccine). In general, the substudy participants were younger, more racially diverse, and had fewer comorbid conditions than those in the main study. Reactogenicity events were more common in the co-administration group than in the NVX-CoV2373 alone group: tenderness (113 [64·9%] of 174 vs 592 [53·3%] of 1111) or pain (69 [39·7%] vs 325 [29·3%]) at injection site, fatigue (48 [27·7%] vs 215 [19·4%]), and muscle pain (49 [28·3%] vs 237 [21·4%]). Incidences of unsolicited adverse events, treatment-related medically attended adverse events, and serious adverse events were low and balanced between the co-administration group and the NVX-CoV2373 alone group. No episodes of anaphylaxis or deaths were reported within the substudy. Co-administration resulted in no change to influenza vaccine immune response although a reduction in antibody responses to the NVX-CoV2373 vaccine was noted. NVX-CoV2373 vaccine efficacy in the substudy (ie, participants aged 18 to
Published: 2022

2. Stakeholder perspectives on proposed policies to improve distribution and retention of doctors in rural areas of Uttar Pradesh, India

Author: Veena Sriram, Shreya Hariyani, Ummekulsoom Lalani, Sara Bennett, Ravi Teja Buddhiraju, and Pooja Pandey
Subjects: Government, business.industry, Research, Health Policy, Corporate governance, Public sector, Stakeholder, India, Public relations, Policy, Physicians, Accountability, Workforce, Humans, Stakeholder analysis, Medicine, Rural Health Services, Rural area, Public aspects of medicine, RA1-1270, Human resources, business
Abstract: Background In India, the distribution and retention of biomedical doctors in public sector facilities in rural areas is an obstacle to improving access to health services. The Government of Uttar Pradesh is developing a comprehensive, ten-year Human Resources for Health (HRH) strategy, which includes policies to address rural distribution and retention of government doctors in Uttar Pradesh (UP). We undertook a stakeholder analysis to understand stakeholder positions on particular policies within the strategy, and to examine how stakeholder power and interests would shape the development and implementation of these proposed policies. This paper focuses on the results of the stakeholder analysis pertaining to rural distribution and retention of doctors in the government sector in UP. Our objectives are to 1) analyze stakeholder power in influencing the adoption of policies; 2) compare and analyze stakeholder positions on specific policies, including their perspectives on the conditions for successful policy adoption and implementation; and 3) explore the challenges with developing and implementing a coordinated, ‘bundled’ approach to strengthening rural distribution and retention of doctors. Methods We utilized three forms of data collection for this study – document review, in-depth interviews and focus group discussions. We conducted 17 interviews and three focus group discussions with key stakeholders between September and November 2019. Results We found that the adoption of a coordinated policy approach for rural retention and distribution of doctors is negatively impacted by governance challenges and fragmentation within and beyond the health sector. Respondents also noted that the opposition to certain policies by health worker associations created challenges for comprehensive policy development. Finally, respondents believed that even in the event of policy adoption, implementation remained severely hampered by several factors, including weak mechanisms of accountability and perceived corruption at local, district and state level. Conclusion Building on the findings of this analysis, we propose several strategies for addressing the challenges in improving access to government doctors in rural areas of UP, including additional policies that address key concerns raised by stakeholders, and improved mechanisms for coordination, accountability and transparency.
Published: 2021

3. Fiber Bragg Grating Sensors as Innovative Monitoring Tool for Beam Induced RF Heating on LHC Beam Pipe

Author: Noemi Beni, Benoit Salvant, Salvatore Buontempo, Giovanni Breglio, Sara Bennett Spedding, Andrea Irace, Austin Ball, Vincenzo Romano Marrazzo, Vittorio Vaccaro, Wolfram Dietrich Zeuner, Zoltan Szillasi, Francesco Fienga, Fienga, F., Marrazzo, V. R., Spedding, S. B., Szillasi, Z., Beni, N., Irace, A., Zeuner, W., Ball, A., Vaccaro, V. G., Salvant, B., Buontempo, S., and Breglio, G.
Subjects: particle accelerator, Large Hadron Collider, Materials science, High energy particle, business.industry, beam pipe, Particle accelerator, Atomic and Molecular Physics, and Optics, fiber Bragg grating, law.invention, Physics::Fluid Dynamics, Optics, Fiber Bragg grating, law, Fiber optic sensor, fiber optic sensor, Physics::Accelerator Physics, Structural health monitoring, monitoring system, business, Particle beam, Beam induced heating, Beam (structure)
Abstract: The i-pipe system is a peculiar structural health monitoring system, based on Fiber Bragg Grating technology, installed on the central beam pipe of the compact Muon solenoid (CMS) experiment at CERN. In this contribution, i-pipe temperature sensors, originally conceived as thermal compensator for the strain sensors, are employed to monitor central beam pipe thermal behavior in correlation with the parameters of the particle beam travelling inside, in order to directly measure possible Beam RF induced heating effect. The i-pipe system turned out to be capable of monitoring, directly and without interference, the parameters of the particle beam circulating in the LHC ring. Hence, the results presented in this work pave the way to the use of the i-pipe as monitoring system of an accelerated high energy particle beam.
Published: 2021

4. Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Author: Obbina Abani, Ali Abbas, Fatima Abbas, Mustafa Abbas, Sadia Abbasi, Hakam Abbass, Alfie Abbott, Nabeel Abdallah, Ashraf Abdelaziz, Mohamed Abdelfattah, Bushra Abdelqader, David Abdo, Basir Abdul, Althaf Abdul Rasheed, Ajibode Abdulakeem, Rezan Abdul-Kadir, Amina Abdulle, Abdulfatahi Abdulmumeen, Rasheed Abdul-Raheem, Niyaz Abdulshukkoor, Kula Abdusamad, Yazeed Abed El Khaleq, Mai Abedalla, Abeer Ul Amna Abeer Ul Amna, Katrina Abernethy, Adebanke Aboaba, Hani Abo-Leyah, Ahmed Abou-Haggar, Mahmoud Abouibrahim, Miriam Abraham, Tizzy Abraham, Abraheem Abraheem, Judith Abrams, Hyacinth-John Abu, Ahmed Abu-Arafeh, Syed M Abubacker, Akata Abung, Yaa Aceampong, Amaka Achara, Devikumar Acharya, Sarah Acheampong, Janet Acheson, Andres Acosta, Catherine Acton, Jacqueline Adabie-Ankrah, Sara Adair, Fiona Adam, Matthew Adam, Huzaifa Adamali, Carol Adams, Charlotte Adams, Kate Adams, Lisa Adams, Richard Adams, Tim Adams, Kirsty Adcock, Jemaimah Addai, Ade Adebiyi, Ken Adegoke, Vicki Adell, Debo Ademokun, Sherna Adenwalla, Oluwasegun A Adesemoye, Emmanuel O Adewunmi, Joyce Adeyemi, Rina Adhikary, Gabrielle Adkins, Adnan Adnan, John Aeron-Thomas, Debbie Affleck, Dominic Affron, Carmel Afnan, Muhammad Afridi, Zainab A Aftab, Meenakshi Agarwal, Rachel Agbeko, Chris Agbo, Penny Agent, Sunil Aggarwal, Arameh Aghababaie, Shafana Ahamed Sadiq, Mohamed H Ahammed Nazeer, Humayun Ahmad, Mohammad Ahmad, Syed Ahmad, Asim Ahmed, Bilal Ahmed, Forizuddin Ahmed, Hamze Ahmed, Iram Ahmed, Irshad Ahmed, Khaled Ahmed, Liban Ahmed, Mahin Ahmed, Maria C Ahmed, Muhammad S Ahmed, Naseer Ahmed, Nausheen Ahmed, Osama Ahmed, Rajia A Ahmed, Rizwan Ahmed, Saif Ahmed, Sammiya Ahmed, Sara Ahmed, Sophia Ahmed, Syed Ahmed, Syed Haris Ahmed, Roa Ahmed Ali, Sana Ahmed, Sana Ahmer, Dhiraj Ail, Mark Ainsworth, Giulia Airoldi, Myriam Aissa, Lindianne Aitken, Bini Ajay, Francis Ajeneye, Abdulakeem Ajibode, Ayesha Ajmi, Tahir Akbar, Naim Akhtar, Nasim Akhtar, Nauman Akhtar, Suha Akili, Oludoyinsola Akindolie, Yinka Akinfenwa, Olugbenga Akinkugbe, Ibrahim Akinpelu, Olajide Akinwumiju, Olugbenro Aktinade, Ahmad Al Aaraj, Asma Al Balushi, Majd Al Dakhola, Aladdin Al Swaifi, Eslam Al-Abadi, Narendra Aladangady, Ayaz Alam, Sajid Alam, Abbas Al-Asadi, Karina Al-Asadi, Kyriaki Alatzoglou, Manaf Al-Bayati, Paul Albert, Lorraine Albon, Gemma Alcorn, Stephen Alcorn, Aggie Aldana, David Alderdice, Rayan Aldouri, Jonathan Aldridge, Nicolas Aldridge, Ana Alegria, Alison Alexander, John Alexander, Peter D G Alexander, Charlotte Alford, Julyan Al-Fori, Laith Alghazawi, Bahij Al-Hakim, Shams Al-Hity, Ali Ali, Asad Ali, Fawzia R Ali, Hoodo Ali, Jawad Ali, Mariam Ali, Mohammad Ali, Nayab Ali, Oudai Ali, Sabira Ali, Sakina Ali, Syed Ali, Abid Alina, Fine Aliyuda, Katrin Alizadeh, Maithem Al-Jibury, Saba Al-Juboori, Majid Al-Khalil, Moutaz Alkhusheh, Allameddine Allameddine, Fiona Allan, Rachel Allan, Alison Allanson, Robert Allcock, Beverley Allen, Eireann Allen, Jess Allen, Kerry Allen, Laura Allen, Louise Allen, Poppy Allen, Rebecca Allen, Sam Allen, Sharon Allen, Simon Allen, Kathryn Allison, Bethan Allman, Lynne Allsop, Hassan Al-Moasseb, Magda Al-Obaidi, Lina Alomari, Akram Al-Rabahi, Bahar Al-Ramadhani, Zayneb Al-Saadi, Inji Alshaer, Rustam Al-Shahi Salman, Warkaq Al-Shamkhani, Bashar Al-Sheklly, Sara Altaf, Mary Alvarez, Balaal Alyas, Maysaa Alzetani, Susan Amamou, Noor Amar, Sakkarai Ambalavanan, Sarah-Jayne Ambler, Robert Ambrogetti, Chris Ambrose, Amir Ameen, Kenneth Amenyah, Maria R Amezaga, Allison Amin, Amina Amin, Kanish Amin, Syed Amin, Tara Amin, Amjad Amjad, Neelma Amjad, Mariam Ammoun, Victoria Amosun, Khaled Amsha, Pugh Amy, Atul Anand, Rekha Anand, Samantha Anandappa, Julie Anderson, Kevin Anderson, Laura Anderson, Michelle Anderson, Nicola Anderson, Rachel Anderson, Rory Anderson, Wendy Anderson, Prematie Andreou, Angela Andrews, Antonette Andrews, Jill Andrews, Susan Andrews, Gregory Andrikopoulos, Kanayochukwu Aneke, Andrew Ang, Wan Wei Ang, Tammy Angel, Aramburo Angela, Paola Angelini, Lazarus Anguvaa, Oleg Anichtchik, Millicent Anim-Somuah, Krishnan Aniruddhan, Jessica Annett, Patrick J Anstey, Rebekah Anstey, Alpha Anthony, Aaron Anthony-Pillai, Philip Antill, Zhelyazkova Antonina, Varghese Anu, Muhammad Anwar, George Apostolides, Aristeidis Apostolopoulos, Sarah Appleby, Diane Appleyard, Maia Far Aquino, Bianca Araba, Samuel Aransiola, Mariana Araujo, Emily Arbon, Ann Archer, Denise Archer, Simon Archer, Christian Ardley, Ana-Maria Arias, Ryoki Arimoto, Charlotte Arkley, Charlotte Armah, Ilianna Armata, Adam Armitage, Ceri Armstrong, Maureen Armstrong, Sonia Armstrong, Sylvia Armstrong-Fisher, Philippa Armtrong, Heike Arndt, Clare Arnison-Newgass, David Arnold, Rachael Arnold, Sarah Arnott, Dhawal Arora, Kavan Arora, Pardeep Arora, Rishi Arora, Andrea Arroyo, Arslam Arter, Ayush Arya, Rita Arya, Denisa Asandei, Adeeba Asghar, Catherine Ashbrook-Raby, Glen Ashby, Helen Ashby, Jan Ashcroft, John Ashcroft, Samuel Ashcroft, Deborah Asher, Ayesha Ashfaq, Ben Ashford, Suhail Ashgar, Abdul Ashish, Sally Ashman-Flavell, Sundar Ashok, Abd-El-Aziz Ashour, Muhammad Z Ashraf, Saima Ashraf, Mohammad B Ashraq, Deborah Ashton, Susan Ashton, Andrew Ashworth, Rebecca Ashworth, Arshia Aslam, Harshini Asogan, Abigail Asquith, Atif Asrar, Omar Assaf, Raine Astin-Chamberlain, Richard Athay-Hunt, Deborah Athorne, Billie Atkins, Christopher Atkins, Stacey Atkins, John Atkinson, Vicki Atkinson, Brygitta Atraskiewicz, Claire Atterbury, Abdul Ahmad Attia, Rita Atugonza, Paula Aubrey, Avinash Aujayeb, Aye Chan Thar Aung, Hnin Aung, Kyaw Thu Aung, Ni Aung, Yin Aung, Zaw Myo Aung, Emily Austin, Karen Austin, Abdusshakur Auwal, Miriam Avery, Joanne Avis, Georgina Aviss, Cristina Avram, Paula Avram, Gabriel Awadzi, Atia Awan, Aszad Aya, Eman Ayaz, Amanda Ayers, Jawwad Azam, Mohammed Azharuddin, Ghazala Aziz, N Aziz, Ali Azkoul, Ashaari Azman Shah, Giada Azzopardi, Hocine Azzoug, Fiyinfoluwa Babatunde, Melvin Babi, Babiker Babiker, Gayna Babington, Matthew Babirecki, Marta Babores, Adetona O Babs-Osibodu, Sammy Bacciarelli, Roudi Bachar, Gina Bacon, Jenny Bacon, Bibi Badal, Gurpreet R Badhan, Shreya Badhrinarayanan, Joseph P Bae, Sibel Bafekr Mishamandani, Alice Baggaley, Amy Baggott, Graham Bagley, Dinesh Bagmane, Lynsey Bagshaw, Kasra Bahadori, James Bailey, Katie Bailey, Lindsey Bailey, Liz Bailey, Morgan Bailey, Pippa Bailey, Sarah Bailey, Stephen Bailey, Hamish Baillie, J Kenneth Baillie, Jennifer Bain, Sanchia Baines, Vikram Bains, Aimi Baird, David Baird, Susan Baird, Tracy Baird, Yolanda Baird, Aiysha Bajandouh, Charles Baker, Emma Baker, Evelyn Baker, Johanne Baker, Josephine Baker, Kenneth Baker, Rebecca Baker, Terri-Anne Baker, Victoria Baker, Hugh Bakere, Nawar Bakerly, Michelle Baker-Moffatt, Nauman Bakhtiar, Panos Bakoulas, Julie Balaam, Niranjan Balachandran, Andrea Balan, Theodosios Balaskas, Madhu Balasubramaniam, Alison Balcombe, Alexander Baldwin, Ashley Baldwin, Caron Baldwin, Danielle Baldwin, Rebekah Baldwin-Jones, James Balfour, Gagan Bali, Sonya Balkee, Ceri Ball, Kasia Ballard, Amy Ballinger, Ismael Balluz, Craig Balmforth, Emese Balogh, Amir Baluwala, Gabby Bambridge, Alasdair Bamford, Amy Bamford, Peter Bamford, Adefunke Bamgboye, Elizabeth Bancroft, Hollie Bancroft, Tanya Bancroft, Joyce Banda, Krishna Bandaru, Srini Bandi, Nageswar Bandla, Somaditya Bandyopadhyam, Amit Banerjee, Millie Banerjee, Ritwik Banerjee, Harrison Banks, Lauren Banks, Luke Banks, Paul Banks, Oliver Bannister, Bharat Bansal, Robert Banthorpe, Laura Banton, Mariamma Baptist, Tanya Baqai, Ananya Mouli Baral, Desislava Baramova, Alex Barber, Russel Barber, Emma Barbon, Miriam Barbosa, Monica Barbosa, Jamie Barbour, Alexander Barclay, Claire Barclay, George Bardsley, Stephanie Bareford, Shahedal Bari, Amy Barker, Debbie Barker, Helen Barker, Joseph Barker, Leon Barker, Oliver Barker, Kerry Barker-Williams, Sinha Barkha, Juliana Barla, Gavin Barlow, Richard Barlow, Valerie Barlow, James Barnacle, Alex Barnard, Debi Barnes, Nicky Barnes, Theresa Barnes, Calum Barnetson, Amy Barnett, Matthew Barnett, Ashton Barnett-Vanes, William Barnsley, Andrew Barr, David Barr, Shaney Barratt, Manuella Barrera, Amy Barrett, Fiona Barrett, Jessica Barrett, Joe Barry, Jazz Bartholomew, Claire Bartlett, Georgina Bartlett, Greg Barton, Jill Barton, Lorna Barton, Rachael Barton, Rosaleen Baruah, Sonia Baryschpolec, Archana Bashyal, Betsy Basker, Ayten Basoglu, Gilda Bass, John Bassett, G Bassett, Chris Bassford, Pavinder Bassi, Betsy Bassis, Bengisu Bassoy, Victoria Bastion, Anupam Basumatary, Tristan Bate, Harry J Bateman, Ian Bateman, Kathryn Bateman, Vhairi Bateman, Eleanor Bates, Hayley Bates, Michelle Bates, Simon Bates, Sally Batham, Ana Batista, Amit Batla, Dushyant Batra, Donna Batty, Harry Batty, Thomas Batty, Peter Baughan, Miranda Baum, Carina Bautista, Fareha Bawa, Fatima S Bawani, Simon Bax, Lydia Baxter, Matt Baxter, Nicola Baxter, Zachary Baxter, Hannah Bayes, Charlotte Baylem, Lee Bayliss, Eileen Bays, Farid Bazari, Rohit Bazaz, Ahmad Bazli, Laura Beacham, Wendy Beadles, Philip Beak, Andy Beale, Kirk Beard, Jack Bearpark, Karen Beaumont, Dawn Beaumont-Jewell, Theresa Beaver, Sarah Beavis, Christy Beazley, Sarah Beck, Virginia Beckett, Rosie Beckitt, Heidi Beddall, Seonaid Beddows, Deborah Beeby, Gail Beech, Michelle Beecroft, Sally Beer, Jane Beety, Gabriela Bega, Alison Begg, Susan Begg, Sara Beghini, Ayesha Begum, Salman Begum, Selina Begum, Teresa Behan, Jasmine Beharry, Roya Behrouzi, Jon Beishon, Claire Beith, James Belcher, Holly Belfield, Katherine Belfield, Ajay Belgaumkar, Dina Bell, Gareth Bell, Gill Bell, Gillian Bell, Joshua Bell, Lauren Bell, Louise Bell, Nicholas Bell, Pippa Bell, Stephanie Bell, Jennifer L Bell, Jennifer Bellamu, Mary Bellamy, Arianna Bellini, Amanda Bellis, Fionn Bellis, Lesley Bendall, Naveena Benesh, Nicola Benetti, Leonie Benham, Guy Benison-Horner, Alexander Bennett, Ann Bennett, Caroline Bennett, Christopher Bennett, Gillian Bennett, Ian Bennett, Kristopher Bennett, Lorraine Bennett, Sara Bennett, Karen Bennion, Vivienne Benson, Jane Benstead, Andrew Bentley, Dionne Bentley, James Bentley, Ian Benton, Eva Beranova, Matthew Beresford, Colin Bergin, Malin Bergstrom, Jolanta Bernatoniene, Thomas Berriman, Zoe Berry, Marnie Berwick, Kimberley Best, Ans-Mari Bester, Yvonne Beuvink, Emily Bevan, Sarah Bevins, Tom Bewick, Andrew Bexley, Sonay Beyatli, Fenella Beynon, Arjun Bhadi, Sanjay Bhagani, Shiv Bhakta, Rekha Bhalla, Khushpreet Bhandal, Kulbinder Bhandal, Ashwin Bhandari, Sangam Bhandari, Aashutosh Bhanot, Ravina Bhanot, Sruti Bhaskara, Prashanth Bhat, Nikhil Bhatia, Rahul Bhatnagar, Karan Bhatt, Janki Bhayani, Deepika Bhojwani, Salimuzzaman Bhuiyan, Anna Bibby, Fatima Bibi, Naheeda Bibi, Salma Bibi, Tihana Bicanic, Sarah Bidgood, Julie Bigg, Sarah Biggs, Alphonsa Biju, Andras Bikov, Sophie Billingham, Jessica Billings, Carron Bilton, Teodirico Binas, Martin Binney, Alice Binns, Muhammad BinRofaie, Oliver Bintcliffe, Catherine Birch, Jenny Birch, Louann Birch, Janet Birchall, Katherine Birchall, Sam Bird, Sumedha Bird, Charndip Biring, Mark Birt, Raquel Bisa, Kilanalei Bishop, Linda Bishop, Lisa Bishop, Karen Bisnauthsing, Nibedan Biswas, Sahar Biuk, Karen Blachford, Ethel Black, Helen Black, Karen Black, Mairead Black, Polly Black, Hayley Blackgrove, Bethan Blackledge, Joanne Blackler, Samantha Blackley, Helen Blackman, Stuart Blackmore, Caroline Blackstock, Loraine Blackwood, Francesca Blakemore, Helen Blamey, Alison Bland, Sujata Blane, Simon Blankley, Mary Blanton, Parry Blaxill, Jenny Blaxland, Katie Blaylock, Jane Blazeby, Carol Blears, Natalie Blencowe, Donna Blofield, Ben Bloom, Jack Bloomfield, Angela Bloss, Hannah Bloxham, Louise Blundell, Andrew Blunsum, Mark Blunt, Ian Blyth, Kevin Blyth, Andrew Blythe, Karen Blythe, Marilyn Boampoaa, Boniface Bobie, Karen Bobruk, Pritesh Bodalia, Neena Bodasing, Tanya Bodenham, Sherin Bodh, Gabriele Boehmer, Marta Boffito, Kristyna Bohmova, Sumit Bokhandi, Maria Bokhar, Saba Bokhari, Sakina Bokhari, Syed Owais Bokhari, Ambrose Boles, Sarah Bollington, Sam Bolton, Charlotte Bomken, Charlotte Bond, Hayley Bond, Helena Bond, Stuart Bond, Thomas Bond, Alice Bone, Georgia Boniface, Wendy Bonnert, Lizzy Bonney, Leigh Boorman, Catherine Booth, Joanne Borbone, Cameron Borhani, Naomi Borman, Rachel Borrell, Mamu Boshir, Fiona Bottrill, Laura Bough, Hayley Boughton, Zoe Boult, Miriam Bourke, Stephen Bourke, Michelle Bourne, Rachel Bousfield, Lucy Boustred, Darren Bowen, Kaye Bowen, Alexandra Bowes, Amy Bowes, Philip Bowker, Louise Bowman, Simon Bowman, Rachel Bowmer, Angie Bowring, Geoff Bowyer, Helen Bowyer, Carmel Boyd, Jenny Boyd, Laura Boyd, Maxine Boyd, Namoi Boyle, Pauline Boyle, Rosalind Boyle, Louise Boyles, Osman Bozdag, Leanna Brace, David Brack, Charlotte Brackstone, Rob Bradburn, Jodie Bradder, Barry Bradley, Clare Jane Bradley, Pamela Bradley, Patrick Bradley, Paul Bradley, Joanne Bradley-Potts, Lynne Bradshaw, Sarah Bradshaw, Zena Bradshaw, Rebecca Brady, Shirin Brady, Denise Braganza, Suhail Brailsford, Jill Braithwaite, Marie Branch, Thomas Brankin-Frisby, Jamie Brannigan, Louise Brassington, Sophie Brattan, Fiona Bray, Nancy Bray, Angela Brazier, Manny Brazil, Lucy Brear, Tracy Brear, Stephen Brearey, Laura Bremner, Morwenna Brend, Giovanna Bretland, Chris Brewer, Hannah Bridge, Gavin Bridgwood, Hayley Briggs, Mark Briggs, Sara Brigham, John Bright, Chris Brightling, Lutece Brimfield, Elaine Brinkworth, Robin Brittain-Long, Vianne Britten, Terri Brittin, Lauren Broad, Sarah Broad, Rosie Broadhurst, Andrew Broadley, Marie Broadway, Christopher Brockelsby, Megan Brocken, Tomos Brockley, Andrew Broderick, Mary Brodsky, Fiona Brogan, David Broggio, Liz Brohan, Felicity Brokke, Jacob Brolly, David Bromley, Hannah Brooke-Ball, Verity Brooker, Ceri Brookes, Matthew Brookes, Alison Brooks, Karen Brooks, Nicole Brooks, Philip Brooks, Rachel Brooks, Sophie Brooks, Natalie Broomhead, Chloe Broughton, Nathaniel Broughton, Matt Brouns, Marie Browett, Alison Brown, Ammani Brown, Carly Brown, Catrin Brown, Chloe Brown, Elizabeth Brown, Ellen Brown, Heather Brown, Janet Brown, Louise Brown, Niall Brown, Pauline Brown, Rachel Brown, Richard Brown, Robert Brown, Steven Brown, Tom Brown, Wayne Brown, Bria Browne, Charlotte Browne, Duncan Browne, Mitchell Browne, Stephen Brownlee, Alba Brraka, David Bruce, Johanna Bruce, Michelle Bruce, Wojciech Brudlo, Nigel Brunskill, Alan Brunton, Margaret Brunton, Mandy Bryan, Meera Bryant, April Buazon, Maya Buch, Julie Buchan, Ruaridh Buchan, Alexis Buchanan, Ruaridh Buchanan, Danielle Buche, Amanda Buck, Matthew Buckland, Laura Buckley, Philip Buckley, Sarah Buckley, Carol Buckman, Kathleen Buckmire, George Bugg, Ramadan Bujazia, Marwan Bukhari, Shanze Bukhari, Richard Bulbulia, Alex Bull, Damian Bull, Rhian Bull, Thomas Bull, Naomi Bulteel, Kasun Bumunarachchi, Roneleeh Bungue-Tuble, Caroline Burchett, Dorota Burda, Christy Burden, Thomas G Burden, Mika Burgess, Paula Burgess, Richard Burgess, Sophia Burgess, Paula Burgett, Adrian Burman, Sara Burnard, Caroline Burnett, John Burnett, Amanda Burns, Amy Burns, Collette Burns, James Burns, Karen Burns, Samuel Burns, Sarah Burns, Daniel Burrage, Sadie Burrage, Kate Burrows, Claire Burston, Ben Burton, Fiona Burton, Matthew Burton, Angela Busby, Deborah Butcher, Aaron Butler, Jessica Butler, Joanne Butler, Joshua Butler, Lesley Butler, Peter Butler, Susan Butler, Al-Tahoor Butt, Mohammad M Butt, Sophia Butt, Caryl Butterworth, Nicola Butterworth-Cowin, Robert Buttery, Tom Buttle, Heather Button, Daniel Buttress, Jane Byrne, Wendy Byrne, Victoria Byrne-Watts, Eleanor Byworth, Amanda Cabandugama, Ruth Cade, Anthony Cadwgan, Donna Cairney, James Calderwood, Darren Caldow, Moira Caldwell, Giorgio Calisti, Debbie Callaghan, Jennifer Callaghan, Claire Callens, Donaldson Callum, Caroline Calver, Melissa Cambell-Kelly, Tracey Camburn, David R Cameron, Eleanor Cameron, Fraser Cameron, Sarah Cameron, Sheena Cameron, Christian Camm, Renee F D Cammack, Alison Campbell, Amy Campbell, Barbara Campbell, Bridget Campbell, Debbie Campbell, Helen Campbell, Hilary Campbell, Jonathan Campbell, Mark Campbell, Robyn Campbell, Wynny Campbell, Quentin Campbell Hewson, Julie Camsooksai, Ana Canabarro, Lisa Canclini, Shaula Mae Candido, Janie Candlish, Cielito Caneja, Johnathon Cann, Ruby Cannan, Emma Cannon, Michael Cannon, Petra Cannon, Vivienne Cannons, Jane Cantliff, Ben Caplin, Santino Capocci, Noemi Caponi, Angelika Capp, Anne Capps-Jenner, Thomas Capstick, Ishmael Carboo, Nuria Cardenas, Mary Cardwell, Rachel Carey, Simon Carley, Tammy Carlin, Andrew Carlton, Samantha Carmichael, Mandy Carnahan, Rebecca Carnegie, Charlotte Caroline, Emily Carpenter, Jodi Carpenter, David Carr, Sharon Carr, Anna Carrasco, Samantha Carrington, Zoe Carrington, Paul Carroll, Caroline Carron, Anne Carstairs, Jonathan Carter, Michael Carter, Moira Carter, Paul Carter, Penny Carter, Steven Carter, Simon Carter-Graham, Douglas Cartwright, Jo-Anne Cartwright, Claire Carty, Sinead Carty, Jaime Carungcong, Carolyn Carveth-Marshall, Susan Casey, Annie Cassells, Barbara Cassimon, Teresa Castiello, Gail Castle, Bridget Castles, Melanie Caswell, Ana Maria Catana, Heidi Cate, Susanne Cathcart, Katrina Cathie, Christine Catley, Laura Catlow, Matthew Caudwell, Jill Caulfield, Anna Cavazza, Luke Cave, Simon Cavinato, Frianne Cawa, Kathryn Cawley, Chloe Caws, Hankins Cendl, Hannah Century, Jeva Cernova, Mansur Cesay, Ed Cetti, Stephanie Chabane, Manish Chablani, Cathleen Chabo, David Chadwick, Julie Chadwick, Robert Chadwick, Ela Chakkarapani, Arup Chakraborty, Mallinath Chakraborty, Mollika Chakravorty, James Chalmers, Richard Chalmers, Georgina Chamberlain, Sarah Chamberlain, Emma Chambers, Jonathan Chambers, Lucy Chambers, Naomi Chambers, Alex Chan, Carmen Chan, Cheuk Chan, Evelyn Chan, Kayen Chan, Kimberley Chan, Ping Chan, Rebekah (Pui-Ching) Chan, Xin Hui Chan, Chris Chandler, Heidi Chandler, Kim J Chandler, Stuart Chandler, Zoe Chandler, Vikki Chandler-Vizard, Sumit Chandra, Navin Chandran, Badrinathan Chandrasekaran, Cherry Chang, Yvonne Chang, Josephine Chaplin, Graeme Chapman, John Chapman, Katie Chapman, Laura Chapman, Lianne Chapman, Polly Chapman, Timothy Chapman, Lucy Chappell, Linda Chapple, Amanda Charalambou, Bethan Charles, Dianne Charlton, Sally Charlton, Kevin Chatar, Calvin Chatha, Ritesh Chaube, Muhammad YN Chaudhary, Iram Chaudhry, Nazia Chaudhuri, Muhammad Chaudhury, Anoop Chauhan, Ruchi S Chauhan, Vipul Chauhan, Nicola Chavasse, Iknam Chaven, Rosanna Chavez, Vipal Chawla, Maria Cheadle, Lindsay Cheater, James Cheaveau, Charlotte Cheeld, Michelle Cheeseman, Fang Chen, Hui Min Chen, Terence Chen, Lok Yin Cheng, Zhihang Cheng, Helen Chenoweth, Chun How Cheong, Shiney Cherian, Suzanne Cherif, Mary Cherrie, Helen Cheshire, Barry Chesterson, Betty Cheung, Chee Kay Cheung, Elaine Cheung, Michelle Cheung, Claire Cheyne, Swati Chhabra, Wei Ling Chia, Eric Chiang, Angela Chiapparino, Rosavic Chicano, Zviedzo A Chikwanha, Sam Chilcott, Phillipa Chimbo, KokWai Chin, Wen Jie Chin, Rumbidzai Chineka, Amol Chingale, Karen Chinn, Vashira Chiroma, Heather Chisem, Claire Chisenga, Ben Chisnall, Carolyn Chiswick, Sunder Chita, Nihil Chitalia, Matthew Chiu, Brenda Chivima, Catherine Chmiel, Soha Choi, Willy Choon Kon Yune, Vandana Choudhary, Sarah Choudhury, Bing-Lun Chow, Fateha Chowdhury, Mahibbur Chowdhury, Shahid Chowdhury, Victoria Christenssen, Peter Christian, Alexander Christides, Fiona Christie, Daniel Christmas, Thereza Christopherson, Mark Christy, Paris Chrysostomou, Yunli Chua, Shabs Chucha, Dip Chudgar, Richard Chudleigh, Srikanth Chukkambotla, Michael E Chukwu, Izu Chukwulobelu, Chi Y Chung, Ben Church, Elaine Church, Sara R Church, David Churchill, Nicole Cianci, Nick Ciccone, Paola Cicconi, Paola Cinardo, Zdenka Cipinova, Bessie Cipriano, Sarah Clamp, Melanie Clapham, Edel Clare, Sarbjit Clare, Andrew Clark, Charlotte Clark, Diane Clark, Felicity Clark, Gabrielle Clark, James Clark, Katherine Clark, Kaylea Clark, Louise Clark, Lucy Clark, Matthew Clark, Patricia Clark, Richard Clark, Thomas Clark, Wendy Clark, Zoe Clark, Andrea Clarke, Heather Clarke, Mark Clarke, Paul Clarke, Robert Clarke, Roseanne Clarke, Samantha Clarke, Sarah Clarke, Sheron Clarke, Tracy Clarke, Andrew Clarkson, Alleyna Claxton, Kate Clay, Elizabeth Clayton, Olivia Clayton, Jill Clayton-Smith, Chris Cleaver, Carlota Clemente de la Torre, Jayne Clements, Suzanne Clements, Francesca Clemons, Lee Clifford, Lynne Clifford, Rachael Clifford, Sarah Clifford, Amelia Clive, Jonathan Clouston, Samantha Clueit, Andrea Clyne, Michelle Coakley, Peter G L Coakley, Tony Coates, Kathryn Cobain, Alexandra Cochrane, Patricia Cochrane, Maeve Cockerell, Helen Cockerill, Shirley Cocks, Rachel Codling, Adam Coe, Samantha Coetzee, David Coey, Danielle Cohen, Jonathan Cohen, Oliver Cohen, Mike Cohn, Louise Coke, Olutoyin Coker, Nicholas Colbeck, Roghan Colbert, Carol Cole, Esther Cole, Jade Cole, Joby Cole, Julie Cole, Richard Cole, Sue Cole, Garry Coleman, Matt Coleman, Holly Coles, Rebecca Coles, Macleod Colin, Alicia Colino-Acevedo, Julie Colley, Dawn Collier, Heather Collier, Paul Collini, Emma Collins, Jaimie Collins, Joanne Collins, Nicola Collins, Sally Collins, Vicky Collins, Andrew Collinson, Bernadette Collinson, Jennifer Collinson, Matthew Collis, Madeleine Colmar, Hayley E Colton, James Colton, Katie Colville, Carolyn Colvin, Ryan Colwell, Edward Combes, David Comer, Alison Comerford, Mike Comery, Dónal Concannon, Robin Condliffe, Lynne Connell, Natalie Connell, Karen Connelly, Gavin Connolly, Mireille Connolly, Emma Connor, Samantha Conran, Antonia Conroy, Veronica Conteh, Rory Convery, Camilla Conway, Francesca Conway, Grainne Conway, Rhiannon Conway, Jo-Anna Conyngham, Colette Cook, Eloise Cook, Gemma Cook, Helen Cook, Julie Cook, Danielle Cooke, Graham Cooke, Katrina Cooke, Soo Cooke, Tim Cooke, Adele Cooper, Alison Cooper, Chris Cooper, David Cooper, Helen Cooper, Jamie Cooper, Joanne Cooper, Joshua Cooper, Laura Cooper, Lauren Cooper, Nick Cooper, Rowena Cooper, Emma Cooperwaite, Thomas Cope, Sinead Corbet, Carolyn Corbett, John Corcoran, Chris Cordell, Jessica Cordle, Alasdair Corfield, John Corless, Alison Corlett, Joe Cornwell, Michael Cornwell, Diana Corogeanu, Mirella Corredera, Ruth Corrigan, Catherine Corry, Rita Corser, Denise Cosgrove, Tracey Cosier, Patricia Costa, Charlie Coston, Susannah Cotgrove, Zoe Coton, Lisa-Jayne Cottam, Rhiannon Cotter, Donna Cotterill, Alice Cotton, Caroline Cotton, Katy Cotton, Andrew Coull, James Coulson, David Counsell, David Counter, Cherry Coupland, Ellie Courtney, Julia Courtney, Rebecca Cousins, Alexander Cowan, Elena Cowan, Ruth Cowburn, Richard Cowell, Louise Cowen, Steve Cowman, Amanda Cowton, Debra Anne Cox, Ellie Cox, Giles Cox, Karina Cox, Miriam Cox, Karen Coy, Beverly Craig, Victoria Craig, Felicity Craighead, Matthew Cramp, Beverley Crane, Jacolene Crause, Adrian Crawford, Angie Crawford, Emma Crawford, Isobel Crawford, Richard Crawforth, Sarah Crawshaw, Ben Creagh-Brown, Andrew Creamer, Ryan Creighton, Joanne Cremona, Saveria Cremona, Janet Cresswell, Mark Cribb, Charles Crichton, Declan Crilly, Lauren Crisp, Nikki Crisp, Dominic Crocombe, Maria Croft, Ian Cron, Derrick Crook, Jennifer Crooks, Helen Croot, Harriet Crosby, Sarah Cross, Tim Cross, Amy Crothers, Stephen Crotty, Susan Crouch, Madeleine Crow, Amanda Crowder, Kate Crowley, Teresa Crowley, Rebecca Croysdill, Callum Cruickshank, Conor Cruickshank, Irena Cruickshank, James Cruise, Helen Crumley, Carina Cruz, Trino Cruz Cervera, Dominic Cryans, Guanguo Cui, Helen Cui, Donna Cullen, Lorraine Cullen, Gillian Cummings-Fosong, Marie Cundall, Victoria Cunliffe, Lorraine Cunningham, Neil Cunningham, Nicola Cunningham, Jason Cupitt, Hollie Curgenven, Debra Curley, Gerens Curnow, David Curran, Simon Curran, Craig Currie, Jacqueline Currie, Scarlett Currie, Abi Curtis, Becca Curtis, Jonathan Curtis, Katrina Curtis, Olivia Curtis, Thomas Curtis, Rebecca Cuthbertson, Sean Cutler, Marta Czekaj, Patrycja Czylok, Joana da Rocha, Andrew Dagens, Helen Daggett, Phil Daggett, Jacqui Daglish, Sandeep Dahiya, Helen Dakers-Black, Anne Dale, Katie Dale, Michaela Dale, Sam Dale, Jolyon Dales, Helen Dalgleish, Nikki Dallas, Helen Dallow, Dermot Dalton, Zoe Daly, Akila Danga, Amelia Daniel, Priya Daniel, Allison Daniels, Adela Dann, Sandra Danso-Bamfo, Nimo Daoud, Alex Darbyshire, Janet Darbyshire, Paul Dargan, Paul Dark, Tace Darling, Kate Darlington, Tom Darton, Guledew Darylile, Manjusha Das, Sukamal Das, Martin Daschel, Joanne Dasgin, Dibyendu Datta, Anna Daunt, Emily Davenport, Mark Davey, Michelle Davey, Miriam Davey, Molly Davey, Arlene David, Mini David, Alexander Davidson, Laura Davidson, Neil Davidson, Richard Davidson, Albert Davies, Alison Davies, Amanda Davies, Amy Davies, Angela Davies, Carolyn Davies, Catrin Davies, Cheryl Davies, Drew Davies, Elaine Davies, Ffyon Davies, Helen Davies, James Davies, Jane Davies, Jeni Davies, Jim Davies, Karen Davies, Kelly Davies, Kim Davies, Louisa Davies, Mark Davies, Matthew Davies, Michelle Davies, Nina Davies, Owen Davies, Patrick Davies, Rachel Davies, Rhys Davies, Ruth Davies, Sarah Davies, Simon Davies, Alison Davis, Gwyneth Davis, Illinos Davis, Julie-Ann Davis, Katherine Davis, Peter Davis, Alexander Davison, Sophia Davison, Mark Davy, Christine Dawe, H Dawe, Mark Dawkins, Danielle Dawson, Elizabeth Dawson, Joy Dawson, Susan Dawson, Tom Dawson, Andrew Daxter, Andrew Day, Helena Day, Jacob Day, Jeremy Day, Lynn Day, Jamie D'Costa, Parijat De, Duneesha de Fonseka, Toni de Freitas, Frederico De Santana Miranda, Eleanor de Sausmarez, Shanika de Silva, Thushan de Silva, Jessica De Sousa, Paulo De Sousa, James de Souza, Anthony de Soyza, Natasha de Vere, Johannes de Vos, Bethan Deacon, Sharon Dealing, Anna Dean, Julie Dean, Katrina Dean, Stephen Dean, Tessa Dean, Jill Deane, James Dear, Effie Dearden, Alison Deary, Catherine Deas, Samuel Debbie, Gabor Debreceni, Vashist Deelchand, Matthew Deeley, Joanne Deery, Emmanuel Defever, Raji Dehulia, Max Deighton, Manuela Del Forno, Arnold Dela Rosa, Lisa Delaney, Amanda Dell, Carrie Demetriou, David DeMets, Jane Democratis, Jacqueline Denham, Emmanuelle Denis, Laura Denley, Craig Denmade, Kathy Dent, Martin Dent, Elise Denton, Tom Denwood, Nishigandh Deole, Darshita Depala, Maria Depante, Randle Derbyshire, Susan Dermody, Amisha Desai, Asmita Desai, Purav Desai, Sanjeev Deshpande, Vai Deshpande, Brendan Devine, Sirjana Devkota, Nicola Dewland, Prakash Dey, Vishal Dey, Rogin Deylami, Jazz Dhaliwal, Kevin Dhaliwal, Jas Dhalliwal, Mandeep Dhanda, Sundip Dhani, Amandeep Dhanoa, Mili Dhar, Devesh Dhasmana, Aman Dhesi, Ekanjali Dhillon, Reiss Dhillon, Pamela Diamond, Priya Dias, Stephanie Diaz, Kayleigh Diaz-Pratt, Debbie Dickerson, Pamela Dicks, Stuart Dickson, Julie Dijo, Sean Dillane, Sarah Diment, Paul Dimitri, Maria Dineen, ThaiHa Dinh, Tri Dinh, Alex Dipper, Laura Dirmantaite, Lisa Ditchfield, Sarah Diver, Lavanya Diwakar, Caroline Dixon, Giles Dixon, Stephen Dixon-Mould, Brice Djeugam, Petr Dlouhy, Laurence Dobbie, Marinela Dobranszky Oroian, Charlotte Dobson, Lee Dobson, Marie Docherty, David Dockrell, James Dodd, Jackie Dodds, Rebecca Dodds, Steve Dodds, Richi Dogra, Erin Doherty, Warren Doherty, Yumiko Doi, Iain Doig, Eleanor Doke, Daniel Dolan, Mark Dolman, Rozzie Dolman, Lisa Donald, Callum Donaldson, Christopher Donaldson, Denise Donaldson, Gillian Donaldson, Kate Donaldson, Joanne Donnachie, Christopher Donnelly, Eilish Donnelly, Ronan Donnelly, Aravindhan Donohoe, Gemma Donohoe, Bryan Donohue, Sinead Donton, Emma Dooks, Grainne Doran, Kane Dorey, Sharon Dorgan, Amanda Dornan, Moonira Dosani, Davinder Dosanjh, Paula Dospinescu, Katie Douglas, Jonathan Douse, Lucy Dowden, Michelle Dower, Kerry Dowling, Sud Dowling, Nicola Downer, Charlotte Downes, Rob Downes, Thomas Downes, Damian Downey, Philippa Downey, Robert Downey, Louise Downs, Simon Dowson, Cornel Dragan, Cristina Dragomir, Cristina Dragos, Maire Drain, Chelsea Drake, Victoria Drew, Olivia Drewett, Celine Driscoll, Helena Drogan, Nikki Drogman, Graham Drummond, Ronald Druyeh, Simon Drysdale, An Du Thinh, Hazel Dube, Judith Dube, Ophias Dube, Stephen Duberley, Hayley Duckles-Leech, Nicola Duff, Emma Duffield, Sam Duff-Miller, Helen Duffy, Lionel Dufour, Annette Duggan, Helen Duggan, Parveen Dugh, Janice Duignan, Mick Duley, Simon Dummer, Andrew Duncan, Christopher Duncan, Fullerton Duncan, Gregory Duncan, Stephanie Dundas, Alessia Dunn, Charlotte Dunn, Damian Dunn, Laura Dunn, Paul Dunn, Charlene Dunne, Karen Dunne, Fiona Dunning, Aidan Dunphy, Venkat Duraiswamy, Beatriz Duran, Ingrid DuRand, Steve Durgacharan, Natalie Duric, Alison Durie, Emily Durie, Hannah Durrington, Haris Duvnjak, Akshay Dwarakanath, Laasya Dwarakanath, Ellen Dwyer, Claudia Dyball, Lee Dyble, Kristyn Dyer, Harvey Dymond, Tom Dymond, Chris Eades, Laura 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Elliott, Toby Elliott, Annie Ellis, Ann-Marie Ellis, Christine Ellis, Kay Ellis, Kaytie Ellis, Tak-Yan Ellis, Yvette Ellis, Megan Ellison, Rahma Elmahdi, Einas Elmahi, Hannah-May Elmasry, Mohammed Elmi, Najla Elndari, Omer Elneima, Mohamed Elokl, Ahmed Elradi, Mohamed Elsaadany, Sally El-Sayeh, Hana El-Sbahi, Tarek Elsefi, Karim El-Shakankery, Robert Elshaw, Hosni El-Taweel, Sarah Elyoussfi, Jonathan Emberey, Jonathan R Emberson, John Emberton, Julian Emmanuel, Ingrid Emmerson, Michael Emms, Florence Emond, Marieke Emonts, Nicu Enachi, Angila Engden, Katy English, Emma Entwistle, Hene Enyi, Marios Erotocritou, Helen Escreet, Peter Eskander, Hanif Esmail, Lise Estcourt, Amy Evans, Brynach Evans, Chris Evans, Daren Evans, Debra Evans, Gail Evans, Gareth Evans, Jennifer Evans, Lisa Evans, Lynn Evans, Margaret Evans, Michelle Evans, Mim Evans, Morgan Evans, Ranoromanana Evans, Ryan Evans, Teriann Evans, Terry John Evans, Tony Eve, Caroline Everden, Serenydd Everden, Hayley Evison, Lynsey Evison, Penny Eyton-Jones, Jacqueline Faccenda, Leila Fahel, Youstina Fahmay, Sara Fairbairn, Terry Fairbairn, Andy Fairclough, Louise Fairlie, Mark Fairweather, Anne Fajardo, Naomi Falcone, Euan Falconer, Jonathan Falconer, John Fallon, Andrea Fallow, David Faluyi, Victoria Fancois, Qayyum Farah, Novin Fard, Amr Farg, Margaret Farinto, Adam Farmer, Katie Farmer, Toni Farmery, Samantha Farnworth, Faiyaz Farook, Hadia Farooq, Sidrah Farooq, Fiona Farquhar, Karen Farrar, Aaron Farrell, Barbara Farrell, James Farthing, Syeda Farzana, Rahmatu Fasina, Azam Fatemi, Mina Fatemi, Nibah Fatimah, Maria Faulkner, Saul N Faust, Joe Fawke, Sinmidele Fawohunre, Abul Fazal, Kelly Feane, Simon Fearby, Alex Feben, Federico Fedel, Daria Fedorova, James Feely-Henderson, Christopher Fegan, Mae Felongco, Lynsey Felton, Tim Felton, Kate Fenlon, Andrea Fenn, Isabelle Fenner, Ciara Fenton, Melisa Fenton, Cameron Ferguson, Jenny Ferguson, Kathryn Ferguson, Katie Ferguson, Stephanie Ferguson, Susan Ferguson, Susie Ferguson, Victoria Ferguson, Denzil Fernandes, Candida Fernandez, Eduardo Fernandez, Maria Fernandez, Sonia Fernandez Lopez, Callum Jeevan Fernando, Ahmed Feroz, Pietro Ferranti, Thais Ferrari Gersogamo, Eleanor Ferrelly, Alexandra Ferrera, Emma Ferriman, Nicholas Fethers, Ben Field, Janet Field, Rebecca Field, Karen Fielder, Lindsey Fieldhouse, Andra Fielding, Julie Fielding, Len Fielding, Sarah Fielding, Asma Fikree, Sarah Ann Filson, Sarah Finbow, Debbie Finch, Joanne Finch, Laurie Finch, Joanne Finden, Natalie Fineman, Lauren Finlayson, Adam Finn, Joanne Finn, Clare Finney, Sofia Fiouni, Jo Fiquet, Dani Fisher, Emily Fisher, James Fisher, Neil Fisher, Meadow Fisher Crisp, Daniel Fishman, Krystofer Fishwick, Lorraine Fitzgerald, Chloe Fitzpatrick-Creamer, Jan Flaherty, Michael Flanagan, Charles Flanders, Cathy Flatters, Julie Fleming, Lucy Fleming, Paul Fleming, William Flesher, Alison Fletcher, Jonathan Fletcher, Lucy Fletcher, Simon Fletcher, Sophie Fletcher, Karen Flewitt, Christopher Flood, Ian Floodgate, Vincent Florence, Sharon Floyd, Kelly Flynn, Rachel Flynn, Sara Flynn, Claire Foden, Adama Fofana, Georgina Fogarty, Claire Foley, Paul Foley, Linda Folkes, Daniela Mock Font, Evodian Fonyonga, Aiwyne Foo, Jane Foo, Andrew Foot, Jayne Foot, Jane Forbes, Jamie Ford, Kathy Ford, Jennifer Foreman, Caroline Fornolles, Adam Forrest, Ellie Forsey, Miranda Forsey, Thomas Forshall, Elliot Forster, Julian Forton, Emily Foster, Joseph Foster, Rachel A Foster, Tracy Foster, Theodora Foukanelli, Angela Foulds, Ian Foulds, Folakemi Fowe, Emily Fowler, Robert Fowler, Stephen Fowler, Caroline Fox, Claire Fox, Daniel Fox, Heather Fox, Jonathan Fox, Lauren Fox, Natalie Fox, Olivia Fox, Simon Fox, Sarah-Jane Foxton, Yasin Fozdar, Rebecca Frake, Alex Francioni, Olesya Francis, Rebecca Francis, Sarah Francis, Theodora Francis-Bacon, Jason Frankcam, Helen Frankland, Gayle Franklin, Jessica Franklin, Darron Franks, Catherine Fraser, Laura Fraser, Sharon Frayling, Martyn Fredlund, Matthew Free, Carol Freeman, Elaine Freeman, Hannah Freeman, Nicola Freeman, Clare Freer, Ian Freestone, Eleanor French, Matthew Frise, Renate Fromson, Claire Froneman, Adam Frosh, John Frost, Victoria Frost, Oliver Froud, Rachel Frowd, Arun Fryatt, Jake Fryer, Janet Fu, Bridget Fuller, Liz Fuller, Neil Fuller, Tracy Fuller, Duncan Fullerton, Jenny Fullthorpe, Carrie Fung, Gayle Fung, Sarah Funnell, John Furness, Charlene Furtado, Andrew Fyfe, Nytianandan G, Elizabeth Gabbitas, Claire Gabriel, Diana Gabriel, Hadiza Gachi, Rose Gad, Joshua Gahir, Sarveen Gajebasia, Katarzyna Gajewska-Knapik, Zacharoula Galani, Christopher Gale, Hugo Gale, Rebecca Gale, Swetha Gali, Karen Galilee, Bernadette Gallagher, Jude Gallagher, Rosie Gallagher, William Gallagher, Joanne Galliford, Catherine Galloway, Chris Galloway, Emma Galloway, Jacqui Galloway, James Galloway, Laura Gamble, Liz Gamble, Brian Gammon, Jaikumar Ganapathi, Ramesh Ganapathy, Kaminiben Gandhi, Sarah Gandhi, Usha Ganesh, Abrar Gani, Emma-James Garden, Antoni D Gardener, Emma Gardiner, Jill Gardiner, Michael Gardiner, Phil Gardiner, Siobhan Gardiner, Caroline Gardiner-Hill, Jonathan Gardner, Mark Garfield, Atul Garg, Nathan Garlick, Justin Garner, Lucie Garner, Zoe Garner, Kimberley Garnett, Robert Garney, Rosaline Garr, Michael Garstka, Peter Gartan, Florence Garty, Rachel Gascoyne, Hyeriju Gashau, Noha Gasmalseed, Michaela Gaspar, Aoife Gatenby, Erin Gaughan, Alok Gaurav, Mariana Gavrila, Jane Gaylard, Emma Gaywood, Catherine Geddie, Alison Geddis, Ian Gedge, Sarah Gee, Minerva Gellamucho, Karzan Gelly, Leila Gelmon, Sandra Gelves-Zapata, Gemma Genato, Susan Gent, Natalie Geoghegan, Chloe George, Sam George, Tina George, Simon Georges, Domonique Georgiou, Peter Gerard, Leigh Gerdes, Louise Germain, Helen Gerrish, Abel Getachew, Louise Gethin, Hisham Ghanayem, Amardeep Ghattaoraya, Anca Gherman, Alison Ghosh, Justin Ghosh, Sudhamay Ghosh, Sarra Giannopoulou, Malick Gibani, Andrew Gibb, Ben Gibbison, Kerry Gibbons, Alex Gibson, Bethan Gibson, Kimberley Gibson, Kirsty Gibson, Sian Gibson, Cat Gilbert, Jeanette Gilbert, Joanne Gilbert, Kayleigh Gilbert, Sean Gilchrist, Benjamin Giles, Mandy Gill, Rose Gill, Lynne Gill, Paul Gillen, Annelies Gillesen, Katherine Gillespie, Matt Gillespie, Elizabeth Gillham, Andrew Gillian, Deborah Gilliland, Robert Gillott, Danielle Gilmour, Kate Gilmour, Theodora Giokanini-Royal, Anna Gipson, Joanna Girling, Rhian Gisby, Angelena Gkioni, Aikaterini Gkoritsa, Effrossyni Gkrania-Klotsas, Amy Gladwell, James Glanville, Jessica Glasgow, Susannah Glasgow, Jon Glass, Lynn Glass, Sharon Glaysher, Lisa Gledhill, Ana Glennon, John Glover, Kyle Glover, Jan Glover Bengtsson, Chevanthy Gnanalingam, Julie Goddard, Wendy Goddard, Emily Godden, Jo Godden, Gillian Godding, Emma Godson, Gerry Gogarty, Sukanya Gogoi, Aiky Goh, Rebeca Goiriz, Sriya Gokaraju, Philip Gold, Raphael Goldacre, Arthur Goldsmith, Portia Goldsmith, Darren Gomersall, Lucia Gomez, Raquel Gomez-Marcos, Ali Gondal, Celia Gonzalez, Jack Goodall, Bob Goodenough, Laura Goodfellow, James Goodlife, Camelia Goodwin, Elizabeth Goodwin, Jayne Goodwin, Paula Goodyear, Rajiv Gooentilleke, Sharif Goolam-Hossen, Michelle Goonasekara, Sheila Gooseman, Shameer Gopal, Peter Gordon, Sally Gordon, Hugh Gorick, Caitlin Gorman, Claire Gorman, Stuart Gormely, Diana Gorog, Jan Gorry, Michelle Gorst, Thomas Gorsuch, Jayshreebahen Gosai, Rebecca Gosling, Sally Gosling, Georgina Gosney, Vanessa Goss, Dzintars Gotham, Naomi Gott, Elizabeth Goudie, Amanda Gould, Angela Gould, Susan Gould, Lysander Gourbault, Anna Gouveia, Abha Govind, Sharon Gowans, Girish Gowda, Rohit Gowda, Pauline Gowdy, Hannah Gower, Thomas Gower, Pankaj Goyal, Sunil Goyal, Sushant Goyal, Beverley Graham, Clive Graham, Jane Graham, Jonathan Graham, Justin Graham, Libby Graham, Sharon Graham, Matthew Graham-Brown, Julia Grahamslaw, Gianluca Grana, Tracyanne Grandison, Louis Grandjean, Alison Grant, Ann Grant, David Grant, 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Griffiths, Yvonne Griffiths, Sofia Grigoriadou, Steph Grigsby, Paul Grist, Stephen Grist, Evelina Grobovaite, Clarissa Grondin, Rachel Groome, Liliana Grosu, Jenny Grounds, Margaret Grout, Helen Grover, Jayne Groves, Neil Grubb, Julie Grundy, Francesca Guarino, Sharada Gudur, Sharazeq Guettari, Shivang Gulati, Vikas Gulia, Pumali Gunasekera, Malin Gunawardena, Kirun Gunganah, Jessica Gunn, Emma Gunter, Alok Gupta, Atul Gupta, Rajeev Gupta, Richa Gupta, Rishi Gupta, Tarun Gupta, Vineet Gupta, Ankur Gupta-Wright, Victoria Guratsky, Alvyda Gureviciute, Sambasivarao Gurram, Bhawana Gurung, Shraddha Gurung, Hazel Guth, Ruth Habibi, Berkin Hack, Pamela Hackney, Christian Hacon, Aiman Haddad, Denise Hadfield, Michalis Hadjiandreou, Nikolaos Hadjisavvas, Leah Hadzik, Anna Haestier, Nauman Hafiz, Rana Hafiz-Ur-Rehman, Javed Hafsa, Samantha Hagan, Jack W Hague, Rosemary Hague, Kate Haigh, Christina Haines, Scott Hainey, Morton Hair, Brigid Hairsine, Juraj Hajnik, Anne Haldeos, Writaja Halder, Jennie Hale, Carmel Halevy, Paul Halford, William Halford, Alistair Hall, Anthony Hall, Claire Hall, Elizabeth Hall, Emma Hall, Fiona Hall, Helen Hall, Jennifer Hall, Kathryn Hall, Bill Hall, Jan Hallas, Kyle Hallas, Charles Hallett, Becky-Lee Halls, Heather Halls, Maryam Hamdollah-Zadeh, Bilal Hameed, Imran Hamid, Mohamad Hamie, Bethany Hamilton, Fergus Hamilton, Leigh Hamilton, Nicola Hamilton, Ruth Hamlin, Eleanor Hamlyn, Beatrice Hammans, Shirley Hammersley, Kate Hammerton, Bev Hammond, Leah Hammond, Sara Hammond, Fiona Hammonds, Ibrahim Hamoodi, Karen Hampshire, Elizabeth Hampson, Jude Hampson, Lucy Hampson, Ozan Hanci, Ian Hancock, Sadiyah Hand, Jasmine Handford, Soran Handrean, Sarah Haney, Sheharyar Hanif, E Hanison, Alison Hanlon, Jennifer Hannah, Amy Hannington, Merhej Hannun, Aidan Hanrath, Anita Hanson, Jane Hanson, Kathryn Hanson, Steve Hanson, Helen Hanwell, Mazhar Ul Haq, Ala Haqiqi, Monjurul Haque, Lesley Harden, Zoe Harding, Simon Hardman, Joanna Hardy, Kumar Haresh, Rachel Harford, Beverley Hargadon, Carolyn Hargreaves, Emily Hargreaves, James Hargreaves, Alice Harin, Mohammed Haris, Edward Harlock, Sandra Harlow, Paula Harman, Tracy Harman, Mark Harmer, Muhammad A Haroon, Charlie Harper, Fiona Harper, Heather Harper, Melanie Harper, Peter Harper, Rosemary Harper, Sarah Harrhy, Sian Harrington, Yasmin Harrington-Davies, Jade Harris, Jess Harris, John Harris, Laura Harris, Marie-Clare Harris, Naomi Harris, Nichola Harris, Sophie Harris, Alex Harrison, David Harrison, Julie Harrison, Laura Harrison, Melanie Harrison, Rowan Harrison, Susie Harrison, Thomas Harrison, Wendy Harrison, Elizabeth Harrod, Ciaran Hart, Dominic Hart, Lisa Hartley, Rosemary Hartley, Ruth Hartley, Tom Hartley, William Hartrey, Phillipa Hartridge, Stuart Hartshorn, Heli Harvala, Alice Harvey, Angela Harvey, Max Harvey, Catherine Harwood, Helen Harwood, Brigitte Haselden, Kazi Hashem, Mohammed Hashimm, Tadaaki Hashimoto, Imranullah Hashmi, Sarah Haskins, Zena Haslam, Adil Hassan, Ali Hassan, Wagae UI Hassan, Waqar Ul Hassan, Sapna Hassasing, Jane Hassell, Philip Hassell, Alex Hastings, Bethany Hastings, Janice Hastings, Stephanie Hatch, Jonathan Hatton, Sheryl Haviland, May Havinden-Williams, Stefan Havlik, Daniel B Hawcutt, Kadean Hawes, Liz Hawes, Nicola Hawes, Annie Hawkins, Catherine Hawkins, Nancy Hawkins, Tanya Hawkins, Dan Hawley, Ed Hawley-Jones, Edward Haworth, Cathy Hay, Amna Hayat, Jamal Hayat, Mohamed-Riyal Hayathu, Tamsin Haydon, Anne Hayes, Jonas Hayes, Kate Hayes, Melony Hayes, Vanessa Hayes, Fiona Hayes, Patrick Hayle, Chloe Haylett, Antara Hayman, Melanie Hayman, Matthew Haynes, Richard Haynes, Rachel Hayre, Sarah Haysom, James Hayward, Patrick Haywood, Tracy Hazelton, Phoebe Hazenberg, Zhengmai He, Elizabeth Headon, Carrie Heal, Brendan Healy, Amy Hearn, Angela Heath, Rowan Heath, Diane Heaton, Kerry Hebbron, Gemma Hector, Andy Hedges, Katrine Hedges, Cheryl Heeley, Elaine Heeney, Rajdeep Heire, Ulla Hemmila, Cassie Hemmings, Scott 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Susie Holt, Alexandra Holyome, Marie Home, Toni Home, Renate Homewood, Kate Hong, Laura Hontoria del Hoyo, Clare Hooper, Sarah Hoosdally, Samantha Hope, Susan Hope, Bridget Hopkins, Peter W Horby, Stephanie Horler, Anil Hormis, Daniel Hornan, Nicola Hornby, Zoey Horne, Latoya Horsford, Megan Horsford, Mark Horsford, Valana Horsham, Alexander Horsley, Ashley Horsley, Elizabeth Horsley, Sarah Horton, Nicola Horton-Turner, Jane Hosea, Toby Hoskins, Muhammad S Hossain, Rashed Hossain, Leanne Hostler, Maxine Hough, Sarah Hough, Brittany Houghton, Catherine Houghton, Iain Houghton, Kathryn Houghton, Rebecca Houlihan, Angela Houston, Hamish Houston, Tawedzegwa Hove, Roseanna Hovvels, Lee How, Laura Howaniec, Laura Howard, Linda Howard, Lucy Howard, Sarah Howard, Stuart Howard, Richard Howard-Griffin, Alison Howarth, Diane Howarth, Serena Howe, Mark Howells, Lyn Howie, Kerry Howlett, Sophie Howlett, Joanne Hoyle, Josh Hrycaiczuk, Naing Zaya Htoon, Su Htwe, Ying Hu, Chiang Ooi Huah Huah, Abby Huckle, Shahzya Huda, Alison Hudak, Lisa Hudig, Alex Hudson, Cara Hudson, Heather Hudson, Peter Hudson, Oli Hudson, Alison Hufton, Connor Huggins, Alistair Hughes, Eithne Hughes, Emma Hughes, Gareth Hughes, Heather Hughes, Luke Hughes, Rachel Hughes, Rebecca Hughes, Samantha Hughes, Stephen Hughes, Vikki Hughes, Wesley Hughes, Lukas Huhn, Ching Hui, Ruth Hulbert, Diana Hull, Grace Hull, Robert Hull, Amanda Hulme, Peter Hulme, Wendy Hulse, George Hulston, Ryan Hum, Laura Humber, Megan Hume, Charlotte Humphrey, Ismay Humphreys, Alasdair Humphries, Joanne Humphries, Lena Hunold, Fiona Hunt, Kristen Hunt, Luke Hunt, Sophie Hunt, Al Hunter, Alexandra Hunter, Isobel Hunter, Karl Hunter, Neil Hunter, George Huntington, Elizabeth Hurditch, Cian Hurley, Katrina Hurley, Mohammed A Husain, Syeda Yusra Husaini, Coralie Huson, Afreen Hussain, Ibraar Hussain, Ifza Hussain, Mohammad Hussain, Muhammad Hussain, Reda Hussain, Sajid Hussain, Samia Hussain, Sanniah Hussain, Wasim Hussain, Yasmin Hussain, Mohammed Hussam El-Din, Raheem Hussein, Rebecca Hussey, Camille Hutchinson, Dorothy Hutchinson, Elizabeth Hutchinson, John Hutchinson, Claire Hutsby, Paula Hutton, Daniella Hydes, Jamie Hyde-Wyatt, Niamh Hynes, Megan Hyslop, Mazen Ibraheim, Abdalla Ibrahim, Ahmed Ibrahim, Asil Ibrahim, Mohamed Ibrahim, Monzeer Ibrahim, Wadah Ibrahim, Adetokunbo I Idowu, Muhammad Idrees, Hina Iftikhar, Mawara Iftikhar, Chukwuemeka Igwe, Mohammad Ijaz, Amaju Ikomi, Clare Iles, Stamatina Iliodromiti, Mary Ilsley, Lorna Ilves, La'ali Imam-Gutierrez, Christopher Imray, Alison Imtiaz, Haider Imtiaz, Claire Ingall, Jack Ingham, Julie Ingham, Rory Ingham, Tejas Ingle, Jennifer Inglis, Anne Ingram, Luke Ingram, Peter Inns, Ken Inweregbu, Andreea A Ionescu, Ana Ionita, Ilian P Iordanov, Anil Ipe, Adil Iqbal, Madiha Iqbal, Mohammed Iqbal, Faisal Iqbal Sait, Jane Ireland, Robert Irons, Mohannad Irshad, Muhammad S Irshad, Janice Irvine, Val Irvine, Pamela Irving, Robert Irving, Mina Ishak, Erica Isherwood, Aminul Islam, Abdurrahman Islim, Ali Ismail, Omar Ismail, Caroline Ison, M'hamedi Israa, Sharon Isralls, Ali Issa, Monica Ivan, Catrina Ivel, Chineze Ivenso, Ashleigh Ivy, Sophie Iwanikiw, Karen Ixer, Menaka Iyer, Mia Iyer, Calum Jack, Amanda Jackson, Anthony Jackson, Ben Jackson, Beth Jackson, Douglas Jackson, Ella Jackson, Hayley Jackson, Helen Jackson, Jane Jackson, Julie Jackson, Karin Jackson, Lauren Jackson, Melanie Jackson, Nicola Jackson, Shane Jackson, Sharon Jackson, Nikita Jacob, Patricia Jacob, Reni Jacob, Nicola Jacques, Terri-Lisa Jacques-Brown, Anisa Jafar, Daniel Jafferji, Ali Jaffery, Chandrashekar Jagadish, Vijay Jagannathan, Sam Jaggard, Mandeep Jagpal, Fernandez R Jaime, Neemisha Jain, Seema Jain, Susan Jain, Sanjay Jaiswal, Danyal Jajbhay, Thomas Jaki, Bintou Jallow, Yusuf Jaly, Sabine Jamal, Zeba Jamal, Yasmin Jameel, Albie James, Christie James, Kate James, Lee James, Linda James, Mark James, Nicholas James, Olivia James, Rebecca James, Ruth James, Tracy James, Jack Jameson, Aaron Jamison, Phoebe Jane, Azara Janmohamed, Sabrina Jansz, Deepa Japp, Lorraine Jappy, Victor Jardim, Catherine Jardine, Emma Jarnell, Ellie Jarvie, Ann Jarvis, Claire Jarvis, Lisa Jarvis, Rosina Jarvis, Patrycja Jastrzebska, Hafsa Javed, Mays Jawad, Lona Jawaheer, Kauky Jawaid, Anu Jayachandran, Dinakaran Jayachandran, Angelina Jayakumar, Deepak Jayaram, Ravi Jayaram, Geeshath Jayasekera, Thilina Jayatilleke, Abi Jayebalan, Saman Jeddi, Vandana Jeebun, Mohammad S Jeelani, Zeynab Jeewa, Emma Jefferson, Katie Jeffery, Helen Jeffrey, Jenni Jeffrey, Rachel Jeffrey, Sue Jeffrey, Nathan Jeffreys, Benjamin Jeffs, Debbie Jegede, Taylor Jemima, Ifan Jenkin, Alison Jenkins, Christopher Jenkins, David Jenkins, Elinor Jenkins, Sarah Jenkins, Sian Jenkins, Stephen Jenkins, Jacqui Jennings, Louise Jennings, Rebecca Jennings, Virginia Jennings, Ellen Jerome, Douglas Jerry, Ellen Jessup-Dunton, Jorge Antonio Jesus Silva, Champa Jetha, Kishan Jethwa, Jeby Jeyachandran, Visuvanathan Jeyakumar, Dharshana Jeyapalan, Shaman Jhanji, Khoo Jian, Zhixin Jiao, Laura Jimenez, Ana Jimenez Gil, Jithin Jith, Teishel Joefield, Navraj Johal, Karine Johannessen, Aisyah Johari, Annie John, Anu John, Navin John, Sarah John, Emma Johns, Margaret Johns, Anne-Marie Johnson, Antoinette Johnson, David Johnson, Emma Johnson, Gillian Johnson, Kathryn Johnson, Katie Johnson, Luke Johnson, Mark Johnson, Nelsonseelan Johnson, Oliver Johnson, Rachel Johnson, Tracy Johnson, Zoe Johnson, Claire Johnston, Janet Johnston, Laura Johnston, Susan Johnston, Victoria Johnston, Dawn Johnstone, Ed Johnstone, Janet Johnstone, Manohar Joishy, Adam Jones, Alistair Jones, Annabel Jones, Ben Jones, Bryony Jones, Carys Jones, Ceri Jones, Charlotte Jones, Christine E Jones, Debra Jones, Emily Jones, Gareth Jones, Geraldine Jones, Hazel Jones, Jac Jones, James Jones, Jamie Jones, Jessica Jones, Jonathon Jones, Julie Jones, Karen Jones, Kate E Jones, Kevin Jones, Laura Jones, Laura M Jones, Lorna Jones, Louise Jones, Mathew Jones, Nicola Jones, Paul Jones, Rhianna Jones, Ruth E Jones, Samantha Jones, Sophie Jones, Stefanie Jones, Steve Jones, Taya Jones, Tim Jones, Tracey Jones, Ramya Jonnalagadda, Rebecca Jordache, Annette Jose, Sanal Jose, Anna Joseph, Joseph Joseph, Rosane Joseph, Sibet Joseph, Dhaara Joshi, Mehul Joshi, Pratichi Joshi, Revati Joshi, Benz Josiah, Tiffany Joyce, Adriel Ju Wen Kwek, Edward Jude, Parminder Judge, Jessica Juhl, Sirisha Jujjavarapu, Mark Juniper, Edmund Juszczak, Deepthi Jyothish, Kasamu Kabiru Dawa, Mark Kacar, Katarina Kacinova, Nikhil Kadam, Rebecca Kahari, Gail Kakoullis, Azad Kala Bhushan, Richard JK Kalayi, Roobala Kaliannan Periyasami, Efthymia Kallistrou, Seika Kalsoom, Elisa Kam, John Kamara, Mohamed Kamara, Ajay Kamath, Prakash Kamath, Ravindra Kamath, Siddharth Arun Kamerkar, Nick Kametas, Musaiwale Kamfose, Arul Kandaswamy, Leia Kane, Osei Kankam, Thogulava Kannan, Abhinav Kant, Vikas Kapil, Ritoo Kapoor, Sonal Kapoor, Sourjya Kar, Janaka Kara, Vasita Kara, Marina Karakantza, Rona Kark, Nicholas Karunaratne, Natashja Kasianczuk, Vidya Kasipandian, Rizwan Kassam, Janarth Kathirgamachelvam, Victoria Katsande, Kulbinder Kaul, Daljit Kaur, Dervinder Kaur, Jasmin Kaur, Jaspreet Kaur, Satvinder Kaur, Zunaira Kausar, Mohammad AA Kawser, Andrea Kay, Sarah Kay, Jossy N Kayappurathu, Callum Kaye, Ahemd Kazeem, Naved Kazi, Sharon Kaznica, Samantha Kearley, Rachel Kearns, Nichola Kearsley, Joanne Keating, John Keating, Liza Keating, Elizabeth Keddie-Gray, Katie Keen, Natalie Keenan, Jonathan Kefas, Stephen Kegg, Laura Keith, Uzoamaka Keke, Tosin Kelani, Joanne Kellett, Jeremy Kellington, Alison Kelly, Conor Kelly, David Kelly, Diane Kelly, Dominic Kelly, Emma Kelly, Laura Kelly, Martin Kelly, Michael Kelly, Rosalind Kelly, Sinead Kelly, Stephen Kelly, Thomas Kelly, Mary Kelly-Baxter, Marketa Keltos, Timothy Kemp, Kelly Kemsley, Alexandra Kendall-Smith, Sarah Kennard, Ann Kennedy, Caroline Kennedy, James Kennedy, Sophie Kennedy-Hay, Julia Kenny, Kelly Kent, Melanie Kent, Lynne Keogan, Alexander Keough, Clement Kerlin, A Kerr, Andrew Kerr, Maria Kerr, Caroline Kerrison, Anthony Kerry, Samantha Kershaw, Helen Kerslake, Ian Kerslake, Helen Kerss, Jocelyn Keshet-Price, Margaret Kevern, Georgina Keyte, Abdul Khadar, Ali Khalid, Muhammad U Khalid, Syed Khalid, Amir Khalil, Asma Khalil, Sijjad Khalil, Abubakar Khan, Ali Khan, Al-Imran Khan, Arham Khan, Asad Khan, Aurangzeb Khan, Burhan Khan, Camran Khan, Fatimah Khan, Kausik Khan, Malik Aamaz Khan, Marria Khan, Mehrunnisha Khan, Mohammad Khan, Mohammed Khan, Nayeem Khan, Omar Khan, Rahe Khan, Rahila Khan, Sabiya Khan, Shabana Khan, Shahul Khan, Shoaib Khan, Tasaduksultan Khan, Waseem Khan, Usman F Khatana, Jibran Khatri, Jyoti Khatri, Hafiza Khatun, Taslima Khatun, Mena Kheia, Jacyntha Khera, Htet Ei Khin, Najaf Khoja, Kiran Khokhar, Jayne Khorsandi, Chloe Khurana, Faith Kibutu, Andrew Kidd, Michelle Kidd, Joe Kidney, Shane Kidney, Will Kieffer, James Kilbane, Caroline Kilby, 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Michelle Lake, Nicki Lakeman, David Lalloo, Fiona Lalloo, Alison Lam, Fiona Lamb, Lucy Lamb, Thomas Lamb, Nick Lambe, Pauline Lambert, Claudia Lameirinhas, Mohammed KG Lami, Abigail Lamikanra, Holly Lamont, Michal Lamparski, Djillali Lamrani, Christine Lanaghan, Rebecca Lanaway, Ivone Lancona-Malcolm, Julia Lancut, Geraldine Landers, Martin J Landray, Matthew Lane, Nicholas Lane, Alidih Lang, Stephen Lang, Daniel Langer, Margaret Langley, Charles Langoya, Emily Langthorne, Taiya Large, Wojciech Lason, Anna Last, Scott Latham, John Latham-Mollart, Afzal Latheef, Darren Latimer, Nang Latt, Carly-Jane Lattimore, Dawn Lau, Eva Lau, Myra Laurenson, Hou Law, Jennifer Law, Jessica Law, Penny Law, Richard Law, Colin Lawler, Mark Lawley, Emma Lawrence, Jo Lawrence, Neil Lawrence, Ryan Lawrie, Jemima Lawson, Joanne Lawson, Louise Lawson, Rebecca Lawton, Michael Lay, Christine Laycock, Reina Layug, Maria Lazo, Vietland Le, Amelia Lea, William Lea, Ian Leadbitter, Thomas Leahy, Richard Lean, Lorna Leandro, Darren Leaning, Sandra Leason, Christina Leaver, Marie Anne Ledingham, Emma Lee, Hannah Lee, Irish Lee, Judith Lee, Sam Lee, Shi Han Lee, Simon Lee, Sindy Lee, Stephanie Lee, Tracey Lee, Xiang Lee, Diana Lees, Jennifer Lees, Helen Legge, Julian Leggett, Katie Leigh-Ellis, Kevan Leighton, Nicky Leitch, Eleni Lekoudis, Petula Lemessy, Nicholas Lemoine, Joana Lemos, Irina Lenchuk, Katy Leng, Katrina Lennon, Liz Lennon, Isabel Lentell, Kelly Leonard, Wen Leong, Nicky Leopold, Oskar Lepiarczyk, Isla Leslie, Eleni Lester, Joe Leung, Ullrich Leuschner, Emma Levell, Chris Levett, Alice Lewin, Michaela Lewin, Alison Lewis, David Lewis, Dee Lewis, Georgina Lewis, Gillian Lewis, Joanne Lewis, Joseph Lewis, Kathryn Lewis, Keir Lewis, Leon Lewis, Lisa Lewis, Marissa Lewis, Rob Lewis, Robert Lewis, Catherine Lewis-Clarke, Lorraine Lewis-Prosser, Katherine Lewiston, Adam Lewszuk, Penny Lewthwaite, Samantha Ley, Anna Li, Jenny Li, Angela Liao, Victoria Licence, David Lieberman, Susan 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Thushika Mahendiran, Siva Mahendran, Sarah Maher, Anistta Maheswaran, Shameera Maheswaran, Tina Maheswaran, Parisa Mahjoob-Afag, Ahmed Mahmood, Farhana Mahmood, Waheed Mahmood, Zahra Mahmood, Hager Mahmoud, Ewan Mahony, Luke Mair, Toluwani Majekdunmi, Kesson Majid, Rupert Major, Jaydip Majumdar, Mohammad KH Majumder, Stephen Makin, Marius Malanca, Hannah Malcolm, Flora Malein, Neeraj Malhan, Ayesha Malik, Gulshan Malik, Mohammed Maljk, Paul Mallett, Petrina Mallinder, Georgia Mallison, Louise Mallon, Edward Malone, Gracie Maloney, Edgar Malundas, Madhu Mamman, Irene Man, Kathy Man, Rossana Mancinelli, Marco Mancuso-Marcello, Tracy Manders, Lauren Manderson, Justin Mandeville, Roope Manhas, Carmen Maniero, Ravi Manikonda, Bobby Mann, Jonathan Manning, Lynne Mannion, Katherine Mansi, Katarina Manso, Dina Mansour, Isheunesu T Mapfunde, Predeesh Mappa, Hemant Maraj, Garikayi Marange, Lisa March, Clare Marchand, Neil Marcus, Maria Marecka, Gomathi Margabanthu, Jordi Margalef, Lavinia Margarit, Georgios Margaritopoulos, Mike Margarson, Fernandez M Maria del Rocio, Teresa Maria Pfyl, Victor Mariano, Helen Maria-Osborn, Ashleigh Maric, Grace Markham, John Markham, Maria Marks, Pamela Marks, Elisabeth Marouzet, Arran Marriott, Cheryl Marriott, Nemonie Marriott, Brian Marsden, Karen Marsden, Paul Marsden, Sarah Marsden, Tracy Marsden, Robyn Marsh, Adam Marshall, Andrew Marshall, Gail Marshall, Henry Marshall, Jaimie Marshall, James Marshall, Jenna Marshall, Nicola Marshall, Riley Marshall, Jennifer Marshall, Samantha Marston, Emmeline Martin, Hayley Martin, Hope Martin, Jane Martin, Karen Martin, Kate Martin, Laila Martin, Michael Martin, Noelia Martin, Tim Martin, Winston Martin, Sarah Martin, Tim Martindale, Marcus Martineau, Alexander Martinez, Lauren Martinez, Jose Carlos Martinez Garrido, Juan Martin-Lazaro, Olivia Martins, Lucas Martins Ferreira, Vijay Kumar Maruthamuthu, Gemma Maryan, Roman Mary-Genetu, Sam Maryosh, Vidan Masani, Diego Maseda, Sheila Mashate, 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Raj, Pradeep Rajagopalan, Nithy Rajaiah, Arvind Rajasekaran, Aylur Rajasri, Thurkka Rajeswaran, Jyothi Rajeswary, Jeyanthy Rajkanna, Gayathri Rajmohan, Ruth Rallan, David Ralphs, Katherine Ralston, Maximilian Ralston, Matsa Ram, Balaji Ramabhadran, Fathima Ramali, Mohamed Ramali, Athimalaipet Ramanan, Shashikira Ramanna, Maheshi Ramasamy, Dhanishta Ramdin, Jozel Ramirez, Mylah Ramirez, Geshwin Ramnarain, Lidia Ramos, Shanthi Ramraj, Alex Ramshaw, Aleem Rana, Ghulam F Rana, Rehman Rana, Abby Rand, James Rand, Helen Randall, Harpal Randheva, Poonam Ranga, Manmeet Rangar, Harini Rangarajan, Sameer Ranjan, Poormina Ranka, Rajesh Rankhelawon, Haley Ranton, Anita Rao, Sandhya Rao, Sanjay Rao, Deepak Rao, Anuja Rasarathnam, Alia Rashid, Khalid Rashid, Simbisai Ratcliff, Sam Ratcliffe, Sophy Ratcliffe, Sanjeev Rath, Mohmad I Rather, Selina Rathore, Aravinden Ratnakumar, Jonathan Ratoff, Deepa Rattehalli, Jason Raw, Hywel Rawlins, Gautam Ray, Michelle Ray, Adam Raymond-White, Dana Raynard, 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Anand Shah, Bhavni Shah, Momin Shah, Neil Shah, Pallav Shah, Priyank Shah, Qasim Shah, Sarfaraz H Shah, Snehal Shah, Suraj Shah, Syed Shah, Wajid Shah, Saarma Shahad, Sousan Shahi, Sipan Shahnazari, Muhammad Shahzeb, Aisha Shaibu, Zara Shaida, Amina Y Shaikh, Maliha Shaikh, Rajit Shail, Mariya Shaji, Muhammad Shakeel, Korah Shalan, Nadia Shamim, Kazi Shams, Alison Shanahan, Thomas Shanahan, Shaminie Shanmugaranjan, Hamed Sharaf, Muhammad Sharafat, Asir Sharif, Ajay Sharma, Akhilesh Sharma, Ash Sharma, Bhawna Sharma, Mona Sharma, Ojasvi Sharma, Poonam Sharma, Rajeev Sharma, Sanjeev Sharma, Sarkhara Sharma, Shriv Sharma, Sonal Sharma, Alexander Sharp, Charles Sharp, Gemma Sharp, Paula Sharratt, Phoebe Sharratt, Katherine Sharrocks, Emma Sharrod, Christopher Shaw, Daisy Shaw, David Shaw, Deborah Shaw, Joanne Shaw, Jonathan Shaw, Lisa Shaw, Tomos G Shaw, Anna Shawcross, Jill Shawe, Lou Shayler, Khuram Shazad, Sophy Shedwell, Jonathan Sheffield, Zak Shehata, Arshiya Sheik, Asif Sheikh, 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Harriet Smith, Hazel Smith, Helen Smith, Jacky Smith, Janice Smith, Jessica Smith, Juliet Smith, Karen Smith, Kate Smith, Kathryn Smith, Katie Smith, Kelly Smith, Kerry Smith, Lara Smith, Linda Smith, Lisa Smith, Loren Smith, Maria Smith, Mel Smith, Oliver Smith, Rachel Smith, Rebecca Smith, Richard Smith, Ruth Smith, Sally Smith, Samantha Smith, Stacey Smith, Stephanie Smith, Susan Smith, Imogen Smith, John Smith, Gemma Smithson, Sue Smolen, Sara Smuts, Naoise Smyth, Annette Snell, David Snell, Luke Snell, Beng So, Michelle Soan, Toluleyi Sobande, Alberto Sobrino Diaz, Basit Sohail, Bina Sohail, Herminder Sohal, Roy Soiza, Mary Sokolowski, Olajumoke Solademi, Krishma Solanki, Babak Soleimani, Amanda Solesbury, Reanne Solly, Louise Solomon, Subash Somalanka, Chandrashekaraiah Somashekar, Raj Sonia, Shiu-Ching Soo, Deepti Sood, Pavandeep Soor, Germanda Soothill, Jennifer Soren, Youssef Sorour, Apina Sothinathan, Pragalathan Sothirajah, Najwa Soussi, Donna Southam, David Southern, Iain 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Holt Walters, James Walters, Jocelyn Walters, Eileen Walton, Lucy Walton, Olivia Walton, Sharon Walton, Susan Walton, Mandy Wan, Thin Wan, Mary Wands, Rachel Wane, Frank Wang, Nick Wang, Ran Wang, Deborah Warbrick, Samantha Warburton, Deborah Ward, Emma Ward, Joanna Ward, Karen Ward, Luke Ward, Nicola Ward, Rachael Ward, Rebecca Ward, Thomas Ward, Tom Ward, Scott A Warden, Adele Wardle, Karen Wardle, Steve Wardle, Hassan Wardy, Scott Waring, Jenny Warmington, Ben Warner, Christian Warner, Lewis Warnock, Sarah Warran, Jade Warren, Lisa Warren, Yolanda Warren, Hannah Warren-Miell, Gill Warwick, Charlotte Washington, Helen Wassall, Hazel J Watchorn, Holly Waterfall, Abby Waters, Donald Waters, Mark Waterstone, Catherine Watkins, Catrin Watkins, Eleanor Watkins, Karen Watkins, Lynn Watkins, Nick Watkins, Abigail Watson, Adam JR Watson, Ekaterina Watson, Eleanor Watson, Paul Watson, Rebecca Watson, Robert Watson, Sandra Watson, Malcolm Watters, Donna Watterson, Daniel Watts, John Watts, Merlin Watts, Victoria Waugh, Emma Wayman, Akhlaq Wazir, Mark Weatherhead, Nick Weatherly, Paul Weaver, Hayley Webb, Kathryn Webb, Kylie Webb, Stephen Webb, Cheryl Websdale, Deborah Webster, Ian Webster, Tim Webster, Kathleen Wedgeworth, Ling Wee, Rebecca Weerakoon, Thanuja Weerasinghe, Janaka Weeratunga, Maria Weetman, Shuying Wei, Immo Weichert, Hugh Welch, James Welch, Leanne Welch, Steven Welch, Samantha Weller, Lucy Wellings, Brian Wells, Susan Wellstead, Berni Welsh, Richard Welsh, Ingeborg Welters, Rachael Welton, Lauren Wentworth, Kate Wesseldine, James Wesson, Jim Wesson, Adam West, Magdelena West, Raha West, Ruth West, Sophie West, Luke Western, Ruth Westhead, Heather Weston, Alice Westwood, Bill Wetherill, Sharon Wheaver, Helen Wheeler, Ben Whelan, Matthew Whelband, Amanda Whileman, Alison Whitcher, Abbie White, Andrew White, Benjamin White, Christopher White, Duncan White, Emily White, James White, Jonathan White, Katie White, Marie White, Nick White, Sarah White, Sonia White, Stephen White, Tracey White, Catherine Whitehead, Anne Whitehouse, Claire Whitehouse, Tony Whitehouse, Julia Whiteley, Sophie Whiteley, Victoria Whiteside, Drew Whitley, Kaitlyn Whitley, Gabriel Whitlingum, David Whitmore, Elizabeth Whittaker, Lindsay Whittam, Andrew Whittingham Hirst, Ashley Whittington, Helen Whittle, Robert Whittle, Suzanne Whyte, Eunice Wiafe, Lou Wiblin, John Widdrington, Jason Wieboldt, Hannah Wieringa, Cornelia Wiesender, Laura Wiffen, Andrew Wight, Christopher Wignall, Danielle Wilcock, Emma Wilcock, Louise Wilcox, Laura Wild, Stephen Wild, Michael Wilde, Peter Wilding, Ritchie Wildman, Tracey Wildsmith, Joe Wileman, Donna Wiles, Joy Wiles, Kate Wiles, Elva Wilhelmsen, Thomas Wiliams, Chloe Wilkes, Janet Wilkie, David Wilkin, Hannah Wilkins, Joy Wilkins, Suzanne Wilkins, Helen Wilkinson, Holly Wilkinson, Iain Wilkinson, Lesley Wilkinson, Martin Wilkinson, Nicola Wilkinson, Sophia Wilkinson, Susan Wilkinson, Tim Wilkinson, Sylvia Willetts, Aimee Williams, Alexandra Williams, Alison Williams, Angharad Williams, Ava Williams, Carl Williams, Caroline V Williams, Claire Williams, Dewi Williams, Gail Williams, Gemma Williams, Gina Williams, Hannah Williams, James Williams, Jayne Williams, Jennie Williams, John Williams, Joseph Williams, Karen Williams, Kathryn Williams, Marie Williams, Matthew Williams, Patricia Williams, Penny Williams, Rachael Williams, Rupert Williams, Samson Williams, Sarah Williams, Sophie Williams, Tamanna Williams, Annie Williamson, Cath Williamson, Catherine Williamson, Dawn Williamson, James D Williamson, Rachel Williamson, Helen Williamson, Bruce Willian, Elizabeth Willis, Emily Willis, Heather Willis, Herika Willis, Joanna Willis, Laura Willmott, Louise Wills, Lucy Willsher, Catherine Willshire, Francesca Willson, Alison Wilson, Andrea Wilson, Antoinette Wilson, Billy Wilson, Catherine Wilson, Eve Wilson, James Wilson, Karen Wilson, Kate Wilson, Lucinda Wilson, Mark Wilson, Matthew Wilson, Toni Wilson, Evie Wiltsher, Marlar Win, Tin Win, Wut Yee Win Win, Lucinda Winckworth, Laura Winder, Piers Winder, Phillip Windrum, Kerry Winham-Whyte, Helen Winmill, Simon Winn, Carmen Winpenny, Helen Winslow, Helen Winter, Jonathan Winter, Pascal Winter, Barbara Winter-Goodwin, Stephen Wisdom, Matthew Wise, Martin Wiselka, Rebecca Wiseman, Sophie Wiseman, Steven Wishart, Holly Wissett, Eric Witele, Nicholas Withers, Janet Wittes, Donna Wixted, Therese Wodehouse, Will Wolf, Nicola Wolff, Kirsten Wolffsohn, Rebecca Wolf-Roberts, Magda Wolna, Elena Wolodimeroff, Adam Wolstencroft, Alan Wong, Charlotte Wong, Chi-Hung Wong, Edwin Wong, Jessica Sue Yi Wong, Kit Y Wong, Lee Wong, Mei Yin Wong, Nick Wong, Sam Wong, Yun Man Wong, Amanda Wood, Caroline Wood, Carrie Anne Wood, Dianne Wood, Fiona Wood, Hannah Wood, Jennifer Wood, Joe Wood, Julia Wood, Kathryn Wood, Lisa Wood, Louise Wood, Michelle Wood, Stephen Wood, Tracy Wood, Ursula Wood, Katharine Woodall, Rebecca Woodfield, Christopher Woodford, Elizabeth Woodford, Jill Woodford, Luke Woodford, Louise Woodhead, Timothy Woodhead, Philip Woodland, Marc Woodman, Debra Woods, Jane Woods, Katherine Woods, Sarah Woods, Zoe Woodward, Rachel Wookey, Megan Woolcock, Gemma Wooldridge, Rebecca Woolf, Chris Woollard, Christopher Woollard, Louisa Woollen, Emma Woolley, Jade Woolley, Daniel Woosey, Dan Wootton, Joanne Wootton, Daniel Worley, Stephy Worton, Jonathan Wraight, Maria Wray, Tim Wreford-Bush, Joanne Wren, Kim Wren, Lynn Wren, Caroline Wrey Brown, Catherine Wright, Demi Wright, Francesca Wright, Imogen Wright, Lee Wright, Lianne Wright, Pete Wright, Rachel Wright, Rebecca Wright, Stephanie Wright, Tim Wright, Caroline Wroe, Hannah Wroe, Henry Wu, Peishan Wu, Pensee Wu, Jonathan Wubetu, Retno Wulandari, Craig Wyatt, Frederick Wyn-Griffiths, Inez Wynter, Bindhu Xavier, Arnold Xhikola, Zhongyang Xia, Huiyuan Xiao, Masseh Yakubi, May Yan, Freda Yang, Yingjia Yang, Michael Yanney, Woei Lin Yap, Nabil Yaqoob, Naairah Yaqub, Salima Yasmin, Bryan Yates, David Yates, Edward Yates, Helen Yates, Julie Yates, Mark Yates, Charlotte Yearwood Martin, Andrew Yeatman, Khin Yein, Fiona Yelnoorkar, Peter Yew, Kawai Yip, Laura Ylquimiche, Laura Ylquimiche Melly, Inez Ynter, H Yong, Jemma Yorke, Jasmine Youens, Abdel Younes Ibrahim, Eoin Young, Gail Young, Louise Young, Richard Young, Asfand Yousafzar, Sajeda Youssouf, Ahmed Yousuf, Chrissie Yu, Bernard Yung, Daniel Yusef, Said Yusef, Intekhab Yusuf, Anna-Sophia Zafar, Silvia Zagalo, Su Zaher, Aqsa Zahoor, Kareem Zaki, Nabhan Zakir, Kasia Zalewska, Ane Zamalloa, Mohsin Zaman, Raisa Zaman, Shakir Zaman, Julie Zamikula, Louise Zammit, Marie Zammit-Mangion, Lynn Zarb, Esther Zebracki, Daniel Zehnder, Lisa Zeidan, Marian Zelman, Xiaobei Zhao, Dongling Zheng, Doreen Zhu, Madiha Zia, Omar Zibdeh, Rabia Zill-E-Huma, Ei Thankt Zin, Veronica Zindonda, Eleanor Zinkin, Vivian Zinyemba, Christos Zipitis, Arkadiusz Zmierczak, Azam Zubir, Roslin Zuha, Naz Zuhra, Rasha Zulaikha, Sabrina Zulfikar, Carol Zullo, Ana Zuriaga-Alvaro, Will Zuurbier, Sheba Zyengi, and University of St Andrews. School of Medicine
Subjects: Male, Convalescent plasma, medicine.medical_treatment, 030204 cardiovascular system & hematology, Antibodies, Viral, Rate ratio, 0302 clinical medicine, RA0421, RA0421 Public health. Hygiene. Preventive Medicine, Medicine, Hospital Mortality, 030212 general & internal medicine, 11 Medical and Health Sciences, Aged, 80 and over, Medicine(all), Mortality rate, Covid19, Articles, 3rd-DAS, General Medicine, Middle Aged, Hospitals, Treatment Outcome, Female, Open label, Coronavirus Infections, Life Sciences & Biomedicine, RM, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), 03 medical and health sciences, Medicine, General & Internal, SDG 3 - Good Health and Well-being, General & Internal Medicine, Internal medicine, Humans, In patient, Pandemics, COVID-19 Serotherapy, Aged, Mechanical ventilation, Science & Technology, SARS-CoV-2, business.industry, Significant difference, Immunization, Passive, COVID-19, Length of Stay, NIS, R1, Respiration, Artificial, United Kingdom, RM Therapeutics. Pharmacology, RECOVERY Collaborative Group, business
Abstract: Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research.
Published: 2021

5. Investigation of the use of venlafaxine for treatment of refractory misdirected play and impulse-control aggression in a cat: A case report

Author: Sara Bennett and Kevin Pflaum
Subjects: Fluoxetine, General Veterinary, 040301 veterinary sciences, medicine.drug_class, Aggression, business.industry, Serotonin reuptake inhibitor, 0402 animal and dairy science, Venlafaxine, 04 agricultural and veterinary sciences, 040201 dairy & animal science, 0403 veterinary science, Anesthesia, medicine, Dosing, Serotonin, medicine.symptom, Adverse effect, business, medicine.drug, Serotonin–norepinephrine reuptake inhibitor
Abstract: Venlafaxine was evaluated as treatment for refractory misdirected play and impulse-control aggression in a cat. The patient, a 6-year-old male castrated domestic short-hair, had been well controlled on fluoxetine, a selective serotonin reuptake inhibitor at 7.5 mg (1.4 mg/kg) PO q24 h. However, after 3 years of therapy, urinary retention was gradually developed. For this reason, the fluoxetine was weaned. Although the urinary retention resolved, this led to the aggression relapsing. A physical examination was performed and found to be within normal limits. A trial of venlafaxine, a serotonin norepinephrine reuptake inhibitor, was initiated at 6.25 mg (1.1 mg/kg) PO q24 h. The patient's aggression improved to its previous level on the fluoxetine within 24 hours of starting therapy. Nearly one year after starting therapy, the patient remains well controlled with no adverse side effects reported by the owner. This patient's outcome suggests venlafaxine may be a safe and effective alternative for patients with serotonin responsive anxiety and impulse-related behavior problems in which selective serotonin reuptake inhibitors are not tolerated. Further study is warranted on the safety, efficacy, dosing, and use of serotonin norepinephrine reuptake inhibitors in feline patients.
Published: 2021

6. Strengthening social accountability in ways that build inclusion, institutionalization and scale: reflections on FHS experience

Author: Eizabeth Ekirapa-Kiracho, Sara Bennett, Shehrin Shaila Mahmood, Ligia Paina, and David H. Peters
Subjects: Scale-up, Community score cards, 03 medical and health sciences, 0302 clinical medicine, Political science, Humans, Uganda, 030212 general & internal medicine, Social accountability, Health policy, Social policy, Social accounting, Inclusion, Bangladesh, Social Responsibility, Equity (economics), Balanced scorecard, Health Equity, business.industry, 030503 health policy & services, Health Policy, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Health services research, lcsh:RA1-1270, Theory of change, Public relations, Editorial, Sustainability, Accountability, 0305 other medical science, business, Delivery of Health Care
Abstract: This editorial provides an introduction to the special issue on “Lessons about intervening in accountability ecosystems: implementation of community scorecards in Bangladesh and Uganda”. We start by describing the rationale for this work in the two study countries. While our project, the Future Health Systems (FHS) project, had been working over the course of more than a decade to strengthen health services, particularly for low income households in rural areas, our teams increasingly recognized how difficult it would be to sustain service improvements without fundamental changes to local accountabilities. Accordingly, in the final phase of the project 2016–2018, we designed, implemented and assessed community scorecard initiatives, in both Bangladesh and Uganda, with the aim of informing the design of a scalable social accountability initiative that could fundamentally shift the dynamics of health system accountability in favor of the poor and marginalized.We describe the particular characteristics of our approach to this task. Specifically we (i) conducted a mapping of accountabilities in each of the contexts so as to understand how our actions may interact with existing accountability mechanisms (ii) developed detailed theories of change that unpacked the mechanisms through which we anticipated the community scorecards would have effect, as well as how they would be institutionalized; and (iii) monitored closely the extent of inclusion and the equity effects of the scorecards. In summarizing this approach, we articulate the contributions made by different papers in this volume.
Published: 2020

7. How does embedded implementation research work? Examining core features through qualitative case studies in Latin America and the Caribbean

Author: N. Ilona Varallyay, Caitlin E. Kennedy, David H. Peters, Sara Bennett, and Abdul Ghaffar
Subjects: Implementation research, knowledge translation, Bolivia, Latin Americans, Knowledge management, health policy and systems research, Comparative case, collaborative research partnerships, Psychological intervention, Supplement Articles, evidence-informed decision-making, Colombia, 03 medical and health sciences, 0302 clinical medicine, evidence-to-action, Knowledge translation, Political science, Humans, AcademicSubjects/MED00860, evidence coproduction, low- and middle-income countries, 030212 general & internal medicine, Qualitative Research, Operationalization, business.industry, 030503 health policy & services, Health Policy, research–practice partnerships, Latin America and the Caribbean, Latin America, Incentive, Caribbean Region, Work (electrical), embedded research, decision-maker-led research, 0305 other medical science, business
Abstract: Innovative strategies are needed to improve the delivery of evidence-informed health interventions. Embedded implementation research (EIR) seeks to enhance the generation and use of evidence for programme improvement through four core features: (1) central involvement of programme/policy decision-makers in the research cycle; (2) collaborative research partnerships; (3) positioning research within programme processes and (4) research focused on implementation. This paper examines how these features influence evidence-to-action processes and explores how they are operationalized, their effects and supporting conditions needed. We used a qualitative, comparative case study approach, drawing on document analysis and semi-structured interviews across multiple informant groups, to examine three EIR projects in Bolivia, Colombia and the Dominican Republic. Our findings are presented according to the four core EIR features. The central involvement of decision-makers in EIR was enhanced by decision-maker authority over the programme studied, professional networks and critical reflection. Strong research–practice partnerships were facilitated by commitment, a clear and shared purpose and representation of diverse perspectives. Evidence around positioning research within programme processes was less conclusive; however, as all three cases made significant advances in research use and programme improvement, this feature of EIR may be less critical than others, depending on specific circumstances. Finally, a research focus on implementation demanded proactive engagement by decision-makers in conceptualizing the research and identifying opportunities for direct action by decision-makers. As the EIR approach is a novel approach in these low-resource settings, key supports are needed to build capacity of health sector stakeholders and create an enabling environment through system-level strategies. Key implications for such supports include: promoting EIR and creating incentives for decision-makers to engage in it, establishing structures or mechanisms to facilitate decision-maker involvement, allocating funds for EIR, and developing guidance for EIR practitioners.
Published: 2020

8. Developing a High-Impact Learning Program for Global Health Professionals: The STAR Project

Author: Anike Akridge, Bhakti Hansoti, George Pariyo, Daniela C. Rodríguez, Sara Bennett, Thomas C. Quinn, David Hausner, Angelina Gordon, Caroline Dolive, Sharon Rudy, Meike Schleiff, and Sean Tackett
Subjects: medicine.medical_specialty, 020205 medical informatics, business.industry, Public health, Public Health, Environmental and Occupational Health, 02 engineering and technology, Public relations, Star (graph theory), 03 medical and health sciences, 0302 clinical medicine, Capacity strengthening, Political science, 0202 electrical engineering, electronic engineering, information engineering, medicine, Global health, 030212 general & internal medicine, business
Abstract: Background. The Sustaining Technical and Analytical Resources (STAR) project seeks to invest in and expand the capacity of diverse senior global public health professionals. STAR builds on traditional work-based fellowships by partnering with universities in order to curate (or develop) and deliver high-quality, tailored learning across a set of required “core competency domains” as well as elective skills- or content-based competency domains. Pedagogy. In a rapidly changing global health context, ongoing learning is essential but often gets sidelined by other pressures; STAR’s approach aims to respond to these challenges by developing a learning curriculum tailored to the needs of our participants and their roles in global health. STAR’s pedagogy utilizes individualized learning plans, a deliberate practice approach, and a hybrid mentorship model to support project participants to achieve their learning objectives as well as broader project goals. Next Steps. The STAR project is in its first year of implementation. Furthermore, our future work will focus on developing a monitoring and evaluation plan that seeks to track the progress of our participants, guide project improvements, measure the impact of learning activities, and inform the pedagogy of future global health training initiatives.
Published: 2020

9. Safety and immunogenicity of seven COVID-19 vaccines as a third dose (booster) following two doses of ChAdOx1 nCov-19 or BNT162b2 in the UK (COV-BOOST): a blinded, multicentre, randomised, controlled, phase 2 trial

Author: Phedra Marius, Lynne Grundy, Nabeela Nazir Ahmed, Margaret Irwin, Jeanette Thorpe, Hannah Robinson, Helen Thorp, Maria Moon, Sadaf Farooqi, Nick Andrews, Louise Haskell, Bea Choi, Helen Beckett, Sharon Davies-Dear, Victoria Cornelius, Tracey Dare, Sunder Chita, Stephen Singh, Chris Twelves, John Haughney, Patrick S. Moore, Maja dabagh, Xinxue Liu, S Bibi, Suzanne Wilkins, Mohammed Khan, Charlotte Trinham, Emily Brunt, Edwin Justice, Hanna Nguyen, Andrew Gowland, Andrew Riordan, Tanveer Bawa, Daniel Pan, Ceri Davies, Suahil Aslam, Chris A Rogers, Dileep Kumar, Yvanne Enever, Siobhan Roche, Karen Bisnauthsing, Hayley Tulloch, Andrew Ustianowski, Steve Hurdover, Ehsaan Qureshi, Akamino Egbo, Ingrid Seath, Jo Salkeld, Carla Ferreira Da Silva, Ray Sheridan, Samantha Keenan, Shama Hamal, Jo Piper, Kerry Godwin, Sara Bennett, Liliana Cifuentes, Nicholas Ronan, Nicki Lakeman, Lona Tudor Jones, Ian Bentley, Rachel White, Chloe McDonnell, Nina Parungao, Emma Plested, Kyra Holliday, Lisa Berry, Christine Minnis, Victoria Graham, Christopher J Edwards, Beth Giddins, Tara Watson, Suzie Colquhoun, Johanna Mouland, Marion K Campbell, Rostam Osanlou, Carlota Pereira Dias Alves, Simon Fowler, Becky Mansfield, Sally Batham, Orod Osanlou, Arpan Guha, Stephen Saich, Kush Naker, Marcin Bula, Igor Starinskij, Bassam Hallis, Sonia Baryschpolec, Shirley Todd, Agatha A. van der Klaauw, Claire Brown, Emma Snashall, Andrew Seaton, Helen Radford, John Hladkiwskyj, Rachael Drake-Brockman, Matilda lang, Linda Harndahl, Holly Burton, Tim Whitbred, Sue Charlton, Mushiya Mpelembue, Anna Stewart, Anil Shenoy, Zalina Rashid-Gardner, Joseph Newman, John Gavin, Mary Savage, Julie Evans, Aidan Lingwood, Lauren Allen, Parvinder K. Aley, Rebecca Lyon, Rachel Bousfield, Robert C. Read, Joanne Spencer, David Baxter, Anastasia de la Haye, James Calderwood, Emily Chiplin, Evgenia Kourampa, Helen Gutteridge, Jade Gouriet, Trishna Champaneri, Javier Magan, Luke Vamplew, Abigail Oliver, Sally Reeder, Sunil Sharma, Nicola Turner, Yukari Sakagami, Mikayala King, Steve Thomas, Chanice Knight, Samantha Broadhead, Erica Peters, Dennyl Vail, Marta Merida-Morillas, Emily Locke, Krishna Chatterjee, Debbie Suggitt, Sara Fraser, Mihaela Pacurar, Kerry Hughes, Jessica Hailstone, Eleni Ladikou, Leah Richmond, Wythehi Ambihapathy, Kari Nightingale, Chris Cooper, Victoria Wenn, Kimberley Driver, Rachel Hughes, Filipa Dos Santos, Michael Singh, Ben Gardside, Donna Wixted, Jessica Lewis-Taylor, Jason Domingo, Scott Elliott, Wiesia Woodyatt, Jonathan Kwok, Subarna Roy, Amisha Desai, Iryna Boubriak, Helen Haydock, Arabella Stuart, Amy Ross-Russell, Rossana Romani, Lauren Fox, Gillian McMillan, Angela M. Minassian, Ann Sturdy, R. A. James, Valerie Renals, Stephanie Leung, Lillian Goncalves cordeiro, Fran Westwell, Robert Shaw, Anna L. Goodman, Katrina Cathie, Ryan Stephen Elliott, Adrian Palfreeman, Phillip Brown, Kim En Lee, Farida khan, Suzanne Tasker, Anna Hardy, Elisa Nanino, Donald van Welsenes, Adam Farrier, Antonette Andrews, Jacqueline Brandon, Alicja Kownacka, Jennifer Murira, Kate Dodd, Emily Horsfall, Chantelle Moorbey, Alison Hogan, Lynda Wagstaff, Gita Patel, Rebecca Cutts, Matthew D. Snape, Karen Regan, Beverley Longhurst, Saul N. Faust, Vincenzo Libri, Andrea Mazzella, Michael Stackpoole, Carool Osuji, Jonathan Baker, Teona Serafimova, Tumena Corrah, Sophie E. Moore, Sarah Warren, Christopher Herbert, Laura Presland, Daniel R. Owens, Colin Hale, Beth Jackson, Fran Hall, Debbie Branney, Martha Nabunjo, Mehmood Mughal, Laura Longshaw, Holly Baker, Elizabeth A. Clutterbuck, Eloise Summerton, Rowena Weighell, Fiona Makia, Alexander Hicks, Leila Janani, Matthew Stokes, Amanda Buadi, E. Thomson, Jennifer Gibney, Jane Hall, Tricia Coughlan, Bridget Tandy, Kelly Littlewood, Christopher A Green, Mary Ramsay, Lorinda Pickup, Karren Buttigieg, Gavin Babbage, Todd Rawlins, Simon Tunstall, Dominique Barker, Martin J. Llewelyn, James Cullinane, Judith Bell, Elizabeth Gordon, Andrew L. Freedman, Martin Wiselka, Mohammed Kamal, Sarah Whittley, Natalie Baker, Jorden Frankham, Malathi Munusamy, Karen Underwood, Dinesh Saralaya, Olivia Chalwin, Tommy Rampling, Rachael Phillips, Sarah Garrahy, Yee Ting Nicole Yim, Charlotte Sabine, Haniah Habash-Bailey, Ashley Whittington, Benjamin Welham, Patrick Kinch, Avril Bonnaud, Jonathan Macdonald, NinaSimone Hopkins, Kim Storton, Stephen Hughes, Enya Cooney, Alasdair Munro, Christine Cole, John Paul Seenan, Kim Appleby, Laurence John, David J. Smith, Lara Barcella, Imam Shaik, Kate Ellis, Olumide Adebambo, Jane Stockport, Gertraud Morshead, Paminder Lall, Stephen E. Cox, Daniel Hansen, Jonathan Perkins, Yama F Mujadidi, Thomas Honey, Alan Magee, Jonathan S. Nguyen-Van-Tam, Mwila Kasanyinga, Marivic Ricamara, Jaimie Wilson-Goldsmith, Alastair McGregor, Djamila Shamtally, Helena Baker, Tom Eadsforth, Dee Mullan, Karishma Gokani, Kirsty Adams, and Dominic Galvin
Subjects: Adult, Male, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Population, Immunization, Secondary, Department of Error, Group A, Group B, COV-BOOST study group, Medicine, General & Internal, Immunogenicity, Vaccine, General & Internal Medicine, ChAdOx1 nCoV-19, Internal medicine, Safety, immunogenicity, COVID-19, vaccines, booster, Humans, Medicine, Adverse effect, education, Pandemics, BNT162 Vaccine, 11 Medical and Health Sciences, Aged, Aged, 80 and over, education.field_of_study, Science & Technology, Booster (rocketry), Reactogenicity, SARS-CoV-2, business.industry, Immunogenicity, COVID-19, General Medicine, Articles, Middle Aged, United Kingdom, Female, Patient Safety, business, Life Sciences & Biomedicine
Abstract: Background: \ud Few data exist on the comparative safety and immunogenicity of different COVID-19 vaccines given as a third (booster) dose. To generate data to optimise selection of booster vaccines, we investigated the reactogenicity and immunogenicity of seven different COVID-19 vaccines as a third dose after two doses of ChAdOx1 nCov-19 (Oxford–AstraZeneca; hereafter referred to as ChAd) or BNT162b2 (Pfizer–BioNtech, hearafter referred to as BNT).\ud \ud Methods: \ud COV-BOOST is a multicentre, randomised, controlled, phase 2 trial of third dose booster vaccination against COVID-19. Participants were aged older than 30 years, and were at least 70 days post two doses of ChAd or at least 84 days post two doses of BNT primary COVID-19 immunisation course, with no history of laboratory-confirmed SARS-CoV-2 infection. 18 sites were split into three groups (A, B, and C). Within each site group (A, B, or C), participants were randomly assigned to an experimental vaccine or control. Group A received NVX-CoV2373 (Novavax; hereafter referred to as NVX), a half dose of NVX, ChAd, or quadrivalent meningococcal conjugate vaccine (MenACWY) control (1:1:1:1). Group B received BNT, VLA2001 (Valneva; hereafter referred to as VLA), a half dose of VLA, Ad26.COV2.S (Janssen; hereafter referred to as Ad26) or MenACWY (1:1:1:1:1). Group C received mRNA1273 (Moderna; hereafter referred to as m1273), CVnCov (CureVac; hereafter referred to as CVn), a half dose of BNT, or MenACWY (1:1:1:1). Participants and all investigatory staff were blinded to treatment allocation. Coprimary outcomes were safety and reactogenicity and immunogenicity of anti-spike IgG measured by ELISA. The primary analysis for immunogenicity was on a modified intention-to-treat basis; safety and reactogenicity were assessed in the intention-to-treat population. Secondary outcomes included assessment of viral neutralisation and cellular responses. This trial is registered with ISRCTN, number 73765130.\ud \ud Findings: \ud Between June 1 and June 30, 2021, 3498 people were screened. 2878 participants met eligibility criteria and received COVID-19 vaccine or control. The median ages of ChAd/ChAd-primed participants were 53 years (IQR 44–61) in the younger age group and 76 years (73–78) in the older age group. In the BNT/BNT-primed participants, the median ages were 51 years (41–59) in the younger age group and 78 years (75–82) in the older age group. In the ChAd/ChAD-primed group, 676 (46·7%) participants were female and 1380 (95·4%) were White, and in the BNT/BNT-primed group 770 (53·6%) participants were female and 1321 (91·9%) were White. Three vaccines showed overall increased reactogenicity: m1273 after ChAd/ChAd or BNT/BNT; and ChAd and Ad26 after BNT/BNT. For ChAd/ChAd-primed individuals, spike IgG geometric mean ratios (GMRs) between study vaccines and controls ranged from 1·8 (99% CI 1·5–2·3) in the half VLA group to 32·3 (24·8–42·0) in the m1273 group. GMRs for wild-type cellular responses compared with controls ranged from 1·1 (95% CI 0·7–1·6) for ChAd to 3·6 (2·4–5·5) for m1273. For BNT/BNT-primed individuals, spike IgG GMRs ranged from 1·3 (99% CI 1·0–1·5) in the half VLA group to 11·5 (9·4–14·1) in the m1273 group. GMRs for wild-type cellular responses compared with controls ranged from 1·0 (95% CI 0·7–1·6) for half VLA to 4·7 (3·1–7·1) for m1273. The results were similar between those aged 30–69 years and those aged 70 years and older. Fatigue and pain were the most common solicited local and systemic adverse events, experienced more in people aged 30–69 years than those aged 70 years or older. Serious adverse events were uncommon, similar in active vaccine and control groups. In total, there were 24 serious adverse events: five in the control group (two in control group A, three in control group B, and zero in control group C), two in Ad26, five in VLA, one in VLA-half, one in BNT, two in BNT-half, two in ChAd, one in CVn, two in NVX, two in NVX-half, and one in m1273.\ud \ud Interpretation: \ud All study vaccines boosted antibody and neutralising responses after ChAd/ChAd initial course and all except one after BNT/BNT, with no safety concerns. Substantial differences in humoral and cellular responses, and vaccine availability will influence policy choices for booster vaccination.\ud \ud Funding: \ud UK Vaccine Taskforce and National Institute for Health Research.
Published: 2021

10. COVID-19 vaccine coverage in health-care workers in England and effectiveness of BNT162b2 mRNA vaccine against infection (SIREN): a prospective, multicentre, cohort study

Author: Amanda Semper, P Burns, K Gajee, Amoolya Vusirikala, L Moore, S Joyce, Paul Klenerman, R Longfellow, R Matthews, Jacqueline Hewson, L Prentice, Alastair Grant, Edgar Wellington, A Tengbe, S Ambalkar, Alex Soriano, I Karagiannis, A Ashby, C Carr, O Kay, B Larru, Manjula Meda, T Lewis, H Aziz, R Chaudhuri, Ioannis Karagiannis, Martin S. Williams, J Conneely, Tim Planche, A M Moody, A Ho, Ashley Otter, K McLelland-Brooks, N Todd, J Alderton, Matthew T. G. Holden, A Boulos, T DeSilva, A Rajgopal, R Pritchard Jones, J Khawam, SC Bain, V J Hall, S Birch, Sarah Foulkes, MA Chand, CS Brown, P Cowling, K Hollinshead, M Halkes, M Ramsay, Cathy Rowe, Colin S Brown, Mark Joseph, N Slawson, Blanche Oguti, L Hall, J Russell, Ayoub Saei, Linda Partridge, Shahjahan Miah, L Coke, Steven Platt, Angie Lackenby, Victoria Hall, M Sartaj, L Keen, A Saei, T Chin, C Thomas, Louise Robinson, Christopher W Holmes, C Subudhi, M Beekes, R Laugharne, Diane Wycherley, R.J. Shorten, R Temple-Purcell, H Chenoweth, V Maxwell, A Atti, Padmasayee Papineni, J Giles, K. Black, M Booth, Jane Democratis, D McCracken, L Cromey, Peter Kirwan, D Delgado, D Hilton, R Crosby-Nwaobi, Susanna Dunachie, A Roebuck, G Sebbage, S Foulkes, K Tempeton, Edward M. Smith, J Murira, Ajay Chawla, Joanna Ellis, J Lopez-Bernal, S Jose, Nick Andrews, A Charlett, Bjl Burton, I Sinanovic, N Aldridge, Katie Jeffery, Gretchen A Stevens, Y Ellis, J Powell, Shân Davies, Alan Jackson, Jonathan L. Heeney, A Dave, B Oguti, A Swan, EA Sheridan, Sara Bennett, Susan Hopkins, T Donaghy, Sakib Rokadiya, Jasmin Islam, S Akhtar, J Mouland, P Domingos, J Harwood, Christian Gabriel, Christopher J A Duncan, Stephen R. Williams, S Hams, E Cameron, F Westwell, Keith D. James, Meaghan Kall, K Pagget, Justin Pepperell, Robert Tilley, A O'Kelly, S Horne, K Potts, S Gormley, F Sanderson, Sharen Painter, S. Stone, Mariyam Mirfenderesky, Tabitha Mahungu, S Baillon, R Kyffin, S Organ, S Brake, Andre Charlett, S Brand, D Browne, J Ledger, Meera Chand, Madhumita Shrotri, Michael J. Cole, Debra Padgett, M Lee, Martin Wiselka, A M O'Connell, Minal Patel, Katie Munro, L Haahr, T M Byrne, J Gunn, Naomi F. Walker, P Bakker, P Cieciwa, Stephen Winchester, N Chitalia, B Wadams, Michael P. Murphy, P Staves, Ken Agwuh, Cressida Auckland, Sarah Meisner, Ejm Monk, J Howard, C Duff, Susan R. Hopkins, N Andrews, J Elliott, K Braithwaite, AJ Plant, M Howard, Sharon Campbell, A Nissr, Stuart K. Roberts, D Pople, G Maloney, L Mabey, T Bailey, Simon Warren, S Orr, Alex Horsley, J Radmore, Lance Turtle, Helen V. Smith, Badrinathan Chandrasekaran, C Forsyth, R Lear, A Roynon, Claire Price, Ana Atti, Maria Zambon, Stephen R Knight, Jeremy N. Day, Katja Hoschler, Aarti Shah, Chetan Parmar, Rajeka Lazarus, M Lattimore, Julia Stowe, J Aeron-Thomas, J Tomlinson, L Allsop, A Abdelrazik, C Laven, Silvia D'Arcangelo, Z Naheed, A Cochrane, L Price, Emily MacNaughton, K Munro, E King, Chris Jones, S Mcwilliam, G Boyd, Caroline Kerrison, S Hamer, David W Eyre, T Trinick, J Marrs, F Adair, H Coles, Jameel Khawam, S Board, Gordon B. Mills, Mary Ramsay, Nada Ahmed, D Brooking, J Northfield, Jamie Lopez-Bernal, N Kalakonda, D Ironmonger, Shazaad Ahmad, S Taylor, A Watt, J Graves, D Flanagan, Helen Baxendale, R Penn, Louise Berry, D Corrigan, C Favager, M E Green, V Bateman, N Mahabir, J Osbourne, K Gray, Eleri Wilson-Davies, S Pai, I Knox, S Tonge, G Pottinger, M Brazil, Hayley Crawford, K Court, Daniel Harvey, Brendan A I Payne, A Arenas-Pinto, E Hanna, Robin Gopal, Henrietta U. Okafor, Frances L. Game, A Cross, Benjamin J. Stewart, Kevin K. Brown, Timothy M Reynolds, ED Lacey, V Irvine, Julie V. Robotham, A Lloyd, M Aga, D Brennan, C Loughrey, K Shipman, I Del Rosario, Stephen J. Fowler, H Hodgson, K Nimako, Ruth Simmons, Aditi Pai, S Stewart, R Druyeh, Nicholas J. White, A Bexley, E Defever, G Harrison, Trevor J. Barnes, N Wong, Natalie Gillson, S Khanduri, Sarah Wallace, M O'Kane, A Whileman, Arthur Taylor, A Houston, R Sierra, N Elumogo, Ezra Linley, A Higham, J Islam, J Ashcroft, E Underhill, D Camero, Stacey Donaldson, N Gillson, N Osuji, M Z Qazzafi, J Birch, C Sinclair, E Wellington, D Dhasmana, C Pegg, Reuben McGregor, C Norman, Alison Rodger, D Adeboyeku, L E Hughes, H Johnstone, L Gallego, Tim Brooks, Adrian Hawkins, A Selassi, P Swift, P Mercer, A Cowley, A Gibson, P Harrington, A Broadley, P Ridley, S Evans, Ywj Huang, Dunachie, SJ, and Group, SIREN Study
Subjects: medicine.medical_specialty, business.industry, Incidence (epidemiology), Hazard ratio, General Medicine, 030204 cardiovascular system & hematology, Asymptomatic, Vaccination, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Cohort, Medicine, Population study, 030212 general & internal medicine, medicine.symptom, business, Prospective cohort study, Cohort study
Abstract: Summary Background BNT162b2 mRNA and ChAdOx1 nCOV-19 adenoviral vector vaccines have been rapidly rolled out in the UK from December, 2020. We aimed to determine the factors associated with vaccine coverage for both vaccines and documented the vaccine effectiveness of the BNT162b2 mRNA vaccine in a cohort of health-care workers undergoing regular asymptomatic testing. Methods The SIREN study is a prospective cohort study among staff (aged ≥18 years) working in publicly-funded hospitals in the UK. Participants were assigned into either the positive cohort (antibody positive or history of infection [indicated by previous positivity of antibody or PCR tests]) or the negative cohort (antibody negative with no previous positive test) at the beginning of the follow-up period. Baseline risk factors were collected at enrolment, symptom status was collected every 2 weeks, and vaccination status was collected through linkage to the National Immunisations Management System and questionnaires. Participants had fortnightly asymptomatic SARS-CoV-2 PCR testing and monthly antibody testing, and all tests (including symptomatic testing) outside SIREN were captured. Data cutoff for this analysis was Feb 5, 2021. The follow-up period was Dec 7, 2020, to Feb 5, 2021. The primary outcomes were vaccinated participants (binary ever vacinated variable; indicated by at least one vaccine dose recorded by at least one of the two vaccination data sources) for the vaccine coverage analysis and SARS-CoV-2 infection confirmed by a PCR test for the vaccine effectiveness analysis. We did a mixed-effect logistic regression analysis to identify factors associated with vaccine coverage. We used a piecewise exponential hazard mixed-effects model (shared frailty-type model) using a Poisson distribution to calculate hazard ratios to compare time-to-infection in unvaccinated and vaccinated participants and estimate the impact of the BNT162b2 vaccine on all PCR-positive infections (asymptomatic and symptomatic). This study is registered with ISRCTN, number ISRCTN11041050, and is ongoing. Findings 23 324 participants from 104 sites (all in England) met the inclusion criteria for this analysis and were enrolled. Included participants had a median age of 46·1 years (IQR 36·0–54·1) and 19 692 (84%) were female; 8203 (35%) were assigned to the positive cohort at the start of the analysis period, and 15 121 (65%) assigned to the negative cohort. Total follow-up time was 2 calendar months and 1 106 905 person-days (396 318 vaccinated and 710 587 unvaccinated). Vaccine coverage was 89% on Feb 5, 2021, 94% of whom had BNT162b2 vaccine. Significantly lower coverage was associated with previous infection, gender, age, ethnicity, job role, and Index of Multiple Deprivation score. During follow-up, there were 977 new infections in the unvaccinated cohort, an incidence density of 14 infections per 10 000 person-days; the vaccinated cohort had 71 new infections 21 days or more after their first dose (incidence density of eight infections per 10 000 person-days) and nine infections 7 days after the second dose (incidence density four infections per 10 000 person-days). In the unvaccinated cohort, 543 (56%) participants had typical COVID-19 symptoms and 140 (14%) were asymptomatic on or 14 days before their PCR positive test date, compared with 29 (36%) with typical COVID-19 symptoms and 15 (19%) asymptomatic in the vaccinated cohort. A single dose of BNT162b2 vaccine showed vaccine effectiveness of 70% (95% CI 55–85) 21 days after first dose and 85% (74–96) 7 days after two doses in the study population. Interpretation Our findings show that the BNT162b2 vaccine can prevent both symptomatic and asymptomatic infection in working-age adults. This cohort was vaccinated when the dominant variant in circulation was B1.1.7 and shows effectiveness against this variant. Funding Public Health England, UK Department of Health and Social Care, and the National Institute for Health Research.
Published: 2021

11. Methodological gaps and opportunities for studying multisectoral collaboration for health in low- and middle-income countries

Author: Sara Bennett, Douglas Glandon, Shehla Zaidi, Ida Okeyo, Mishal S Khan, Shinjini Mondal, and Osman Dar
Subjects: Knowledge management, Divergence (linguistics), business.industry, 030503 health policy & services, Health Policy, Corporate governance, Developing country, Public Policy, Context (language use), 03 medical and health sciences, 0302 clinical medicine, Work (electrical), Low and middle income countries, Content analysis, Humans, Health Services Research, 030212 general & internal medicine, Sociology, 0305 other medical science, business, Intersectoral Collaboration, Qualitative Research, Research method
Abstract: The current body of research into multisectoral collaborations (MSCs) for health raises more questions than it answers, both in terms of how to implement MSCs and how to study them. This article reflects on current methodological gaps and opportunities for advancing MSC research, based on a targeted review of existing literature and qualitative input from researchers and practitioners at the 2018 Health Systems Research (HSR) Symposium in Liverpool. Through framework analysis of 205 MSC research papers referenced in a separately published MSC ‘overview of reviews’ paper, this article identifies six broad MSC question domains (‘meta questions’) and applies content analysis to estimate the relative frequency with which these meta questions and the research method(s) used to answer them are present in the literature. Results highlight a preponderance of research exploring MSC implementation using case study methods, which, in aggregate, does not seem to adequately meet policymakers’ and practitioners’ needs for generalizable or transferable insights. The content analysis is complemented by qualitative insights from HSR Symposium participants and the authors’ own experience to identify six key methodological gaps in research on MSC for health. For each of these gaps, we propose areas in which we believe there are opportunities for methodological development and innovation to help advance this field of study, including: better understanding the role of power dynamics in shaping MSCs; development of a classification framework (or frameworks) of governance arrangements; exploring divergence of perspective and experience among MSC partners; identifying or generating theoretical frameworks for MSC that work across sectors and disciplines; developing intermediate indicators of collaboration; and increasing transferability of insights to other contexts. Collaboration with researchers outside of the health sector will enhance efforts in each of these areas, as will the establishment and strengthening of pluralistic MSC evidence networks also involving policymakers and practitioners.
Published: 2019

12. The differential impacts of PEPFAR transition on private for-profit, private not-for-profit and publicly owned health facilities in Uganda

Author: Mary Qiu, Jess Wilhelm, Sara Bennett, Henry Zakumumpa, and Ligia Paina
Subjects: sub-Saharan Africa, Financing, Government, media_common.quotation_subject, President’s Emergency Plan for AIDS Relief, HIV Infections, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Environmental health, Health care, medicine, Humans, Confidentiality, Uganda, 030212 general & internal medicine, media_common, Public Sector, business.industry, 030503 health policy & services, Health Policy, Public sector, Ownership, Differential (mechanical device), Odds ratio, Original Articles, medicine.disease, private health providers, Outreach, Service (economics), HIV/AIDS, Private Sector, Business, Health Facilities, 0305 other medical science, development assistance for health, Delivery of Health Care
Abstract: While transition of donor programs to national control is increasingly common, there is a lack of evidence about the consequences of transition for private health care providers. In 2015, President’s Emergency Plan for AIDS Relief (PEPFAR) identified 734 facilities in Uganda for transition from PEPFAR support, including 137 private not-for-profits (PNFP) and 140 private for-profits (PFPs). We sought to understand the differential impacts of transition on facilities with differing ownership statuses. We used a survey conducted in mid-2017 among 145 public, 29 PNFP and 32 PFP facilities reporting transition from PEPFAR. The survey collected information on current and prior PEPFAR support, service provision, laboratory services and staff time allocation. We used both bivariate and logistic regression to analyse the association between ownership and survey responses. All analyses adjust for survey design. Public facilities were more likely to report increased disruption of sputum microscopy tests following transition than PFPs [odds ratio (OR) = 5.85, 1.79–19.23, P = 0.005]. Compared with public facilities, PNFPs were more likely to report declining frequency of supervision for human immunodeficiency virus (HIV) since transition (OR = 2.27, 1.136–4.518, P = 0.022). Workers in PFP facilities were more likely to report reduced time spent on HIV care since transition (OR = 6.241, 2.709–14.38, P
Published: 2019

13. Effects of transition on HIV and non-HIV services and health systems in Kenya: a mixed methods evaluation of donor transition

Author: Elizabeth Omondi, Ezinne Eze-Ajoku, Mary Qiu, Daniela C. Rodríguez, Diwakar Mohan, Caroline Mackenzie, Sara Bennett, and Jess Wilhelm
Subjects: Economic growth, medicine.medical_specialty, Service delivery framework, HIV Infections, Health informatics, Health administration, 03 medical and health sciences, 0302 clinical medicine, Health systems, Health facility, Medicine, Humans, 030212 general & internal medicine, Government, business.industry, 030503 health policy & services, Health Policy, Nursing research, Public health, HIV, Mixed-methods evaluation, Health Services, Focus group, Kenya, Government Programs, Sustainability, Donor transition, Health Facilities, Public aspects of medicine, RA1-1270, 0305 other medical science, business, Research Article
Abstract: Background In 2015 the US President’s Emergency Plan for AIDS Relief (PEPFAR) initiated its Geographic Prioritization (GP) process whereby it prioritized high burden areas within countries, with the goal of more rapidly achieving the UNAIDS 90–90-90 targets. In Kenya, PEPFAR designated over 400 health facilities in Northeastern Kenya to be transitioned to government support (known as central support (CS)). Methods We conducted a mixed methods evaluation exploring the effect of GP on health systems, and HIV and non-HIV service delivery in CS facilities. Quantitative data from a facility survey and health service delivery data were gathered and combined with data from two rounds of interviews and focus group discussions (FGDs) conducted at national and sub-national level to document the design and implementation of GP. The survey included 230 health facilities across 10 counties, and 59 interviews and 22 FGDs were conducted with government officials, health facility providers, patients, and civil society. Results We found that PEPFAR moved quickly from announcing the GP to implementation. Despite extensive conversations between the US government and the Government of Kenya, there was little consultation with sub-national actors even though the country had recently undergone a major devolution process. Survey and qualitative data identified a number of effects from GP, including discontinuation of certain services, declines in quality and access to HIV care, loss of training and financial incentives for health workers, and disruption of laboratory testing. Despite these reports, service coverage had not been greatly affected; however, clinician strikes in the post-transition period were potential confounders. Conclusions This study found similar effects to earlier research on transition and provides additional insights about internal country transitions, particularly in decentralized contexts. Aside from a need for longer planning periods and better communication and coordination, we raise concerns about transitions driven by epidemiological criteria without adaptation to the local context and their implication for priority-setting and HIV investments at the local level.
Published: 2021

14. The impact of loss of PEPFAR support on HIV services at health facilities in low-burden districts in Uganda

Author: Henry Zakumumpa, Eric Ssegujja, Ligia Paina, Freddie Ssengooba, Sara Bennett, Moses Mukuru, and Jess Wilhelm
Subjects: medicine.medical_specialty, Service delivery framework, HIV Infections, Ambulatory Care Facilities, Health informatics, Health administration, 03 medical and health sciences, Health systems, 0302 clinical medicine, medicine, Humans, Uganda, 030212 general & internal medicine, Child, Government, business.industry, lcsh:Public aspects of medicine, 030503 health policy & services, Health Policy, Nursing research, Public health, HIV, PEPFAR, lcsh:RA1-1270, Focus Groups, Focus group, Health services, Family medicine, Health Facilities, Donor transition, Thematic analysis, 0305 other medical science, business, Delivery of Health Care, Research Article
Abstract: Background Although donor transitions from HIV programs are more frequent, little research exists seeking to understand the perceptions of patients and providers on this process. Between 2015 and 2017, PEPFAR implemented the ´geographic prioritization´ (GP) policy in Uganda whereby it shifted support from 734 ‘low-volume’ facilities and 10 districts with low HIV burden and intensified support in select facilities in high-burden districts. Our analysis intends to explore patient and provider perspectives on the impact of loss of PEPFAR support on HIV services in transitioned health facilities in Uganda. Methods We report qualitative findings from a larger mixed-methods evaluation. Six facilities were purposefully selected as case studies seeking to ensure diversity in facility ownership, size, and geographic location. Five out of the six selected facilities had experienced transition. A total of 62 in-depth interviews were conducted in June 2017 (round 1) and November 2017 (round 2) with facility in-charges (n = 13), ART clinic managers (n = 12), representatives of PEPFAR implementing organizations (n = 14), district health managers (n = 23) and 12 patient focus group discussions (n = 72) to elicit perceived effects of transition on HIV service delivery. Data were analyzed using thematic analysis. Results While core HIV services, such as testing and treatment, offered by case-study facilities prior to transition were sustained, patients and providers reported changes in the range of HIV services offered and a decline in the quality of HIV services offered post-transition. Specifically, in some facilities we found that specialized pediatric HIV services ceased, free HIV testing services stopped, nutrition support to HIV clients ended and the ‘mentor mother’ ART adherence support mechanism was discontinued. Patients at three ART-providing facilities reported that HIV service provision had become less patient-centred compared to the pre-transition period. Patients at some facilities perceived waiting times at clinics to have become longer, stock-outs of anti-retroviral medicines to have been more frequent and out-of-pocket expenditure to have increased post-transition. Conclusions Participants perceived transition to have had the effect of narrowing the scope and quality of HIV services offered by case-study facilities due to a reduction in HIV funding as well as the loss of the additional personnel previously hired by the PEPFAR implementing organizations for HIV programming. Replacing the HIV programming gap left by PEPFAR in transition districts with Uganda government services is critical to the attainment of 90–90-90 targets in Uganda.
Published: 2021

15. Development and psychometric testing of the FLW-MSC scale for measuring frontline worker multisectoral collaboration in rural India

Author: Sara Bennett, Ligia Paina, Douglas Glandon, Jeannie Marie S. Leoutsakos, Jill A. Marsteller, and Shivam Gupta
Subjects: Knowledge management, Psychometrics, Nurse Midwives, Psychological intervention, India, Global Health, organisation of health services, 03 medical and health sciences, 0302 clinical medicine, Criterion validity, Medicine, Humans, 030212 general & internal medicine, Social determinants of health, Accreditation, Government, Primary Health Care, business.industry, 030503 health policy & services, public health, Construct validity, General Medicine, Exploratory factor analysis, nutrition, Scale (social sciences), 0305 other medical science, business, Factor Analysis, Statistical
Abstract: ObjectivesMultisectoral collaboration (MSC) is widely recognised as a critical aspect of policies, programmes and interventions addressing complex public health issues, yet it is undertheorised and difficult to measure. Limited understanding of the intermediate steps linking MSC formation to intended health outcomes leaves a substantial knowledge gap about the types of strategies that may be most effective in making such collaborations successful. This paper, which reports the quantitative strand of a broader mixed-methods study, takes a step toward filling in this ‘missing middle’ of MSC evaluation by developing and testing the FLW-MSC scale, an instrument to assess collaboration among the frontline workers of one of India’s largest and most widely known MSCs: the Integrated Child Development Services (ICDS) scheme.DesignThis study involved development, field-testing and psychometric testing of an 18-item, Likert-type frontline worker collaboration scale, including internal consistency, construct validity and criterion validity.SettingVillage-level primary healthcare in rural Uttar Pradesh, India.Participants281 anganwadi workers, 266 accredited social health activists and 124 auxiliary nurse midwives selected based on random sampling of anganwadi catchment areas from 346 gram panchayats (GPs), including 173 intervention GPs and 173 pair-matched control GPs from a parent evaluation study.ResultsResults support the scale’s internal consistency (ordinal α=0.92–0.95), construct validity (reasonable exploratory factor analysis model fit for five of the six dyadic relationships Tucker-Lewis Index=0.84–0.88; Root Mean Squared Error of Approximation=0.09–0.11), and criterion validity (regression of collaboration score on an information-sharing indicator β=3.528; p=0.006).ConclusionsThe scale may be useful for ICDS managers to detect and address poor collaboration as the Indian government redoubles its efforts to strengthen and monitor MSC, or ‘convergence’, with important implications for the critical priority of child development. Further, the FLW-MSC scale may be adapted for measuring frontline worker collaboration across sectors in many other scenarios and low/middle-income country contexts.
Published: 2021

16. Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Author: Eugenia Abaleke, Mustafa Abbas, Sadia Abbasi, Alfie Abbott, Ashraf Abdelaziz, Sherif Abdelbadiee, Mohamed Abdelfattah, Basir Abdul, Althaf Abdul Rasheed, Rezan Abdul-Kadir, Abdulfatahi Abdulmumeen, Niyaz Abdulshukkoor, Kula Abdusamad, Yazeed Abed El Khaleq, Mai Abedalla, Abeer UA Abeer Ul Amna, Adebanke Aboaba, Hani Abo-Leyah, Ahmed Abou-Haggar, Mahmoud Abouibrahim, Miriam Abraham, Tizzy Abraham, Abraheem Abraheem, Judith Abrams, Hyacinth-John Abu, Ahmad Abu-Arafeh, Syed M Abubacker, Akata Abung, Yaa Aceampong, Devikumar Acharya, Janet Acheson, Andres Acosta, Catherine Acton, Jacqueline Adabie-Ankrah, Fiona Adam, Matthew Adam, Huzaifa Adamali, Carol Adams, Kate Adams, Richard Adams, Tim Adams, Malgorzata Adamus, Kirsty Adcock, Aderonke Adebiyi, Ken Adegoke, Vicki Adell, Aldrin Adeni, Sherna Adenwalla, Oluwasegun A Adesemoye, Emmanuel O Adewunmi, Joyce Adeyemi, Elizabeth Adeyeye, Gabrielle Adkins, Adnan Adnan, John Aeron-Thomas, Lynn Afari, Debbie Affleck, Carmel Afnan, Deborah Afolabi, Muhammad Afridi, Rachel Agbeko, Chris Agbo, Sunil Aggarwal, Arameh Aghababaie, Judith Agwada-Akeru, Kwame A Agyapong, Shafana Ahamed Sadiq, Mohamed H Ahammed Nazeer, Jonathan Ah-Chuen, Mahin Ahmad, Ashar Ahmed, Bilal Ahmed, Forizuddin Ahmed, Iram Ahmed, Irshad Ahmed, Liban Ahmed, Maria C Ahmed, Muhammad S Ahmed, Naseer Ahmed, Nausheen Ahmed, Osama Ahmed, Rajia A Ahmed, Rizwan Ahmed, Saif Ahmed, Sammiya Ahmed, Sara Ahmed, Syed H Ahmed, Roa Ahmed Ali, Sana Ahmer, Dhiraj Ail, Adam Ainsley, Mark Ainsworth, Myriam Aissa, Lucy Aitchson, Lindianne Aitken, Bini Ajay, Abdulakeem Ajibode, Ayesha Ajmi, Muhammad N Akhtar, Nasim Akhtar, Suha Akili, Oludoyinsola Akindolie, Yinka Akinfenwa, Olugbenga Akinkugbe, Ibrahim Akinpelu, Umeh Akudo, Asma Al Balushi, Majd Al Dakhola, Narendra Aladangady, Sajid Alam, Abbas Al-Asadi, Kyriaki Alatzoglou, Lorraine Albon, Stephen Alcorn, Aggie Aldana, David Alderdice, Rayan Aldouri, Jonathan Aldridge, Nicolas Aldridge, Ana Alegria, Alison Alexander, John Alexander, Peter DG Alexander, Julyan Al-Fori, Bahij Al-Hakim, Shams Al-Hity, Ali Ali, Anyat Ali, Fawzia R Ali, Jawad Ali, Mariam Ali, Mohammad Ali, Oudai Ali, Sakina Ali, Syed Ali, Abid Alina, Katrin Alizaedeh, Maithem Al-Jibury, Moutaz Alkhusheh, Alison Allanson, Robert Allcock, Eireann Allen, Jonathan Allen, Kerry Allen, Louise Allen, Rebecca Allen, Sam Allen, Sharon Allen, Simon Allen, Kathryn Allison, Bethan Allman, Lynne Allsop, Christine Almadenboyle, Hassan Al-Moasseb, Magda Al-Obaidi, Lina Alomari, Akram Al-Rabahi, Bahar Al-Ramadhani, Zayneb Al-Saadi, Warkaq Al-Shamkhani, Bashar Al-Sheklly, Mary Alvarez, Maysaa Alzetani, Susan Amamou, Sakarai Ambalavanan, Sarah-Jayne Ambler, Robert Ambrogetti, Chris Ambrose, Amir Ameen, Maria R Amezaga, Allison Amin, Amina Amin, Kanish Amin, Amjad Amjad, Victoria Amosun, Khaled Amsha, Atul Anand, Samantha Anandappa, Julie Anderson, Laura Anderson, Michelle Anderson, Nicola Anderson, Rachel Anderson, Rory Anderson, Prematie Andreou, Angela Andrews, Jill Andrews, Kanayochukwu Aneke, Andrew Ang, Wan Wei Ang, Tammy Angel, Paola Angelini, Lazarus Anguvaa, Oleg Anichtchik, Millicent Anim-Somuah, Krishnan Aniruddhan, Alpha Anthony, Aaron Anthony-Pillai, Philip Antill, Zhelyazkova Antonina, Varghese Anu, Muhammad Anwar, Aristeidis Apostolopoulos, Sarah Appleby, Diane Appleyard, Bianca Araba, Angela Aramburo, Ann Archer, Denise Archer, Simon Archer, Christian Ardley, Ana-Maria Arias, Ryoki Arimoto, Charlotte Arkley, Charlotte Armah, Ilianna Armata, Adam Armitage, Ceri Armstrong, Maureen Armstrong, Sonia Armstrong, Philippa Armtrong, Heike Arndt, Clare Arnison-Newgass, David Arnold, Rachael Arnold, Dhawal Arora, Pardeep Arora, Rishi Arora, Arslam Arter, Ganesh Arunachalam, Rita Arya, Salma Asam, Denisa Asandei, Adeeba Asghar, Catherine Ashbrook-Raby, Helen Ashby, Jan Ashcroft, John Ashcroft, Ayesha Ashfaq, Abdul Ashish, Sally Ashman-Flavell, Sundar Ashok, Muhammad Z Ashraf, Saima Ashraf, Mohammad B Ashraq, Deborah Ashton, Susan Ashton, Andrew Ashworth, Rebecca Ashworth, Harshini Asogan, Julia Asplin, Atif Asrar, Omar Assaf, Raine Astin-Chamberlain, Deborah Athorne, Christopher Atkins, Stacey Atkins, John Atkinson, Vicki Atkinson, Ahmed Attiq, Paula Aubrey, Suzannah August, Aye CT Aung, Hnin Aung, Kyaw Thu Aung, Nini Aung, Zaw Myo Aung, Emily Austin, Karen Austin, Miriam Avery, Joanne Avis, Cristina Avram, Paula Avram, Gabriel Awadzi, Aszad Aya, Eman Ayaz, Amanda Ayers, Vivek Ayra, Jawwad Azam, Mohammed Azharuddin, Ghazala Aziz, Ashaari Azman Shah, Giada Azzopardi, Hocine Azzoug, Nasaruilla Babajan, Fiyinfoluwa Babatunde, Melvin Babi, Babiker Babiker, Gayna Babington, Matthew Babirecki, Adetona O Babs-Osibodu, Gina Bacon, Jenny Bacon, Bibi Badal, Gurpreet R Badhan, Shreya Badhrinarayanan, Joseph Bae, Alice Baggaley, Amy Baggott, Graham Bagley, Dinesh Bagmane, Kasra Bahadori, Gayathri Baijiu, Charles Bailey, Julie Bailey, Katie Bailey, Lindsey Bailey, Liz Bailey, Morgan Bailey, Peter Bailey, Hamish Baillie, Kenneth Baillie, Jennifer Bain, Karen Bain, Becky Bainton, David Baird, Yolanda Baird, Aiysha Bajandouh, Evelyn Baker, Johanne Baker, Kenneth Baker, Pearl Baker, Hugh Bakere, Nawar Bakerly, Michelle Baker-Moffatt, Panos Bakoulas, Abhijit Bal, Niranjan Balachandran, Irvin Balagosa, Andrea Balan, Theodosios Balaskas, Madhu Balasubramaniam, Alison Balcombe, Cheryl Baldwick, Alexander Baldwin, Ashley Baldwin, Danielle Baldwin, Lisa Baldwin, Rebekah Baldwin-Jones, James Balfour, Ceri Ball, Craig Balmforth, Gabby Bambridge, Alasdair Bamford, Amy Bamford, Peter Bamford, Adefunke Bamgboye, Kasun Bamunuarachchi, Elizabeth Bancroft, Hollie Bancroft, Joyce Banda, Srini Bandi, Nageswar Bandla, Somaditya Bandyopadhyam, Ritwik Banerjee, Sandip Banerjee, Harrison Banks, Luke Banks, Daniel Banner, Oliver Bannister, Christopher Bannon, Laura Banton, Mariamma Baptist, Tanya Baqai, Ananya M Baral, Desislava Baramova, Russell Barber, Emma Barbon, Monica Barbosa, Jamie Barbour, Alexander Barclay, Charlotte Barclay, Stephanie Bareford, Shahedal Bari, Amy Barker, Debbie Barker, Joseph B Barker, Leon Barker, Oliver Barker, Kerry Barker-Williams, Sinha Barkha, Juliana Barla, Gavin Barlow, Richard Barlow, James Barnacle, Alex Barnard, Debi Barnes, Nicky Barnes, Amy Barnett, Debra Barnett, Ashton Barnett-Vanes, William Barnsley, Andrew Barr, David Barr, Shaney Barratt, Manuella Barrera, Fiona Barrett, Jessica Barrett, Jazz Bartholomew, Sarah Bartholomew, Claire Bartlett, Georgina Bartlett, Greg Barton, Jill Barton, Rachael Barton, Rosaleen Baruah, Sonia Baryschpolec, Archana Bashyal, Betsy Basker, Ayten Basoglu, Amira Bassaly, G Bassett, Bengisu Bassoy, Anupam Basumatary, Adam Bataineh, Freddie Batalla, Tristan Bate, Harry John Bateman, Kathryn Bateman, Vhairi Bateman, Eleanor Bates, Hayley Bates, Michelle Bates, Rizvan Batha, Sally Batham, Ana Batista, Amit Batla, Dushyant Batra, Harry Batty, Thomas Batty, Miranda Baum, Carina Bautista, Fatima S Bawani, Simon Bax, Matt Baxter, Nicola Baxter, 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Jamie Ford, Jennifer Foreman, Caroline Fornolles, Adam Forrest, Ellie Forsey, Thomas Forshall, Elliot Forster, Julian Forton, Emily Foster, Joseph Foster, Rachel A Foster, Tracy Foster, Angela Foulds, Ian Foulds, Folakemi Fowe, Emily Fowler, Robert Fowler, Stephen Fowler, Caroline Fox, Claire Fox, Heather Fox, Jonathan Fox, Lauren Fox, Natalie Fox, Simon Fox, Sarah-Jane Foxton, Rebecca Frake, Alex Francioni, Olesya Francis, Rebecca Francis, Sarah Francis, Theodora Francis-Bacon, Victoria Francois, Sharon Frayling, Martyn Fredlund, Michael Freeborn, Carol Freeman, Elaine Freeman, Hannah Freeman, Nicola Freeman, Clare Freer, Eleanor French, Anastasia Fries, Matthew Frise, Renate Fromson, Claire Froneman, John Frost, Victoria Frost, Rachel Frowd, Arun Fryatt, Bridget Fuller, Elizabeth Fuller, Tracy Fuller, Duncan Fullerton, Sarah Funnell, John Furness, Hassina Furreed, Waqas Gaba, Elizabeth Gabbitas, Claire Gabriel, Joshua Gahir, Katarzyna Gajewska-Knapik, Christopher Gale, Hugo Gale, Swetha Gali, Bernadette Gallagher, Edith Gallagher, Jude Gallagher, William Gallagher, Catherine Galloway, Emma Galloway, Jacqui Galloway, James Galloway, Laura Gamble, Liz Gamble, Brian Gammon, Jaikumar Ganapathi, Ramesh Ganapathy, Kaminiben Gandhi, Sarah Gandhi, Usha Ganesh, Abrar Gani, Iris Garcia Deniz, Antoni D Gardener, Danielle Gardiner, Emma Gardiner, Kirsty Gardiner, Siobhan Gardiner, Caroline Gardiner-Hill, Jonathan Gardner, Mark Garfield, Atul Garg, Nathan Garlick, Lucie Garner, Zoe Garner, Rosaline Garr, Mark Garton, Florence Garty, Rachel Gascoyne, Hyeriju Gashau, Aoife Gatenby, Erin Gaughan, Alok Gaurav, Mariana Gavrila, Jane Gaylard, Emma Gaywood, Catherine Geddie, Sarah Gee, Gemma Genato, Neil Gent, Susan Gent, Natalie Geoghegan, Nithin George, Sam George, Tina George, Simon Georges, Domonique Georgiou, Leigh Gerdes, Louise Germain, Helen Gerrish, Abel Getachew, Hisham Ghanayem, Auns Ghazanfar, Anca Gherman, Alison Ghosh, Arjun Ghosh, Justin Ghosh, Sudhamay Ghosh, Sarra 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Julia Greig, Rebecca Grenfell, Teena Grenier, Susan Grevatt, Glaxy Grey, Andrew Gribbin, Ben Griffin, Denise Griffin, Mel Griffin, Sian Griffith, Andrew Griffiths, Daniel Griffiths, David Griffiths, Donna Griffiths, Isabel Griffiths, Nicola Griffiths, Oliver Griffiths, Sofia Grigoriadou, Steph Grigsby, Russell Gritton, Evelina Grobovaite, Clarissa Grondin, Rachel Groome, Liliana Grosu, Jenny Grounds, Jayne Groves, Neil Grubb, Julie Grundy, Francesca Guarino, Sharada Gudur, Shivang Gulati, Vikas Gulia, Pumali Gunasekera, Kirun Gunganah, Jessica Gunn, Emma Gunter, Alok Gupta, Atul Gupta, Rajeev Gupta, Richa Gupta, Tarun Gupta, Vineet Gupta, Ankur Gupta-Wright, Sambasivarao Gurram, Ishy Gurung, Shraddha Gurung, Hazel Guth, Ruth Habibi, Pamela Hackney, Christian Hacon, Aiman Haddad, Denise Hadfield, Michalis Hadjiandreou, Anna Haestier, Nauman Hafiz, Rana Hafiz-Ur-Rehman, Samantha Hagan, Jack W Hague, Rosemary Hague, Andrew Haigh, Kate Haigh, Christina Haines, Scott Hainey, Morton Hair, Brigid Hairsine, Juraj Hajnik, Anne Haldeos, Carmel Halevy, William Halford, Alistair Hall, Anthony Hall, Chloe Hall, Claire Hall, Emily Hall, Helen Hall, Jennifer Hall, Kathryn Hall, Toni Hall, Jan Hallas, Kyle Hallas, Charles Hallett, Heather Halls, Maryam Hamdollah-Zadeh, Bilal Hameed, Imran Hamid, Mohamad Hamie, Bethany Hamilton, Fergus Hamilton, Leigh Hamilton, Ruth Hamlin, Eleanor Hamlyn, Shirley Hammersley, Kate Hammerton, Bev Hammond, Leah Hammond, Rachel Hammond-Hall, Fiona Hammonds, Nidal Hammoud, Ibrahim Hamoodi, Karen Hampshire, Jude Hampson, Shi Han Lee, Ozan Hanci, James Hand, Soran Handrean, Georgina Hands, Sheharyar Hanif, Amy Hannington, Merhej Hannun, Aidan Hanrath, Jane Hanson, Kathryn Hanson, Mazhar U Haq, Ala Haqiqi, Monjurul Haque, Zoe Harding, Simon Hardman, Kumar Haresh, Rachel Harford, Beverley Hargadon, Carolyn Hargreaves, James Hargreaves, Alice Harin, Mohammed Haris, Helen Harizaj, Edward Harlock, Paula Harman, Tracy Harman, Mark Harmer, Muhammad A Haroon, Charlie H Harper, Heather Harper, Peter Harper, Rosemary Harper, Sarah Harrhy, Sian Harrington, Yasmin Harrington-Davies, Claire Harris, Jade Harris, Julie Harris, Laura Harris, Marie-Clare Harris, Nichola Harris, David Harrison, Laura Harrison, Melanie Harrison, Rowan Harrison, Susie Harrison, Tom Harrison, Wendy Harrison, Elizabeth Harrod, Ciaran Hart, Dominic Hart, Rosemary Hartley, Ruth Hartley, Tom Hartley, William Hartrey, Hans Hartung, Alice Harvey, Angela Harvey, Max Harvey, Catherine Harwood, Helen Harwood, Neda Hasan, Brigitte Haselden, Mohammed Hashimm, Imranullah Hashmi, Zena Haslam, Abdulhakim Hassan, Adil Hassan, Ali Hassan, Waqar Ul Hassan, Philip Hassell, Alex Hastings, Bethany Hastings, Jonathan Hatton, Jennifer Haugh, May Havinden-Williams, Stefan Havlik, Dan Hawcutt, Liz Hawes, Nicola Hawes, Annie Hawkins, Nancy Hawkins, Daniel Hawley, Edward Haworth, Cathy Hay, Jamal Hayat, Anne Hayes, Melony Hayes, Fiona Hayes, Antara Hayman, Melanie Hayman, Matthew Haynes, Richard Haynes, Rachel Hayre, Patrick Haywood, Tracy Hazelton, Phoebe Hazenberg, Zhengmai He, Elizabeth Headon, Carrie Heal, Brendan Healy, Amy Hearn, Angela Heath, Rowan Heath, Diane Heaton, Kerry Hebbron, Neil Hedger, Katrine Hedges, Cheryl Heeley, Elaine Heeney, Rajdeep Heire, David Helm, Ulla Hemmila, Scott Hemphill, Deborah Hemsley, Alistair Henderson, Jennifer Henderson, Steven Henderson, Joanne Henry, Karol Henry, Lavinia Henry, Margo Henry, David Henshall, Gillian Herdman, Rosaleen Herdmangrant, William Herrington, Emilia Heselden, Peta Heslop, Simon Hester, Emily Hetherington, Joseph Hetherington, Andrew Hetreed, Chamila Hettiarachchi, Gihan Hettiarachchi, Hayley Hewer, John Hewertson, Anna Hewetson, Sue Hewins, Claire Hewitt, Davina Hewitt, Richard Hewitt, Robert S Heyderman, Matthis Heydtmann, Joseph Heys, Jonathan Heywood, Meg Hibbert, Naomi Hickey, Alexander Hicks, Jenny Hicks, Scott R Hicks, Daniel Higbee, Jennifer Higgins, Lucy Higgins, Andrew Higham, Martin Highcock, Judith Highgate, Mondy Hikmat, Amanda Hill, Helen Hill, Joanne Hill, Phoebe Hill, Annette Hilldrith, Catherine Hillman-Cooper, Zoe Hilton, Alice Hindmarsh, Paul Hine, Kim Hinshaw, Clare Hird, Jemma Hives, Benson Ho, David Hobden, Gill Hobden, Maria Hobrok, Simon Hobson, Simon Hodge, Lesley Hodgen, Holly Hodgkins, Sally Hodgkinson, David Hodgson, Helen Hodgson, Luke Hodgson, Sheila Hodgson, Gemma Hodkinson, Kenneth Hodson, Matthew Hogben, Lucy Hogg, Lee Hoggett, Abigail Holborow, Becky Holbrook, Catherine Holbrook, Catherine Holden, Jill Holden, Melinda Holden, Thomas Holder, Hannah Holdsworth, Lisa Holland, Maureen Holland, Nicky Holland, Marie Hollands, Elizabeth Holliday, Nina Holling, Nigel Hollister, Laszlo Hollos, Evelyn Holmes, Megan Holmes, Raphael Holmes, Rebecca Holmes, Kelly Holroyd, Lyndsey Holt, Siobhan Holt, Alexandra Holyome, Marie Home, Kate Hong, Andrew Hood, Clare Hooper, Samantha Hope, Susan Hope, Bridget Hopkins, Peter W Horby, Stephanie Horler, Anil Hormis, Rachel Horn, Nicola Hornby, Sophie Horrocks, Latoya Horsford, Megan Horsford, Valana Horsham, Alex Horsley, Ashley Horsley, Elizabeth Horsley, Sarah Horton, Jane Hosea, Toby Hoskins, Ejaz Hossain, Muhammad S Hossain, Rashed Hossain, Maxine Hough, Sarah Hough, Kathryn Houghton, Rebecca Houlihan, Gordon Houston, Hamish Houston, Eleanor Hoverd, Roseanna Hovvels, Lee How, Laura Howaniec, Laura Howard, Linda Howard, Lucy Howard, Sarah Howard, Richard Howard-Griffin, Serena Howe, Mark Howells, Lyn Howie, Alex Howlett, Sophie Howlett, Josh Hrycaiczuk, Desmond Hsu, Hein Htet, Zaw Htet, Naing Z Htoon, Su Htwe, Ying Hu, Abby Huckle, Shahzya Huda, Alison Hudak, Lisa Hudig, Heather Hudson, Alison Hufton, Conor Huggins, Alistair Hughes, Emma Hughes, Gareth Hughes, Heather Hughes, Luke Hughes, Rachel Hughes, Rhian Hughes, Samantha Hughes, Stephen Hughes, Vikki Hughes, Wesley Hughes, Lukas Huhn, Ching Hui, Ruth Hulbert, Diana Hull, Robert Hull, Amanda Hulme, Peter Hulme, Wendy Hulse, George Hulston, Ryan Hum, Charlotte Humphrey, Alasdair Humphries, Joanne Humphries, David Hunt, Fiona Hunt, Jane Hunt, Kristen Hunt, Luke Hunt, Karl Hunter, Neil Hunter, Elizabeth Hurditch, Cian Hurley, Katrina Hurley, Mohammed A Husain, Syeda Y Husaini, Coralie Huson, Ibraar Hussain, Mohammad Hussain, Muhammad Hussain, Reda Hussain, Sajid Hussain, Samia Hussain, Sanniah Hussain, Yasmin Hussain, Mohammed Hussam El-Din, Rebecca Hussey, Christopher Hutchcroft, Camille Hutchinson, Dorothy Hutchinson, Elizabeth Hutchinson, John Hutchinson, Claire Hutsby, Paula Hutton, Daniella Hydes, Jamie Hyde-Wyatt, Niamh Hynes, Megan Hyslop, Ahmed Ibrahim, Asil Ibrahim, Kamal Ibrahim, Mohamed Ibrahim, Wadah Ibrahim, Muhammad Idrees, Hina Iftikhar, Chukwuemeka Igwe, Mohammad Ijaz, Amaju Ikomi, Clare Iles, Stamatina Iliodromiti, Lorna Ilves, La'ali Imam-Gutierrez, Christopher Imray, Haider Imtiaz, Jack Ingham, Julie Ingham, Rory Ingham, Tejas Ingle, Anne Ingram, Luke Ingram, Peter Inns, Ken Inweregbu, Andreea A Ionescu, Ana Ionita, Anil Ipe, Madiha Iqbal, Mohammed Iqbal, Faisal Iqbal Sait, Jane Ireland, Robert Irons, Mohannad Irshad, Muhammad S Irshad, Janice Irvine, Val Irvine, Robert Irving, Mina Ishak, Aminul Islam, Munim Islam, Abdurrahman Islim, Ali Ismail, Omar Ismail, M'hamedi Israa, Sharon Isralls, Shabana Issa, Monica Ivan, Chineze Ivenso, Ashleigh Ivy, Sophie Iwanikiw, Karen Ixer, Mia Iyer, Sriram Iyer, Alex Jackson, Amanda Jackson, Ben Jackson, Ella Jackson, Helen Jackson, Lauren Jackson, Melanie Jackson, Nicola Jackson, Shane Jackson, Patricia Jacob, Reni Jacob, Nicola Jacques, Anisa Jafar, Ali Jaffery, Vijay Jagannathan, Mandeep Jagpal, Fernandez R Jaime, Neemisha Jain, Seema Jain, Susan Jain, Sanjay Jaiswal, Danyal Jajbhay, Thomas Jaki, Bintou Jallow, Yusuf Jaly, Sabine Jamal, Yasmin Jameel, Albie James, Anneli James, Linda James, Mark James, Nicholas James, Olivia James, Ruth James, Tracy James, Jack Jameson, Eleana Jamieson, Aaron Jamison, Phoebe Jane, Azara Janmohamed, Lauren Jansen, Sabrina Jansz, Deepa Japp, Catherine Jardine, Ellie Jarvie, Rosina Jarvis, Patrycja Jastrzebska, Hafsa Javed, Lona Jawaheer, Dinakaran Jayachandran, Deepak Jayaram, Geeshath Jayasekera, Lalith Jayasekera, Saman Jeddi, Mohammad S Jeelani, Katie Jeffery, Rachel Jeffrey, Nathan Jeffreys, Benjamin Jeffs, Debbie Jegede, Taylor Jemima, Ifan Jenkin, Alison Jenkins, David Jenkins, Elinor Jenkins, Sarah Jenkins, Sian Jenkins, Stephen Jenkins, Edward Jenner, David Jennings, Jacqui Jennings, Louise Jennings, Virginia Jennings, Ellen Jerome, Douglas Jerry, Ellen Jessup-Dunton, Jorge A Jesus Silva, Kishan Jethwa, Abi Jeyabalan, Akhilesh Jha, Shaman Jhanji, Khoo Jian, Zhixin Jiao, Ana Jimenez Gil, Jithin Jith, Teishel Joefield, Navraj Johal, Karine Johannessen, Aisyah Johari, Annie John, Anu John, Emma Johns, Margaret Johns, Antoinette Johnson, Gillian Johnson, Kathryn Johnson, Luke Johnson, Mark Johnson, Claire Johnston, Janet Johnston, Susan Johnston, Victoria Johnston, Dawn Johnstone, Ed Johnstone, Janet Johnstone, Manohar Joishy, Adam Jones, Annabel Jones, Bryony Jones, Chrissie E Jones, Carys Jones, Charlotte Jones, Gareth Jones, Geraldine Jones, Jac Jones, James Jones, Julie Jones, June Jones, Kate E Jones, Laura Jones, Laura M Jones, Louise Jones, Mathew Jones, Nicola Jones, Paul Jones, Prudence Jones, Quentin Jones, Samantha Jones, Sophie Jones, Steve Jones, Taya Jones, Tim Jones, Tracey Jones, Ramya Jonnalagadda, Rebecca Jordache, Sara Jorgensen, Sanal Jose, Anna Joseph, Rosane Joseph, Sibet Joseph, Mehul Joshi, Pratichi Joshi, Benz Josiah, Tiffany Joyce, Martin Juan, Edward Jude, Parminder Judge, Jessica Juhl, Sirisha Jujjavarapu, Julie Julie Melville, Edmund Juszczak, Deepthi Jyothish, Kasamu Kabiru Dawa, Mark Kacar, Gail Kakoullis, Azad Kala Bhushan, Richard J Kalayi, Roobala Kaliannan Periyasami, Seika Kalsoom, Elisa Kam, Mohamed Kamara, Ajay Kamath, Prakash Kamath, Siddharth A Kamerkar, Nick Kametas, Musaiwale Kamfose, Amin Kanish, Osei Kankam, Thogulava Kannan, Abhinav Kant, Zoe Kantor, Ritoo Kapoor, Sonal Kapoor, Nicholas Karunaratne, Sobia Kashif, Natashja Kasianczuk, Vidya Kasipandian, Jamila Kassam, Xenophon Kassianides, Victoria Katsande, Kulbinder Kaul, Daljit Kaur, Dervinder Kaur, Jasmin Kaur, Jaspreet Kaur, Zunaira Kausar, Mohammad AA Kawser, Andrea Kay, Sarah Kay, Jossy N Kayappurathu, Callum Kaye, Nichola Kearsley, Joanne Keating, John Keating, Liza Keating, Elizabeth Keddie-Gray, Natalie Keenan, Jonathan Kefas, Stephen Kegg, Iain Keith, Chloe Keith-Jopp, Joanne Kellett, Alison Kelly, Diane Kelly, Dominic Kelly, Emma Kelly, Laura Kelly, Martin Kelly, Michael Kelly, Rosalind Kelly, Sinead Kelly, Stephen Kelly, Mary Kelly-Baxter, Marketa Keltos, Timothy Kemp, Alexandra Kendall-Smith, Sarah Kennard, Ann Kennedy, James Kennedy, Sophie Kennedy-Hay, Julia Kenny, Melanie Kent, Lynne Keogan, Alexander Keough, Andrew Kerr, Caroline Kerrison, Anthony Kerry, Helen Kerss, Jocelyn Keshet-Price, Georgina Keyte, Abdul Khadar, Ali Khalid, Muhammad U Khalid, Amir Khalil, Asma Khalil, Sijjad Khalil, Ali Khan, Al-Imran Khan, Asad Khan, Burhan Khan, Fatimah Khan, Kausik Khan, Lubna Khan, Malik A Khan, Marria Khan, Mohammad Khan, Mohammed R Khan, Nayeem Khan, Omar Khan, Rahila Khan, Shabana Khan, Shahul Khan, Tasaduksultan Khan, Waseem Khan, Usman F Khatana, Jibran Khatri, Jyoti Khatri, Sagira Khatun, Taslima Khatun, Chuen R Khaw, Htet HE Khin, Kiran Khokhar, Najaf Khota, Chloe Khurana, Shruti Khurana, Faith Kibutu, Andrew Kidd, Michelle Kidd, Joe Kidney, Shane Kidney, Will Kieffer, Caroline Kilby, Eliz Kilich, Jee Whang Kim, Sarah Kimber, Andy King, Barbara King, Jennifer King, Kirsten King, Rachel King, Sam King, Victoria King, Emily King-Oakley, Laura Kingsmore, Fiona Kinney, Jeremy Kirk, Amy Kirkby, Emily Kirkham, Gemma Kirkman, Ursula Kirwan, Toby Kitching, Laura Kitto, Lauren Kittridge, Sarah Klaczek, Susan Kmachia, Christopher Knapp, Lucy Knibbs, Alicia Knight, Fraser Knight, Marian Knight, Sarah Knight, Steven Knight, Tom Knight, Ellen Knights, Martin Knolle, Carol Knott, Karen Knowles, Laurence Knowles, Emily Knox, Lucy Knox, Oliver Koch, Ronan Kodituwakku, Gouri Koduri, Eirene Kolakaluri, Magdalena Kolodziej, Eirini Kolokouri, Samantha Kon, Mari Kononen, Athanasios Konstantinidis, Imogen Koopmans, Laura Korcierz, James Korolewicz, George Koshy, Chris Kosmidis, Jalpa Kotecha, Easwari Kothandaraman, Rukhsana Kousar, Margarita Kousteni, Alex Kozak Eskenazia, Kestutis Krasauskas, Zuzana Krejcarova, Raghu Krishnamurthy, Manju Krishnan, Suzanne Krizak, Sean Krupej, Agnieszka Kubisz-Pudelko, Soren Kudsk-Iversen, Aurimas Kudzinskas, Chirag Kukadiya, Nainesha Kulkarni, Aditi Kumar, Ramesh Kumar, Ravi Kumar, Rita Kumar, Ritesh Kumar, Rupa Kumar, Satish Kumar, Vimal Kumar, Arun Kundu, Heinke Kunst, Amit Kurani, Mohammed Kurdy, Vimal Kurmars, Cameron Kuronen-Stewart, Ranganai S Kusangaya, Vlad Kushakovsky, Apexa Kuverji, Adriel JW Kwek, Amma Kyei-Mensah, Thyra Kyere-Diabour, Lynsey Kyeremeh, Moe Kyi, Nyan M Kyi, Laura Kyle, Stuart Kyle, Karali-Tsilimpari Kyriaki, Julius Labao, Louise Lacey, Nikki Lack, Emma Ladlow, Heather Lafferty, Shondipon Laha, Sushil Lahane, Clement Lai, James Lai, Robert Laing, Inez Laing-Faiers, Emily Laity, Nicki Lakeman, David Lalloo, Fiona Lalloo, Sarah-Jane Lam, Fiona Lamb, Thomas Lamb, Pauline Lambert, Claudia Lameirinhas, Mohammed KG Lami, Michal Lamparski, Christine Lanaghan, Geraldine Landers, Martin J Landray, Matthew Lane, Nicholas Lane, Matilda Lang, Stephen Lang, Daniel Langer, Maggie Langley, Charles Langoya, Emily Langthorne, Helen Langton, Scott Latham, John Latham-Mollart, Afzal Latheef, Nang Latt, Dawn Lau, Eva Lau, Myra Laurenson, Hou Law, Jessica Law, Penny Law, Richard Law, Emma Lawrence, Ryan Lawrie, Michael Lay, Stephen Laybourne, Christine Laycock, Reina Layug, Maria Lazo, Amelia Lea, William Lea, Ian Leadbitter, Samuel Leafe, Thomas Leahy, Richard Lean, Lorna Leandro, Darren Leaning, Todd Leckie, Marie Anne Ledingham, Emma Lee, Hannah 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MacDonald, Sheila MacFadyen, James G MacFarlane, Jill Macfarlane, Laura Macfarlane, Lisa MacInnes, Jill MacIntyre, Kirsten Mack, Callum Mackay, Euan Mackay, Alexander Mackenzie, Matt Mackenzie, Robert MacKenzie Ross, Ami Mackey, Fiona Mackie, Robert Mackie, Carolyn Mackinlay, Claire Mackintosh, Katherine Mackintosh, Colin MacLeod, Mary J MacLeod, Michael Macmahon, Andrew MacNair, Catherine Macphee, Iain Macpherson, Allan MacRaild, Alannah Madden, Mary Madden, Norman Madeja, Paula Madgwick, Madhavi Madhusudhana, Alpha Madu, Lorraine Madziva, Marion Mafham, Emma Magavern, Negar Maghsoodi, Christopher Magier, Marios Magriplis, Natasha Mahabir, Subramanian Mahadevan-Bava, Anjanie Maharajh, Ajit Mahaveer, Bal Mahay, Hibo Mahdi, Thushika Mahendiran, Siva Mahendran, Sarah Maher, Shameera Maheswaran, Parisa Mahjoob-Afag, Ahmed Mahmood, Farhana Mahmood, Hager Mahmoud, Mian Mahmood, Waheed Mahmood, Ewan Mahony, Luke Mair, James Maitland, Rupert Major, Jaydip Majumdar, Mohammad KH Majumder, Stephen Makin, Marius Malanca, Hannah Malcolm, Neeraj Malhan, Gulshan Malik, Mohammed Maljk, Petrina Mallinder, Louise Mallon, Edward Malone, Gracie Maloney, Madhu Mamman, Irene Man, Marco Mancuso-Marcello, Aritri Mandal, Tracy Manders, Lauren Manderson, Justin Mandeville, Roope Manhas, Carmen Maniero, Bobby Mann, Baranitharan Manoharan, Katherine Mansi, Dina Mansour, Isheunesu T Mapfunde, Predeesh Mappa, Hemant Maraj, Gemma Marayan, Clare Marchand, Neil Marcus, Maria Marecka, Gomathi Margabanthu, Jordi Margalef, Lavinia Margarit, Georgios Margaritopoulos, Mike Margarson, Fernandez M Maria del Rocio, Victor Mariano, Ashleigh Maric, Arran Marriott, Nemonie Marriott, Karen Marsden, Paul Marsden, Tracy Marsden, Robyn Marsh, Adam Marshall, Andrew Marshall, Gail Marshall, Henry Marshall, Jaimie Marshall, Jenna Marshall, Nicola Marshall, Emmeline Martin, Hayley Martin, Hope Martin, Jane Martin, Karen Martin, Laila Martin, Michael Martin, Sarah Martin, Winston Martin, Tim Martindale, Marcus 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Thozthumparambil, Laura Thrasyvoulou, Hannah Thraves, Guy Thwaites, Simon Tiberi, Serena Tieger, Carey Tierney, Caroline Tierney, Mark Tighe, Sorrell Tilbey, Amanda Tiller, Elizabeth Timlick, Hayley Timms, Anne-Marie Timoroksa, Samakomva Tinashe, Heather Tinkler, Marianne Tinkler, Jacqui Tipper, Sophie Tisi, Helen Tivenan, Suzy Tluk, Helen T-Michael, Anne Todd, Jackie Todd, Stacy Todd, Mohamed Tohfa, Melanie Tolson, Ana L Tomas, Natalia Tomasova, Sharon Tomlin, Simon Tomlins, Ivan Tonna, Kirsty Topham, Mathew Topping, Parisa Torabi, M Estee Torok, Mark Toshner, Ruhaif Tousis, Peter Tovey, Gareth Towersey, Jill Townley, Richard Tozer, Myat T Trafford, Helen Tranter, Christopher Travill, Sarah Traynor, Ascanio Tridente, Sanchia Triggs, Fiona Trim, Alex Trimmings, Tom Trinick, Maria Tripouki, Ashifa Trivedi, Dawn Trodd, Amy Trotter, Madeleine Trowsdale Stannard, Nigel Trudgill, Daniel Trushell-Pottinger, Maria Truslove, Shaun Trussell, Tariq Trussell, Kyriaki Tsakiridou, Christine Tsang, Peter Tsang, Kyriaki K Tsilimpari, Georgios Tsinaslanidis, Simon Tso, Sally Tucker, Aisha Tufail, Redmond Tully, Killian Turbitt, Rezon Turel, Tolga Turgut, Claudia Turley, Alison Turnbull, Aine Turner, Ash Turner, Charlotte Turner, Gail Turner, Kate Turner, Kelly Turner, Lucy Turner, Mark Turner, Patricia Turner, Sally Turner, Samantha Turner, Victoria Turner, Sharon Turney, Jon Turvey, Emma Twohey, Bhavya Tyagi, Vedang Tyagi, Abigail Tyer, Jayne Tyler, Jennifer Tyler, Alison Tyzack, Petros Tzavaras, Mohammad S Uddin, Ruhama Uddin, Salamat Ullah, Sanda Ullah, Athavan Umaipalan, Judith Umeadi, Akudo Umeh, Wilfred Umeojiako, Lizzie Undrell, Adam Unsworth, Veerpal SU Uppal, Gerry Upson, Alison Uriel, Sebastian Urruela, Hiromi Uru, Miranda Usher, Rebecca Usher, Andrew Ustianowski, Linda C Vaccari, Abhay Vaidya, Erika Vainieri, Bernardas Valecka, Jennifer Valentine, Balan Valeria, Luke Vamplew, Ekaterini Vamvakiti, Joannis Vamvakopoulos, Maud van de Venne, Alex van der Meer, Nora van der Stelt, Lynne Van Koutrik, Joseph Vance-Daniel, Rama Vancheeswaran, Samuel I Vandeyoon, Padma Vankayalapati, Chloe Vansomeren, William Van't Hoff, Sejal Vara, Anu Varghese, Maria Varghese, Teena Varghese, William Varney, Giulia Varnier, Valeria Vasadi, Vimal Vasu, Vasanthi Vasudevan, Ramu Vathenen, Manu Vatish, Heloyes Vayalaman, Christopher Vaz, Niki Veale, Bar Velan, Swati Velankar, Luxmi Velauthar, Neyme Veli, Nicola Vella, Anitha Velusamy, Ian Venables, Mavi Venditti, Ramya Venkataramakrishnan, Richard Venn, Robert Venn, Lyn Ventilacion, Mark Veres, Stefania Vergnano, Will Verling, Amit Verma, Britney Vernon, Nathan Vernon, Mark Vertue, Natalie Vethanayagam, Lucy Veys, Jennifer Vidler, Denise Vigni, Vinod W Vijayaraghavan Nalini, Enric Vilar, Neringa Vilimiene, Joseph Villiers, Sylvia Vinay, Latha Vinayakarao, Rachel Vincent, Rosie Vincent, Lisa Vincent Smith, Emma Virgilio, Abdullah M Virk, Elisa Visentin, Karunakaran Vithian, Alain Vuylsteke, Eleftheria Vyras, Richard Wach, Beverley Wadams, Susan Wadd, Natalia Waddington, Kirsten Wadsworth, Syed EI Wafa, Daniel Wagstaff, Lynda Wagstaff, Dalia Wahab, Zaroug Wahbi, Khalilullah Wahdati, Sawan Waidyanatha, Rachel Wake, Alice Wakefield, Emma Wakefield, Harry Wakefield, William Wakeford, Fiona Wakinshaw, Andrew Walden, Lorna Walding, Claire Walker, Ian Walker, Kevin Walker, Kim Walker, Linda Walker, Marie Walker, Rachel Walker, Susan Walker, Elaine Wall, Rebecca Wallbutton, Jessica Wallen, Karl Wallendszus, Arabella Waller, Michael Waller, Rosemary Waller, Gabriel Wallis, Louise Wallis, Donna Walsh, Elizabeth Walsh, Lani Walshaw, Daniel Walter, Holt Walters, Jocelyn Walters, Eileen Walton, Maggie Walton, Michael Walton, Olivia Walton, Susan Walton, Mandy Wan, Thin Wan, Mary Wands, Rachel Wane, Frank Wang, Nick Wang, Ran Wang, Deborah Warbrick, Samantha Warburton, Deborah Ward, Emma Ward, Katie Ward, Luke Ward, Rachael Ward, Thomas Ward, Scott A Warden, Steve Wardle, Hassan Wardy, Tobias Wareham, Scott Waring, Jenny Warmington, Ben Warner, Christian Warner, Lewis Warnock, Sarah Warran, Lisa Warren, Yolanda Warren, Hannah Warren-Miell, Hazel J Watchorn, Holly Waterfall, Abby Waters, Donald Waters, Mark Waterstone, Catherine Watkins, Catrin Watkins, Eleanor Watkins, Karen Watkins, Lynn Watkins, Adam JR Watson, Ekaterina Watson, Eleanor Watson, Paul Watson, Robert Watson, Malcolm Watters, Donna Watterson, Daniel Watts, John Watts, Merlin Watts, Victoria Waugh, Emma Wayman, Akhlaq Wazir, Nick Weatherly, Hayley Webb, Kathryn Webb, Stephen Webb, Ian Webster, Tim Webster, Ling Wee, Thanuja Weerasinghe, Janaka Weeratunga, Maria Weetman, Shuying Wei, Freshtah Weidi, Hugh Welch, James Welch, Leanne Welch, Steven Welch, Samantha Weller, Claire Wells, Susan Wellstead, Berni Welsh, RIchard Welsh, Ingeborg Welters, Rachael Welton, Lauren Wentworth, Kate Wesseldine, Magdelena West, Raha West, Ruth West, Sophie West, Heather Weston, Alice Westwood, Bill Wetherall, Helen Wheeler, Matthew Whelband, Amanda Whileman, Jenny Whitbread, Benjamin White, Catherine White, Christopher White, Duncan White, James White, Jonathan White, Katie White, Marie White, Nick White, Sarah White, Sonia White, Tracey White, Catherine Whitehead, Anne Whitehouse, Claire Whitehouse, Tony Whitehouse, Sophie Whiteley, Gabriel Whitlingum, Elizabeth Whittaker, Lindsay Whittam, Ashley Whittington, Helen Whittle, Eunice Wiafe, Lou Wiblin, John Widdrington, Jason Wieboldt, Hannah Wieringa, Cornelia Wiesender, Laura Wiffen, Andrew Wight, Christopher Wignall, Danielle Wilcock, Emma Wilcock, Louise Wilcox, Karen Wild, Laura Wild, Stephen Wild, Michael Wilde, Peter Wilding, Tracey Wildsmith, Joe Wileman, Joy Wiles, Kate Wiles, Elva Wilhelmsen, Thomas Wiliams, David Wilkin, Hannah Wilkins, Joy Wilkins, Suzanne Wilkins, Iain Wilkinson, Lesley Wilkinson, Nicola Wilkinson, Sophia Wilkinson, Susan Wilkinson, Tim Wilkinson, Sylvia Willetts, Alexandra Williams, Alison Williams, Angharad Williams, Ava Williams, Carl Williams, Caroline V Williams, Claire Williams, Dewi Williams, Felicity Williams, Gail Williams, Hannah Williams, James Williams, Jennie Williams, John Williams, Joseph JR Williams, Karen Williams, Kathryn Williams, Marie Williams, Matthew Williams, Patricia Williams, Penny Williams, Samson Williams, Sarah Williams, Sophie Williams, Tamanna Williams, Annie Williamson, Cath Williamson, Catherine Williamson, Dawn Williamson, James D Williamson, Elizabeth Willis, Emily Willis, Heather Willis, Herika Willis, Joanna Willis, Louise Wills, Lucy Willsher, Francesca Willson, Alison Wilson, Andrea Wilson, Antoinette Wilson, Debbie Wilson, James Wilson, Kate Wilson, Lucinda Wilson, Mark Wilson, Toni Wilson, Tim Wilson, Marlar Win, Tin T Win, Lucinda Winckworth, Laura Winder, Piers Winder, Nicola Window, Simon Winn, Carmen Winpenny, Helen Winslow, Martin Winstanley, Helen Winter, Jonathan Winter, Barbara Winter-Goodwin, Stephen Wisdom, Martin Wiselka, Sophie Wiseman, Steven Wishart, Eric Witele, Nicholas Withers, Janet Wittes, Donna Wixted, Nicola Wolff, Kirsten Wolffsohn, Rebecca Wolf-Roberts, Elena Wolodimeroff, Chi-Hung Wong, Edwin Wong, Jessica SY Wong, Kit Y Wong, Nick Wong, Sam Wong, Caroline Wood, Dianne Wood, Fiona Wood, Hannah Wood, Jennifer Wood, Joe Wood, Lisa Wood, Louise Wood, Michelle Wood, Stephen Wood, Tracy Wood, Katharine Woodall, Rebecca Woodfield, Christopher Woodford, Jill Woodford, Louise Woodhead, Timothy Woodhead, Philip Woodland, Marc Woodman, Jane Woods, Katherine Woods, Sarah Woods, Elizabeth Woodward, Zoe Woodward, Megan Woolcock, Gemma Wooldridge, Rebecca Woolf, Chris Woollard, Louisa Woollen, Emma Woolley, Jade Woolley, Daniel Woosey, Dan Wootton, Joanne Wootton, Stephy Worton, Jonathan Wraight, Lynn Wren, Caroline Wrey Brown, Demi Wright, Francesca Wright, Imogen Wright, Lianne Wright, Rachel Wright, Caroline Wroe, Henry Wu, Peishan Wu, Pensee Wu, Johnathan Wubetu, Retno Wulandari, Kim Wyness, Frederick Wyn-Griffiths, Inez Wynter, Bindhu Xavier, Zhongyang Xia, Masseh Yakubi, May Yan, Michael Yanney, Salima Yasmin, Bryan Yates, David Yates, Edward Yates, Helen Yates, Mark Yates, Charlotte Yearwood Martin, Khin Yein, Robert Yellon, Fiona Yelnoorkar, Peter Yew, Kawai Yip, Laura Ylquimiche Melly, Inez Ynter, Cissy Yong, Jemma Yorke, Abdel Younes Ibrahim, Gail Young, Louise Young, Sajeda Youssouf, Ahmed Yousuf, Chrissie Yu, Bernard Yung, Daniel Yusef, Anna-Sophia Zafar, Silvia Zagalo, Su Zaher, Kareem Zaki, Nabhan Zakir, Kasia Zalewska, Ane Zamalloa, Mohsin Zaman, Shakir Zaman, Julie Zamikula, Louise Zammit, Marie Zammit-Mangion, Ausra Zdanaviciene, Esther Zebracki, Daniel Zehnder, Lisa Zeidan, Xiaobei Zhao, Dongling Zheng, Jane Zhixin, Doreen Zhu, Madiha Zia, Omar Zibdeh, Rabia Zill-E-Huma, Ei T Zin, Vivian Zinyemba, Christos Zipitis, Arkadiusz Zmierczak, Azam Zubir, Naz Zuhra, Rasha Zulaikha, Carol Zullo, Ana Zuriaga-Alvaro, National Institute for Health Research, UK Research and Innovation, University of St Andrews. School of Medicine, Horby, PW, Roddick, A, Spata, E, Staplin, N, Emberson, JR, Pessoa-Amorim, G, Peto, L, Day, J, Thwaites, G, Mafham, M, Haynes, R, and Landray, MJ
Subjects: Male, medicine.medical_treatment, 030204 cardiovascular system & hematology, Azithromycin, ResearchInstitutes_Networks_Beacons/humanitarian_conflict_response_institute, Rate ratio, chemistry.chemical_compound, 0302 clinical medicine, RA0421, Oxygen therapy, RA0421 Public health. Hygiene. Preventive Medicine, 030212 general & internal medicine, Hospital Mortality, 11 Medical and Health Sciences, azithromycin, education.field_of_study, Covid19, clinical trial, General Medicine, 3rd-DAS, Middle Aged, Hospitalization, Survival Rate, Treatment Outcome, Humanitarian and Conflict Response Institute, Female, Life Sciences & Biomedicine, medicine.medical_specialty, RM, Population, COVID-19/drug therapy, Azithromycin/therapeutic use, 03 medical and health sciences, Pharmacotherapy, Tocilizumab, Medicine, General & Internal, SDG 3 - Good Health and Well-being, Internal medicine, General & Internal Medicine, medicine, Humans, education, Survival rate, Mechanical ventilation, Science & Technology, business.industry, COVID-19, NIS, Length of Stay, R1, United Kingdom, COVID-19 Drug Treatment, RM Therapeutics. Pharmacology, RECOVERY Collaborative Group, chemistry, Relative risk, business, RA, Anaesthesia Pain and Critical Care
Abstract: The RECOVERY trial is supported by a grant to the University of Oxford from UK Research and Innovation (Medical Research Council) and NIHR (MC_PC_19056) and by core funding provided by NIHR Oxford Biomedical Research Centre, Wellcome, the Bill & Melinda Gates Foundation, the Department for International Development, Health Data Research UK, the Medical Research Council Population Health Research Unit, the NIHR Health Protection Unit in Emerging and Zoonotic Infections, and NIHR Clinical Trials Unit Support Funding. TJ is supported by a grant from UK Medical Research Council (MC_UU_0002/14) and an NIHR Senior Research Fellowship (NIHR-SRF-2015-08-001). WSL is supported by core funding provided by NIHR Nottingham Biomedical Research Centre. Background: Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods: In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall, 561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days (rate ratio 0·97, 95% CI 0·87-1·07; p=0·50). No significant difference was seen in duration of hospital stay (median 10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 1·04, 95% CI 0·98-1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, no significant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (risk ratio 0·95, 95% CI 0·87-1·03; p=0·24). Interpretation: In patients admitted to hospital with COVID-19, azithromycin did not improve survival or other prespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restricted to patients in whom there is a clear antimicrobial indication. Publisher PDF
Published: 2021

17. Measuring management practices in primary health care facilities – development and validation of management practices scorecard in Nigeria

Author: Shunsuke Mabuchi, Yusuke Tsugawa, Sara Bennett, and Olakunle Alonge
Subjects: Performance management, media_common.quotation_subject, Psychological intervention, Primary health care, Nigeria, factor analysis, Financial management, Scarcity, 03 medical and health sciences, Performance based financing, Facility management, 0302 clinical medicine, Health facility, Nursing, health facility management, Humans, 030212 general & internal medicine, Reimbursement, Incentive, Qualitative Research, Management practices, Face validity, media_common, Medical education, Balanced scorecard, Primary Health Care, business.industry, 030503 health policy & services, Health Policy, Primary health care facilities, scorecard, Public Health, Environmental and Occupational Health, Construct validity, Reproducibility of Results, performance-based financing, Exploratory factor analysis, nigeria, Public Health and Health Services, Original Article, primary health care facilities, Business, Health Facility Administration, Public aspects of medicine, RA1-1270, Factor Analysis, Statistical, 0305 other medical science, Research Article
Abstract: Background: In low- and middle-income countries, there is no validated and reliable measurement tool to measure health facility management practices, and many interventions to improve the management and performance of primary health care (PHC) facilities are designed without an adequate evidence base on what management practices are critical and where weaknesses lie. This paper developed and validated a scorecard to measure management practices at PHC facilities in LMICs. Methods: Relevant management practice domains and indicators for PHC facilities were determined based on literature review and a prior qualitative study conducted under a performance-based financing scheme in Nigeria. The domains and indicators were tested for face validity via a consultative review with experts and organized into an interviewer-administered scorecard. A stratified random sample of PHC facilities in three States in Nigeria was conducted to assess the reliability and construct validity of the scorecard. Inter-rater reliability using inter-class correlation (ICC) (1, k) was assessed with one-way ANOVA. Exploratory factor analysis (EFA) with PROMAX rotation was conducted to assess the construct validity, and an updated factor structure were developed for the scorecard. Findings: 32 indicators and 6 broad management practice domains were initially described. Ordinal responses were derived for each indicator. Data on the scorecard were obtained from 111 PHC facilities. The ICC of mean ratings for each team of judges was 0.94. The EFA identified 6 domains and reduced the number of indicators to 17. The average communality of selected items was 0.45, and item per factor ratio was 17:6. The final 6 domains identified were A: Stakeholder engagement and communication; B: Community-level activities; C: Update of plan and target; D: Performance Management; E: Staff attention to planning, target, and performance; and F: Drugs and financial management. Interpretation: Despite a few areas that would benefit from further refinement, this paper presents a reliable and valid scorecard for measuring management practices in PHC facilities. The scorecard is applicable for routine supervisory visits to PHC facilities, and can help accumulate knowledge on facility management, how it affects performance, and how it may be strengthened in LMICs. Funding: The health results innovation trust fund (HRITF) managed by the World Bank provided generous funding to this research. The funding allowed data collection in Nigeria including the hiring of a local consulting firm to collect data. The authors have not been paid to write this article by any of the agencies. We have full access to all the data in the study and had final responsibility for the decision to submit for publication. Declaration of Interest: Dr. Mabuchi has nothing to disclose. Ethical Approval: The IRB review was exempted - moved to the NR/NHSR/NE state (IRB00006836).
Published: 2020

18. Identifying core competencies for practicing public health professionals: results from a Delphi exercise in Uttar Pradesh, India

Author: Sudip Bhandari, Brian Wahl, Sara Bennett, Cyrus Y. Engineer, Pooja Pandey, and David H. Peters
Subjects: medicine.medical_specialty, Consensus, Performance management, Program management, Health Personnel, Delphi method, India, Likert scale, Financial management, 03 medical and health sciences, Professional Competence, 0302 clinical medicine, Delphi technique, Public health competencies, Humans, Medicine, 030212 general & internal medicine, Medical education, 030505 public health, business.industry, lcsh:Public aspects of medicine, Public health, Public Health, Environmental and Occupational Health, Core competency, lcsh:RA1-1270, Workforce development, Human resource development, Public Health, 0305 other medical science, business, Research Article
Abstract: Background Ensuring the current public health workforce has appropriate competencies to fulfill essential public health functions is challenging in many low- and middle-income countries. The absence of an agreed set of core competencies to provide a basis for developing and assessing knowledge, skills, abilities, and attitudes contributes to this challenge. This study aims to identify the requisite core competencies for practicing health professionals in mid-level supervisory and program management roles to effectively perform their public health responsibilities in the resource-poor setting of Uttar Pradesh (UP), India. Methods We used a multi-step, interactive Delphi technique to develop an agreed set of public health competencies. A narrative review of core competency frameworks and key informant interviews with human resources for health experts in India were conducted to prepare an initial list of 40 competency statements in eight domains. We then organized a day-long workshop with 22 Indian public health experts and government officials, who added to and modified the initial list. A revised list of 54 competency statements was rated on a 5-point Likert scale. Aggregate statement scores were shared with the participants, who discussed the findings. Finally, the revised list was returned to participants for an additional round of ratings. The Wilcoxon matched-pairs signed-rank test was used to identify stability between steps, and consensus was defined using the percent agreement criterion. Results Stability between the first and second Delphi scoring steps was reached in 46 of the 54 statements. By the end of the second Delphi scoring step, consensus was reached on 48 competency statements across eight domains: public health sciences, assessment and analysis, policy and program management, financial management and budgeting, partnerships and collaboration, social and cultural determinants, communication, and leadership. Conclusions This study produced a consensus set of core competencies and domains in public health that can be used to assess competencies of public health professionals and revise or develop new training programs to address desired competencies. Findings can also be used to support workforce development by informing competency-based job descriptions for recruitment and performance management in the Indian context, and potentially can be adapted for use in resource-poor settings globally.
Published: 2020

19. Understanding the implications of the Sustainable Development Goals for health policy and systems research: results of a research priority setting exercise

Author: Daniel Maceira, Ankita Meghani, Mary Qiu, Kerry Scott, Abdul Ghaffar, Nasreen S. Jessani, Douglas Glandon, Fadi El-Jardali, Sara Bennett, and Dena Javadi
Subjects: Service delivery framework, Sustainable Development Goals, Multisectoral collaboration, Priority setting, Public Policy, Health Services Accessibility, Political science, Humans, Social accountability, Health policy, Sustainable development, Social Responsibility, business.industry, lcsh:Public aspects of medicine, Research, Health Policy, Public Health, Environmental and Occupational Health, Health services research, Administrative Personnel, lcsh:RA1-1270, Public relations, Millennium Development Goals, Focus Groups, Sustainable Development, Health policy and systems research, Social protection, Conceptual framework, Implementation research, Health Services Research, business
Abstract: Background Given the paradigmatic shift represented by the Sustainable Development Goals (SDGs) as compared to the Millennium Development Goals - in particular their broad and interconnected nature - a new set of health policy and systems research (HPSR) priorities are needed to inform strategies to address these interconnected goals. Objectives To identify high priority HPSR questions linked to the achievement of the Sustainable Development Goals. Methods We focused on three themes that we considered to be central to achieving the health related SDGs: (i) Protecting and promoting access to health services through systems of social protection (ii) Strengthening multisectoral collaborations for health and (iii) Developing more participatory and accountable institutions. We conducted 54 semi-structured interviews and two focus group discussions to investigate policy-maker perspectives on evidence needs. We also conducted an overview of literature reviews in each theme. Information from these sub-studies was extracted into a matrix of possible research questions and developed into three domain-specific lists of 30–36 potential priority questions. Topic experts from the global research community then refined and ranked the proposed questions through an online platform. A final webinar on each theme sought feedback on findings. Results Policy-makers continue to demand HPSR for many well-established issues such as health financing, human resources for health, and service delivery. In terms of service delivery, policy-makers wanted to know how best to strengthen primary health care and community-based systems. In the themes of social protection and multisectoral collaboration, prioritized questions had a strong emphasis on issues of practical implementation. For participatory and accountable institutions, the two priority questions focused on political factors affecting the adoption of accountability measures, as well as health worker reactions to such measures. Conclusions To achieve the SDGs, there is a continuing need for research in some already well established areas of HPSR as well as key areas highlighted by decision-makers. Identifying appropriate conceptual frameworks as well as typologies of examples may be a prerequisite for answering some of the substantive policymaker questions. In addition, implementation research engaging non-traditional stakeholders outside of the health sector will be critical.
Published: 2020

20. A scoping review of the uses and institutionalisation of knowledge for health policy in low- and middle-income countries

Author: Fadi El Jardali, Adam D. Koon, Maryam Bigdeli, Jodi Charles, Jesse Uneke, Lauren Windmeyer, and Sara Bennett
Subjects: medicine.medical_specialty, Institutionalisation, Health Knowledge, Attitudes, Practice, Decision Making, Review, Health administration, 03 medical and health sciences, Evidence-based policy, 0302 clinical medicine, Residence Characteristics, Political science, medicine, Humans, 030212 general & internal medicine, Developing Countries, Health policy, Low- and middle-income countries, business.industry, lcsh:Public aspects of medicine, 030503 health policy & services, Public health, Health Policy, Public sector, Health services research, lcsh:RA1-1270, Public relations, Knowledge, Evidence-Based Practice, Survey data collection, 0305 other medical science, business, Delivery of Health Care
Abstract: There is growing interest in how different forms of knowledge can strengthen policy-making in low- and middle-income country (LMIC) health systems. Additionally, health policy and systems researchers are increasingly aware of the need to design effective institutions for supporting knowledge utilisation in LMICs. To address these interwoven agendas, this scoping review uses the Arskey and O’Malley framework to review the literature on knowledge utilisation in LMIC health systems, using eight public health and social science databases. Articles that described the process for how knowledge was used in policy-making, specified the type of knowledge used, identified actors involved (individual, organisation or professional), and were set in specific LMICs were included. A total of 53 articles, from 1999 to 2016 and representing 56 countries, were identified. The majority of articles in this review presented knowledge utilisation as utilisation of research findings, and to a lesser extent routine health system data, survey data and technical advice. Most of the articles centered on domestic public sector employees and their interactions with civil society representatives, international stakeholders or academics in utilising epistemic knowledge for policy-making in LMICs. Furthermore, nearly all of the articles identified normative dimensions of institutionalisation. While there is some evidence of how different uses and institutionalisation of knowledge can strengthen health systems, the evidence on how these processes can ultimately improve health outcomes remains unclear. Further research on the ways in which knowledge can be effectively utilised and institutionalised is needed to advance the collective understanding of health systems strengthening and enhance evidence-informed policy formulation.
Published: 2020

21. Developing more participatory and accountable institutions for health: identifying health system research priorities for the Sustainable Development Goal-era

Author: Mary Qiu, Sara Bennett, Kerry Scott, and Nasreen S. Jessani
Subjects: Sustainable Development Goals, 03 medical and health sciences, Technical support, 0302 clinical medicine, evidence-to-action, Political science, evidence-based policy, Humans, 030212 general & internal medicine, Health policy, social accountability, Social accounting, Government, Social Responsibility, business.industry, 030503 health policy & services, Corporate governance, Health Policy, Research, Politics, Administrative Personnel, Original Articles, Public relations, Focus Groups, Sustainable Development, Focus group, Health policy and systems research, Government Programs, Editor's Choice, research priorities, governance, Accountability, 0305 other medical science, business, Goals, Evidence-based policy
Abstract: Health policy and systems research (HPSR) is vital to guiding global institutions, funders, policymakers, activists and implementers in developing and enacting strategies to achieve the Sustainable Development Goals. We undertook a multi-stage participatory process to identify priority research questions relevant to improving accountability within health systems. We conducted interviews (n = 54) and focus group discussions (n = 2) with policymakers from international and national bodies (ministries of health, other government agencies and technical support institutions) across the WHO regions. Respondents were asked to reflect on challenges and current policy discussions related to health systems accountability, and to identify their pressing research needs. We also conducted an overview of reviews (n = 34) to determine the current status of knowledge on health systems accountability and to identify any gaps. We extracted research questions from the policymaker interviews and focus groups (70 questions) and from the overview of reviews (112 questions), and synthesized these into 36 overarching questions. Using the online platform Co-Digital, we invited researchers from around the world to refine and then rank the questions according to research importance. The questions that emerged amongst the top priorities focused on political factors that mediate the adoption or effectiveness of accountability initiatives, processes and incentives that facilitate the acceptability of accountability mechanisms among frontline healthcare providers, and the national governance reforms and contexts that enhance provider accountability. The process revealed different underlying conceptions of social accountability and how best to promote it, with some researchers and policymakers focusing on specific interventions and others embracing a more systems-oriented approach to understanding accountability, the multiple forms that it can take, how these interact with each other and the importance of power and underlying social relations. The findings from this exercise identify HPSR funding priorities and future areas for evidence production and policy engagement.
Published: 2018

22. Identifying health policy and systems research priorities for the sustainable development goals: social protection for health

Author: Mary Qiu, Nasreen S. Jessani, and Sara Bennett
Subjects: medicine.medical_specialty, Cash transfers, Priority setting, Social Welfare, 03 medical and health sciences, LMIC, 0302 clinical medicine, Health systems, medicine, Humans, 030212 general & internal medicine, Health policy, SDGs, Social policy, Sustainable development, 030505 public health, Health Care Rationing, Medical Assistance, business.industry, Health Priorities, Public health, Research, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Health services research, lcsh:RA1-1270, Public relations, Sustainable Development, United States, Social protection, 0305 other medical science, business
Abstract: Background There is an established body of evidence linking systems of social protection to health systems and health outcomes. The Sustainable Development Goals (SDGs) provide further emphasis on this linkage as necessary to achieving health and non-health goals. Existing literature on social protection and health has focused primarily on cash transfers. We sought to identify potential research priorities concerning social protection and health in low and middle-income countries, from multiple perspectives. Methods Priority research questions were identified through two sources: 1) research reviews on social protection interventions and health, 2) interviews with 54 policy makers from Ministries of Health, multi-lateral or bilateral organizations, and NGOs. Data was collated and summarized using a framework analysis approach. The final refining and ranking of the questions was completed by researchers from around the globe through an online platform. Results The overview of reviews identified 5 main categories of social protection interventions: cash transfers; financial incentives and other demand side financing interventions; food aid and nutritional interventions; parental leave; and livelihood/social welfare interventions. Policy-makers focused on the implementation and practice of social protection and health, how social protection programs could be integrated with other sectors, and how they should be monitored/evaluated. A collated list resulted in 31 priority research questions. Scale and sustainability of social protection programs ranked highest. The top 10 research questions focused heavily on design, implementation, and context, with a range of interventions that included cash transfers, social insurance, and labor market interventions. Conclusions There is potentially a rich field of enquiry into the linkages between health systems and social protection programs, but research within this field has focused on a few relatively narrowly defined areas. The SDGs provide an impetus to the expansion of research of this nature, with priority setting exercises such as this helping to align funder investment with researcher effort and policy-maker evidence needs. Electronic supplementary material The online version of this article (10.1186/s12939-018-0868-z) contains supplementary material, which is available to authorized users.
Published: 2018

23. 10 Best resources for community engagement in implementation research

Author: Ligia Paina, Douglas Glandon, Olakunle Alonge, David H. Peters, and Sara Bennett
Subjects: Knowledge management, Computer science, Stakeholder engagement, Context (language use), 0603 philosophy, ethics and religion, stakeholders, 03 medical and health sciences, research methods, 0302 clinical medicine, Humans, 030212 general & internal medicine, Public engagement, Community engagement, business.industry, Health Policy, Environmental resource management, Community Participation, Original Articles, 06 humanities and the arts, Grey literature, 3. Good health, Variety (cybernetics), Conceptual framework, Research Design, Implementation, Health Resources, 060301 applied ethics, Implementation research, business
Abstract: Implementation research (IR) focuses on understanding how and why interventions produce their effects in a given context. This often requires engaging a broad array of stakeholders at multiple levels of the health system. Whereas a variety of tools and approaches exist to facilitate stakeholder engagement at the national or institutional level, there is a substantial gap in the IR literature about how best to do this at the local or community level. Similarly, although there is extensive guidance on community engagement within the context of clinical trials—for HIV/AIDS in particular—the same cannot be said for IR. We identified a total of 59 resources by using a combination of online searches of the peer-reviewed and grey literature, as well as crowd-sourcing through the Health Systems Global platform. The authors then completed two rounds of rating the resources to identify the ‘10 best’. The resources were rated based on considerations of their relevance to IR, existence of an underlying conceptual framework, comprehensiveness of guidance, ease of application, and evidence of successful application in low- or middle-income countries or relevant contexts. These 10 resources can help implementation researchers think strategically and practically about how best to engage community stakeholders to improve the quality, meaningfulness, and application of their results in order to improve health and health systems outcomes. Building on the substantial work that has already been done in the context of clinical trials, there is a need for clearer and more specific guidance on how to incorporate relevant and effective community engagement approaches into IR project planning and implementation.
Published: 2017

24. Pathways to high and low performance: factors differentiating primary care facilities under performance-based financing in Nigeria

Author: Temilade Sesan, Shunsuke Mabuchi, and Sara Bennett
Subjects: international health, Performance management, Nigeria, CHILD HEALTH, Ambulatory Care Facilities, Essential medicines, Personnel Management, Skills management, HEALTH SYSTEM REFORM, 03 medical and health sciences, 0302 clinical medicine, health sector reform, Health facility, Nursing, Medicine, Humans, HEALTH FACILITIES, 030212 general & internal medicine, health services, Reimbursement, Incentive, Quality of Health Care, PRIMARY HEALTH CARE, COMMUNITY HEALTH, Community engagement, Primary Health Care, business.industry, 030503 health policy & services, Health Policy, Staff management, Community Participation, International health, Health facilities, Original Articles, maternal and child health, MATERNAL HEALTH, HEALTH WORKERS, health workers, HEALTH SERVICES, HEALTH SECTOR REFORM, Community health, Workforce, community, Health Facility Administration, 0305 other medical science, business, health systems, management
Abstract: The determinants of primary health facility performance in developing countries have not been well studied. One of the most under-researched areas is health facility management. This study investigated health facilities under the pilot performance-based financing (PBF) scheme in Nigeria and aimed to understand which factors differentiated primary health care centers (PHCCs) which had performed well, vs those which had not, with a focus on health facility management practices. The authors used a multiple case study where we compared two high-performing PHCCs and two low performing PHCCs for each of the two PBF target states. Two teams of two trained local researchers spent 1 week at each PHCC and collected semi-structured interview, observation and documentary data. Data from interviews were transcribed, translated and coded using a framework approach. The data for each PHCC were synthesized to understand dynamic interactions of different elements in each case. We then compared the characteristics of high and low performers. The areas in which critical differences between high and low-performers emerged were: community engagement and support; and performance and staff management. The authors also found that (i) contextual and health system factors particularly staffing, access and competition with other providers; (ii) health center management including community engagement, performance management and staff management; and (iii) community leader support interacted and drove performance improvement among the PHCCs. Among them, we found that good health center management can overcome some contextual and health system barriers and enhance community leader support. This study findings suggest a strong need to select capable and motivated health center managers, provide long-term coaching in managerial skills and motivate them to improve their practices. The study also highlights the need to position engagement with community leaders as a key management practice and a central element of interventions to improve PHCC performance.
Published: 2017

25. Enhancing evidence-informed decision making: strategies for engagement between public health faculty and policymakers in Kenya

Author: Caitlin E. Kennedy, Sara Bennett, and Nasreen S. Jessani
Subjects: Semi-structured interview, medicine.medical_specialty, Evidence-based practice, business.industry, 030503 health policy & services, Public health, Evidence informed, Public relations, 03 medical and health sciences, Interpersonal relationship, 0302 clinical medicine, medicine, 030212 general & internal medicine, Sociology, Public engagement, 0305 other medical science, business, Social Sciences (miscellaneous)
Abstract: This article examines the complex interactions and strategies for engagement – both existing as well as desired – between academic Knowledge Brokers (KBs) and national health policymakers in Kenya. Based on semi-structured interviews with academic KBs and university leaders from six Schools of Public Health (SPHs) as well as national policymakers, the authors found that a delicate balance between leveraging personal individual relationships and establishing more sustained institutional partnerships is important for engagement. The authors provide a list of recommended strategies for effective and tailored engagement, and highlight the important but under-appreciated dual role of academic KBs within Kenyan universities.
Published: 2017

26. Modifications to ART service delivery models by health facilities in Uganda in promotion of intervention sustainability: a mixed methods study

Author: Freddie Ssengooba, Sara Bennett, and Henry Zakumumpa
Subjects: medicine.medical_specialty, Health services delivery, Service delivery framework, Population, Health Informatics, HIV Infections, Health informatics, Ambulatory Care Facilities, Health administration, Interviews as Topic, 03 medical and health sciences, 0302 clinical medicine, Health systems, Environmental health, medicine, Humans, Uganda, 030212 general & internal medicine, Adaptation, education, Health policy, education.field_of_study, Medical education, lcsh:R5-920, business.industry, 030503 health policy & services, Health Policy, Public health, Research, Public Health, Environmental and Occupational Health, Health services research, ART scale-up, General Medicine, Resource-limited settings, Home Care Services, 3. Good health, Health promotion, Anti-Retroviral Agents, Sustainability, Implementation, 0305 other medical science, business, lcsh:Medicine (General), Delivery of Health Care
Abstract: Background In November 2015, WHO released new treatment guidelines recommending that all diagnosed as HIV positive be enrolled on antiretroviral therapy (ART). Sustaining and expanding ART scale-up programs in resource-limited settings will require adaptations and modifications to traditional ART delivery models to meet the rapid increase in demand. We identify modifications to ART service delivery models by health facilities in Uganda to sustain ART interventions over a 10-year period (2004–2014). Methods A mixed methods approach involving two study phases was adopted. In the first phase, a survey of a nationally representative sample of health facilities (n = 195) in Uganda which were accredited to provide ART between 2004 and 2009 was conducted. The second phase involved semi-structured interviews (n = 18) with ART clinic managers of 6 of the 195 health facilities purposively selected from the first study phase. We adopted a thematic framework consisting of four categories of modifications (format, setting, personnel, and population). Results The majority of health facilities 185 (95%) reported making modifications to ART interventions between 2004 and 2014. Of the 195 health facilities, 157 (81%) rated the modifications made to ART as “major.” Modifications to ART were reported under all the four themes. The quantitative and qualitative findings are integrated and presented under four themes. Format: Reducing the frequency of clinic appointments and pharmacy-only refill programs was identified as important strategies for decongesting ART clinics. Setting: Home-based care programs were introduced to reduce provider ART delivery costs. Personnel: Task shifting to non-physician cadre was reported in 181 (93%) of the health facilities. Population: Visits to the ART clinic were rationalized in favor of the sub-population deemed to have more clinical need. Two health facilities focused on patients living nearer the health facilities to align with targets set by external donors. Conclusions Over the study period, health facilities made several modifications ART interventions to improve fit with their resource-constrained settings thereby promoting long-term sustainability. Further research evaluating the effect of these modifications on patient outcomes and ART delivery costs is recommended. Our findings have implications for the sustainability of ART scale-up programs in Uganda and other resource-limited settings.
Published: 2017

27. Political commitment for vulnerable populations during donor transition

Author: Alan Whiteside, Daniela C. Rodríguez, and Sara Bennett
Subjects: Economic growth, National Health Programs, 030231 tropical medicine, Population, Global Health, Vulnerable Populations, 03 medical and health sciences, Technical support, 0302 clinical medicine, Medicine, Humans, 030212 general & internal medicine, education, Socioeconomic status, Disease burden, education.field_of_study, business.industry, Health Policy, Financing, Organized, Politics, Public Health, Environmental and Occupational Health, Equity (finance), Gross national income, Policy & Practice, Global Health Initiatives, Theme Issue, business, International development
Abstract: The responsibilities for the programmatic, technical and financial support of health programmes are increasingly being passed from external donors to governments. Programmes for family planning, human immunodeficiency virus, immunization, malaria and tuberculosis have already faced such donor transition, which is a difficult and often political process. Wherever programmes and services aimed at vulnerable populations are primarily supported by donors, the post-transition future is uncertain. Overreliance on donor support is often a reflection of limited domestic political commitment. Limited commitment, which is frequently expressed as the persecution of vulnerable groups, poses a risk to individuals as well as to the effectiveness and sustainability of health programmes. We argue that, for reasons linked to human rights, the social contract and the cost-effectiveness of health promotion, prevention and treatment programmes, it is critical that governments sustain health services for vulnerable populations during and after donor transition. Although civil society organizations could help by engaging with government stakeholders, pushing to change social norms and supporting mechanisms that demand accountability, they may be constrained by economic, political and social factors. Vulnerable populations need to be actively involved in the planning and implementation of donor transition - to ensure that their voice and needs are taken into account and to establish a platform that improves visibility and accountability. As transitions spread across all aspects of global health, transparent conversations about the building and sustainment of political commitment for health services for vulnerable populations become a critical human rights issue.Aujourd'hui, les responsabilités pour le soutien programmatique, technique et financier des programmes de santé sont de plus en plus souvent transférées de donateurs extérieurs aux gouvernements. Les programmes liés à la planification familiale, au virus de l'immunodéficience humaine, aux vaccinations, au paludisme et à la tuberculose ont déjà amorcé ce type de transition, qui constitue un processus difficile et souvent politique. Partout où des programmes et services ciblant des populations vulnérables sont principalement financés par des donateurs, le futur post-transition est incertain. La sur-dépendance à des donations externes traduit souvent un engagement politique national limité. Or, un engagement limité (qui se manifeste fréquemment par la persécution de groupes vulnérables) crée un risque pour les individus mais aussi pour l'efficacité et la pérennisation des programmes de santé. Selon nous, pour des raisons liées aux droits de l'homme, au contrat social et à la rentabilisation des programmes de promotion, prévention et traitement de santé, il est crucial que les gouvernements soutiennent les services de santé destinés aux populations vulnérables, pendant et après cette transition qui affecte les sources de financement. Même si les organisations de la société civile peuvent être utiles, en s'engageant auprès des acteurs gouvernementaux et en faisant pression pour changer les normes sociales et promouvoir des mécanismes de responsabilisation, elles sont parfois entravées dans leur action par des facteurs économiques, politiques et sociaux. Les populations vulnérables doivent être activement impliquées dans la planification et la mise en œuvre de la transition des sources de financement pour que leurs voix et leurs besoins soient pris en compte et pour créer une plate-forme qui améliore la visibilité et la responsabilisation. À l'heure où ce type de transition s'étend à tous les domaines sanitaires mondiaux, la tenue de débats transparents sur la création et le maintien de l'engagement politique en faveur des services de santé destinés aux populations vulnérables devient un enjeu essentiel en termes de respect des droits de l'homme.Cada vez más, las responsabilidades del apoyo programático, técnico y financiero de programas sanitarios se pasan de los donantes externos a los gobiernos. Los programas de planificación familiar, del virus de la inmunodeficiencia humana, de la inmunización, de la malaria y de la tuberculosis ya han experimentado dicha transición de donantes; se trata de un proceso complicado y, a menudo, político. Allí donde los programas y servicios diseñados para poblaciones vulnerables reciben, principalmente, el apoyo de los donantes, el futuro después de la transición es incierto. El exceso de confianza en el apoyo de los donantes suele ser un reflejo del escaso compromiso político nacional. Un compromiso escaso, que suele expresarse como la persecución de grupos vulnerables, supone un riesgo para los individuos, así como para la eficacia y sostenibilidad de los programas sanitarios. El argumento ofrecido es que, por razones vinculadas a los derechos humanos, el contrato social y la rentabilidad de los programas de fomento sanitario, prevención y tratamiento, es fundamental que los gobiernos mantengan los servicios sanitarios para poblaciones vulnerables durante y después de la transición de donantes. A pesar de que organizaciones de la sociedad civil pueden ayudar colaborando con los participantes gubernamentales, fomentando normas de cambio social y apoyando mecanismos de rendición de cuentas, pueden verse limitadas por factores económicos, políticos y sociales. Las poblaciones vulnerables necesitan involucrarse de forma activa en la planificación y la implementación de la transición de donantes a fin de garantizar que su voz y sus necesidades se tengan en cuenta y para establecer una plataforma que mejore su visibilidad y su responsabilidad. Conforme las transiciones se van ampliando en todos los aspectos de la sanidad global, las conversaciones transparentes sobre la construcción y el mantenimiento de un compromiso político ante los servicios sanitarios para poblaciones vulnerables se han convertido en un asunto de derechos humanos fundamental.يتزايد التوجه الرامي إلى نقل مسؤوليات الدعم الهيكلي والتقني والمالي لبرامج الصحة من على عاتق الجهات الخارجية المانحة إلى الحكومات. وقد تعرضت برامج تنظيم الأسرة ومكافحة فيروس نقص المناعة المكتسب والملاريا والسل بالفعل إلى هذه الحالات من تغيير الجهات المانحة، والتي غالبًا ما تمثل عملية سياسية وعسيرة. فكلما اعتمدت البرامج والخدمات التي تهدف إلى مساعدة الشرائح السكانية الهشة بشكل أساسي على مساعدات الجهات الخارجية المانحة، بدا مستقبل ما بعد سياسة تغير الجهات المانحة غير واضح. وغالبًا ما يعكس الاعتماد المفرط على الدعم المقدم من الجهات المانحة التزامًا سياسيًا محدودًا داخل البلاد. وتشكل محدودية الالتزام السياسي الذي يتمثل دائمًا في اضطهاد الشرائح السكانية الهشة خطرًا على أفراد المجتمع ومدي فاعلية برامج الصحة واستدامتها. وحرصًا من جانبنا على أهمية العقد الاجتماعي وتعزيز النظم الصحية بشكل فعال من حيث التكلفة وبرامج العلاج والوقاية لأسباب تتعلق بحقوق الانسان، فإننا ندعو إلى ضرورة قيام الحكومات بدعم الخدمات الصحية للشرائح السكانية الهشة خلال وبعد فترة تغير وتحول الجهات المانحة. وبالرغم من أن منظمات المجتمع المدني قد تقدم يد العون من خلال المشاركة مع الجهات الحكومية المعنية، والدفع في اتجاه تغيير المعايير الاجتماعية، ودعم الآليات التي تطالب بالمساءلة، إلا أنها قد تتقيد بالعوامل الاجتماعية والسياسية والاقتصادية. ويلزم إشراك الشرائح السكانية الهشة في عملية تخطيط وتنفيذ سياسة تغير الجهات المانحة لضمان أخذ أصواتهم واحتياجاتهم بعين الاعتبار وإنشاء آلية لتعزيز المساءلة ووضوح الرؤية. وبينما انتشرت سياسة تحول الجهات المانحة بشكل واسع على جميع المستويات الصحية العالمية، أصبحت المحادثات الشفافة حول تعمير ودعم الالتزام السياسي لتقديم خدمات الصحية للشرائح السكانية الهشة ضرورة وحقًا إنسانيًا.为健康计划提供程序、技术及财政支持的责任正逐渐从外部捐助者转移给政府。计划生育、人类免疫缺陷病毒、免疫接种、疟疾以及结核病计划已面临这一捐助者过渡问题，这是一个艰难的过程，通常为政治过程。无论针对弱势群体的计划与服务在何处受到捐助者的重点支持，实现后过渡的前景都并不明朗。过度依赖捐助者支持往往反映出国内政治承诺的局限性。有限承诺通常表现为对弱势群体的迫害，为个人以及健康计划的有效性和可持续性构成了风险。我们认为，由于与人权以及健康促进、预防和治疗计划的社会契约性与经济效益相关的原因，政府在捐助者过渡期以及过渡期之后继续为弱势群体提供健康服务很关键。尽管民间社会团体能通过与利益相关者合作、推动改变社会规范并支持责任追究机制提供帮助，但是他们也许会受到经济、政治和社会因素的约束。弱势群体需要积极参与捐助者过渡的规划和实施，以确保其心声和需求得到重视，并创建一个提高知名度并改善问责制的平台。由于过渡扩散到全球健康的各个方面，有关建立和维护对弱势群体健康服务的政治承诺的坦诚对话成为重要的人权问题。.Ответственность за разработку, техническую и финансовую поддержку программ здравоохранения все больше перекладывается с внешних доноров на правительства. Программы, связанные с планированием семьи, вирусом иммунодефицита человека, иммунизацией, малярией и туберкулезом, уже столкнулись с подобной передачей ответственности доноров, что является сложным и часто политическим процессом. Во всех случаях будущее программ и служб, нацеленных на работу с уязвимыми группами населения, которые изначально поддерживались донорами, после переноса ответственности становится неопределенным. Излишняя надежда на донорскую помощь часто свидетельствует об ограниченности обязательств внутренней политики, которая нередко выражается в виде дискриминации уязвимых групп населения и представляет угрозу как для отдельных людей, так и для эффективности и устойчивости программ здравоохранения. Авторы уверены, что по причинам, имеющим отношение к правам человека, общественному договору и экономической эффективности программ по укреплению здоровья, профилактике и лечению, важно, чтобы правительства поддерживали существование служб здравоохранения для уязвимых групп населения во время и после передачи ответственности доноров. Хотя общественные организации могут помочь путем привлечения заинтересованных лиц из правительственных кругов, агитации за изменение социальных норм и поддержки механизмов, требующих подотчетности, они могут оказаться под давлением экономических, политических и социальных факторов. Уязвимые группы населения должны принимать активное участие в планировании и осуществлении передачи ответственности доноров, чтобы их мнение и потребности были приняты во внимание и чтобы заложить основы для развития прозрачности и подотчетности. Передача ответственности касается всех аспектов мирового здравоохранения, и открытый диалог по принятию и выполнению политических обязательств в отношении служб здравоохранения для уязвимых групп населения становится решающим вопросом соблюдения прав человека.
Published: 2017

28. Assessing National Health Systems: Why and How

Author: David H. Peters and Sara Bennett
Subjects: National health, Process management, business.industry, Computer science, media_common.quotation_subject, Environmental resource management, Public Health, Environmental and Occupational Health, Stakeholder engagement, Health Informatics, Harmonization, Trustworthiness, Health Information Management, Quality (business), business, Set (psychology), media_common, Health reform, Healthcare system
Abstract: —In reviewing national health systems assessments (HSAs), we identify four primary rationales for doing HSAs: (i) to motivate health systems reform, (ii) to promote harmonization and alignment across actors in the health system, (iii) to help translate health systems reforms into meaningful ways to track performance, and (iv) to facilitate learning through cross-country comparisons. We propose a set of principles to guide HSAs. These include that the HSA should be relevant, addressing the purpose for which it was designed; trustworthy in terms of being of high quality, rigorous and credible in the eyes of stakeholders; and coherent, considering the health system as a meaningful whole with linkages across system components. Given diverse rationales for undertaking HSAs, there is no one standardized framework to guide them. Frameworks and tools should be selected to reflect proposed use, and careful thought should be given to stakeholder engagement and developing local capacity for HSAs.
Published: 2019

29. The evolution of the field of Health Policy and Systems Research and outstanding challenges

Author: Julio Frenk, Anne Mills, and Sara Bennett
Subjects: medicine.medical_specialty, Health administration, law.invention, Translational Research, Biomedical, 03 medical and health sciences, 0302 clinical medicine, Systems research, law, Political science, medicine, Humans, 030212 general & internal medicine, Cooperative Behavior, Policy Making, Health policy, Publishing, business.industry, 030503 health policy & services, Public health, lcsh:Public aspects of medicine, Health Policy, Health services research, Administrative Personnel, lcsh:RA1-1270, Millennium Development Goals, Public relations, Health Services, Dominance (economics), CLARITY, Commentary, Health Services Research, 0305 other medical science, business, Delivery of Health Care
Abstract: Background We provide a historical analysis of the evolution of the field of health policy and systems research (HPSR) since 1996. In the mid-1990s, three main challenges affected HPSR, namely (1) fragmentation and lack of a single agreed definition of the field; (2) ongoing dominance of biomedical and clinical research; and (3) lack of demand for HPSR. Cross-cutting all these challenges was the problem of relatively limited capacity to undertake high quality HPSR. Our discussion analyses how these problems were addressed so as to facilitate growth and enhanced recognition of the field. Discussion HPSR has benefitted significantly from increased recognition of the importance of strong health systems to health outcomes, particularly those linked to the Millennium Development Goals. In addition to this, some of the challenges described above have been addressed through (1) sustained advocacy for the importance of HPSR, (2) efforts to clarify the content and focus of the field, and (3) growing appreciation of and efforts to engage health practitioners and policy-makers in HPSR. While advocacy for the field of HPSR was initially fragmented, since the late 1990s there has been a consistent flow of focusing events and publications that have served to enhance the profile and understanding of the field. There have also been multiple efforts to establish greater coherence within the field, for example, interrogating the distinctions between health services research and health systems research, and how critical the “P” for policy is to HPSR. Finally, HPSR has developed at the same time as growing interest in evidence-informed policy and, more recently, implementation science, which have served to underscore the relevance and utility of HPSR to policy- and decision-makers. Conclusions During the past two decades, the field of HPSR has developed significantly, leading to enhanced clarity about its purpose, activity levels and utility. Several challenges remain that will need to be addressed in the decades ahead.
Published: 2018

30. Can task-shifting work at scale?: Comparing clinical knowledge of non-physician clinicians to physicians in Nigeria

Author: David Bishai, Manuela Villar Uribe, Sara Bennett, and Olakunle Alonge
Subjects: medicine.medical_specialty, Health Personnel, MEDLINE, Nigeria, Health informatics, Ambulatory Care Facilities, Health administration, 03 medical and health sciences, 0302 clinical medicine, Physicians, Medicine, Humans, 030212 general & internal medicine, Set (psychology), Primary Health Care, business.industry, 030503 health policy & services, Health Policy, Nursing research, Public health, lcsh:Public aspects of medicine, lcsh:RA1-1270, Fixed effects model, Scale (social sciences), Family medicine, Clinical Competence, Guideline Adherence, 0305 other medical science, business, Research Article
Abstract: Background In contexts with severe physician shortages, the World Health Organization advocates task shifting to cadres with shorter training. To investigate the effects of task shifting at scale in primary health care, we assessed the clinical knowledge of non-physician clinicians versus physicians working in public primary care facilities in Nigeria. Methods We assessed 4138 health workers using clinical vignettes of hypothetical patients suffering from illnesses commonly seen in primary care. Facility-level fixed effects models were used to compare health worker knowledge of (i) consultation guidelines, (ii) diagnostic accuracy and (iii) treatment guidelines. Results Unadjusted averages of overall health worker knowledge were low across all types of worker except medical officers. After adjustment for potential confounding, the differences across all three measures between cadres became small or statistically insignificant. Conclusion Non-physician clinicians can provide the same quality of primary care, for a set of common illnesses, as Medical Officers with similar personal characteristics, but clinical skills across cadres need strengthening.
Published: 2018

31. Governing multisectoral action for health in low-income and middle-income countries: an agenda for the way forward

Author: Kumanan Rasanathan, Charles Mwansambo, Sara Bennett, Agnes Soucat, and Vincent Atkins
Subjects: Government, Civil society, business.industry, Corporate governance, 030231 tropical medicine, Public Health, Environmental and Occupational Health, government, health policy, Public relations, multisectoral action, 03 medical and health sciences, 0302 clinical medicine, Incentive, Action (philosophy), 030212 general & internal medicine, Implementation research, Peer learning, business, Health policy, Analysis
Abstract: Drawing on experiences reviewed in the accompanying supplement and other literature, we present an agenda for the way forward for policy-makers, managers, civil society and development partners to govern multisectoral action for health in low-income and middle-income countries and consider how such an agenda might be realised. We propose the following key strategies: understand the key actors and political ecosystem, including type of multisectoral action required and mapping incentives, interests and hierarchies; frame the issue in the most strategic manner; define clear roles with specific sets of interventions according to sector; use existing structures unless there is a compelling reason not to do so; pay explicit attention to the roles of non-state sectors; address conflicts of interest and manage tradeoffs; distribute leadership; develop financing and monitoring systems to encourage collaboration; strengthen implementation processes and capacity; and support mutual learning and implementation research. To support countries to strengthen governance for multisectoral action, the global community can assist by further developing technical tools and convening peer learning by policy-makers (particularly from beyond the health sector), supporting knowledge management and sharing of experiences in multisectoral action beyond health, developing an agenda for and execution of implementation research and, finally, driving multilateral and bilateral development partners to transcend their own silos and work in a more multisectoral manner.
Published: 2018

32. Altogether now…understanding the role of international organizations in iCCM policy transfer

Author: Sarah L Dalglish, Pamela A. Juma, Daniela C. Rodríguez, and Sara Bennett
Subjects: Policy transfer, business.industry, International Cooperation, Health Policy, Socialization, Child Health, Developing country, Coercion, Public relations, Interviews as Topic, Competition (economics), Early adopter, Global health, Humans, Child, Policy Making, business, Case Management, Developing Countries, Health policy
Abstract: INTRODUCTION Policy transfer theories explain how policy ideas move across time and geography and offer an approach to understanding waves of policy change, a common phenomenon in global health. Four primary mechanisms for the transfer of policies from global to national levels are posited: learning, coercion, socialization and competition. METHODS We used six concurrent country case studies of policy change for child survival followed by a global study to analyse (1) mechanisms for policy transfer and (2) the roles of international organizations in promoting policy transfer. Our six country cases drew upon early adopters of integrated Community Case Management of Childhood Illness policy (Malawi, Niger), as well as countries that were slower to adopt due either to practical implementation challenges (Mozambique, Mali) and/or policy resistance (Burkina Faso, Kenya). In total, 145 semi-structured interviews and 283 document reviews were conducted across the six country cases, and 25 semi-structured interviews and 72 document reviews for the global study. RESULTS Three of the four diffusion mechanisms (learning, coercion and socialization) were important in these cases, but not competition. Multiple strategies were employed by multilateral organizations to support policy transfer, such as regional meetings or academic publications, frequently serving multiple diffusion mechanisms simultaneously (e.g. both learning and socialization). In just one country case, funding conditionalities were used to press for policy change. The emphasis of policy transfer mechanisms varied between early and later adopters. Early adopters, for example, were more likely to engage in learning. International multilateral organizations were active policy transfer agents, and national policy-makers perception of them as "trusted partners" made them well suited for this role. However, on occasion their role became more that of advocates than neutral facilitators. CONCLUSIONS International actors use multiple synergistic channels to promote uptake of global health policies in low- and middle-income countries, and tailor strategies employed to country contexts.
Published: 2015

33. Evidence-informed policymaking in practice: country-level examples of use of evidence for iCCM policy

Author: Jessica Shearer, Sarah L Dalglish, Sara Bennett, Alda Mariano, Pamela A. Juma, and Daniela C. Rodríguez
Subjects: sub-Saharan Africa, Economic growth, Evidence-based practice, policy analysis, Child Health Services, Developing country, Resistance (psychoanalysis), Supplement Articles, Case management, Interviews as Topic, Politics, evidence-based policy, Medicine, Humans, Niger, Child, Policy Making, Mozambique, Qualitative Research, business.industry, Health Policy, Stakeholder, Child Health, Public relations, Policy analysis, Kenya, Evidence-Based Practice, Africa, business, Qualitative research, Evidence-based policy
Abstract: Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. As countries move to adopt iCCM, it becomes important to understand how this growing evidence base is viewed and used by national stakeholders. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and uses Carol Weiss' models of research utilization to further explain the use of evidence in these contexts. A documentary review and in-depth stakeholder interviews were conducted as part of retrospective case studies in each study country. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organization and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. In terms of country-specific findings, Niger demonstrated both Interactive and Political models of research utilization by using iCCM to capitalize on the existing health infrastructure. Both Mozambique and Kenya exhibit Problem-Solving research utilization with different outcomes. Furthermore, the persistent quest for additional evidence suggests a Tactical use of research in Kenya. Results presented here indicate that while evidence from research studies and other contexts can be critical to policy development, local evidence is often needed to answer key policymaker questions. In the end, evidence may not be enough to overcome resistance if the policy is viewed as incompatible with national goals.
Published: 2015

34. Governing multisectoral action for health in low- and middle-income countries

Author: Rees Murithi Mbabu, Vincent Atkins, Peter Kingsley, Churnrurtai Kanchanachitra, Kirk Emerson, Kumanan Rasanathan, Agnes Soucat, Charles Mwansambo, Jodi Charles, Aloysius Ssennyonjo, Don Matheson, Shehla Zaidi, James Smith, Jeremias Paul, Robert Beschel, Thulisile Radebe, Rajib Dasgupta, Gabriel Carrasquilla, Douglas Glandon, Matthias Wismar, Orielle Solar, Sara Bennett, and Michael Myers
Subjects: Economics, Social Sciences, Health Care Sector, lcsh:Medicine, Political Aspects of Health, Global Health, Pediatrics, 0302 clinical medicine, Learning and Memory, Global health, Medicine and Health Sciences, Psychology, Public and Occupational Health, 030212 general & internal medicine, Cooperative Behavior, Health Systems Strengthening, Policy Forum, Behavior change, Child Health, General Medicine, Government, Income, Private Sector, 0305 other medical science, medicine.medical_specialty, Political Science, Developing country, Public Policy, 03 medical and health sciences, Environmental health, Political science, Development economics, medicine, Learning, Humans, Social determinants of health, Developing Countries, Health policy, Nutrition, 030505 public health, Health Care Policy, Public Sector, business.industry, Public health, Malnutrition, lcsh:R, Cognitive Psychology, International health, Biology and Life Sciences, Health Care, Health promotion, Cognitive Science, business, Delivery of Health Care, Finance, Neuroscience
Abstract: The focus of the health sector in most countries remains almost exclusively on health care services, and the potential of multisectoral collaboration remains untapped in many low- and middle-income countries.Different sectors have different contributions to make towards solving specific health problems. In each case, the profile, interests, incentives, and relationships of key individuals and sectors must be mapped and analysed to inform the design of approaches and systems to tackle a shared problem.Collaborative and distributed leadership is key for effective governance of multisectoral action, with a need to build leadership capacity across sectors and levels of government and cultivate champions in different sectors who can agree on common objectives.Important ways forward to support countries to take a multisectoral approach for health include ensuring that the universal health coverage agenda addresses the capacity of the health sector to work with other sectors, learning from multisectoral efforts that do not involve the health sector, improving the capacity of global institutions to support countries in undertaking multisectoral action, and developing a clear implementation research agenda for multisectoral action for health.
Published: 2017

35. A participatory action research approach to strengthening health managers' capacity at district level in Eastern Uganda

Author: Elizabeth Ekirapa Kiracho, Suzanne N Kiwanuka, Sara Bennett, Anna-Karin Hurtig, Anna-Britt Coe, Asha George, and Moses Tetui
Subjects: Capacity Building, Knowledge management, Service delivery framework, media_common.quotation_subject, Participatory action research, Competing values framework, 03 medical and health sciences, competing values framework, District health managers, Health systems, 0302 clinical medicine, Promotion (rank), Humans, Uganda, 030212 general & internal medicine, Empowerment, Health Services Administration, Qualitative Research, Health policy, media_common, Flexibility (engineering), participatory action research, business.industry, Research, lcsh:Public aspects of medicine, 030503 health policy & services, Health Policy, district health managers, Administrative Personnel, Health services research, lcsh:RA1-1270, Public Health, Global Health, Social Medicine and Epidemiology, Health Services, Quality Improvement, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Accountability, Health Services Research, Business, 0305 other medical science, health systems
Abstract: Background Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers’ capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers’ capacity in Eastern Uganda. Methods This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers’ capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus. Results The findings indicate that the participatory action research approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness. Conclusions Improved health manager capacity is essential if sustained improvements in health outcomes in low-income countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability were the key means by which participatory action research strengthened health managers’ capacity. The participatory approach to implementation therefore created opportunities to strengthen health managers’ capacity. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0273-x) contains supplementary material, which is available to authorized users.
Published: 2017

36. Strengthening scaling up through learning from implementation : comparing experiences from Afghanistan, Bangladesh and Uganda

Author: Anbrasi Edward, Elizabeth Ekirapa-Kiracho, Sara Bennett, Shehrin Shaila Mahmood, and Moses Tetui
Subjects: Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi, Service (systems architecture), Implementation research, Knowledge management, Computer science, Context (language use), stakeholders, Translational Research, Biomedical, scaling up, 03 medical and health sciences, 0302 clinical medicine, Stakeholders, Stakeholder Participation, implementation research, Humans, Uganda, 030212 general & internal medicine, Program Development, Project management, Qualitative Research, Bangladesh, Scaling up, business.industry, 030503 health policy & services, Health Policy, lcsh:Public aspects of medicine, Afghanistan, Health services research, Stakeholder, lcsh:RA1-1270, Public Health, Global Health, Social Medicine and Epidemiology, Health Care Service and Management, Health Policy and Services and Health Economy, Health Services, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Conceptual framework, Reseach, Health Services Research, 0305 other medical science, business, Delivery of Health Care, Qualitative research
Abstract: Background Many effective innovations and interventions are never effectively scaled up. Implementation research (IR) has the promise of supporting scale-up through enabling rapid learning about the intervention and its fit with the context in which it is implemented. We integrate conceptual frameworks addressing different dimensions of scaling up (specifically, the attributes of the service or innovation being scaled, the actors involved, the context, and the scale-up strategy) and questions commonly addressed by IR (concerning acceptability, appropriateness, adoption, feasibility, fidelity to original design, implementation costs, coverage and sustainability) to explore how IR can support scale-up. Methods We draw upon three IR studies conducted by Future Health Systems (FHS) in Afghanistan, Bangladesh and Uganda. We reviewed project documents from the period 2011–2016 to identify information related to the dimensions of scaling up. Further, for each country, we developed rich descriptions of how the research teams approached scaling up, and how IR contributed to scale-up. The rich descriptions were checked by FHS research teams. We identified common patterns and differences across the three cases. Results The three cases planned quite different innovations/interventions and had very different types of scale-up strategies. In all three cases, the research teams had extensive prior experience within the study communities, and little explicit attention was paid to contextual factors. All three cases involved complex interactions between the research teams and other stakeholders, among stakeholders, and between stakeholders and the intervention. The IR planned by the research teams focussed primarily on feasibility and effectiveness, but in practice, the research teams also had critical insights into other factors such as sustainability, acceptability, cost-effectiveness and appropriateness. Stakeholder analyses and other project management tools further complemented IR. Conclusions IR can provide significant insights into how best to scale-up a particular intervention. To take advantage of insights from IR, scale-up strategies require flexibility and IR must also be sufficiently flexible to respond to new emerging questions. While commonly used conceptual frameworks for scale-up clearly delineate actors, such as implementers, target communities and the support team, in our experience, IR blurred the links between these groups. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0270-0) contains supplementary material, which is available to authorized users.
Published: 2017

37. The impact of PEPFAR transition on HIV service delivery at health facilities in Uganda

Author: Mary Qiu, Moses Mukuru, Jess Wilhelm, Sara Bennett, Freddie Ssengooba, Elizabeth Colantuoni, and Ligia Paina
Subjects: RNA viruses, Program evaluation, Viral Diseases, Service delivery framework, Human immunodeficiency virus (HIV), Surveys, Pathology and Laboratory Medicine, medicine.disease_cause, Geographical Locations, 0302 clinical medicine, Immunodeficiency Viruses, Medicine and Health Sciences, Uganda, Public and Occupational Health, 030212 general & internal medicine, Multidisciplinary, 030503 health policy & services, Vaccination and Immunization, AIDS, Government Programs, Outreach, Infectious Diseases, Medical Microbiology, Research Design, Viral Pathogens, Viruses, Medicine, Seasons, Pathogens, 0305 other medical science, Research Article, Science, Immunology, HIV prevention, Antiretroviral Therapy, Research and Analysis Methods, Microbiology, 03 medical and health sciences, Antiviral Therapy, Acquired immunodeficiency syndrome (AIDS), Environmental health, Retroviruses, medicine, Microbial Pathogens, Service (business), Acquired Immunodeficiency Syndrome, Survey Research, business.industry, Lentivirus, Health Services Administration and Management, Organisms, Health Plan Implementation, Biology and Life Sciences, HIV, medicine.disease, Antiretroviral therapy, Health Care, People and Places, Africa, Earth Sciences, Mixed effects, Preventive Medicine, Seasonal Variations, business, Delivery of Health Care, Program Evaluation
Abstract: BackgroundSince 2004, the President's Emergency Plan for AIDS Relief (PEPFAR) has played a large role in Uganda's HIV/AIDS response. To better target resources to high burden regions and facilities, PEPFAR planned to withdraw from 29% of previously-supported health facilities in Uganda between 2015 and 2017.MethodsWe conducted a cross-sectional survey of 226 PEPFAR-supported health facilities in Uganda in mid-2017. The survey gathered information on availability, perceived quality, and access to HIV services before and after transition. We compare responses for facilities transitioned to those maintained on PEPFAR, accounting for survey design. We also extracted data from DHIS2 for the period October 2013-December 2017 on the number of HIV tests and counseling (HTC), number of patients on antiretroviral therapy (Current on ART), and retention on first-line ART (Retention) at 12 months. Using mixed effect models, we compare trends in service volume around the transition period.ResultsThere were 206 facilities that reported transition and 20 that reported maintenance on PEPFAR. Some facilities reporting transition may have been in a gap between implementing partners. The median transition date was September 2016, nine months prior to the survey. Transition facilities were more likely to discontinue HIV outreach following transition (51.6% vs. 1.4%, pConclusionsTransition from PEPFAR resulted in facilities reporting worsening patient access and service quality for HIV care, but there is insufficient evidence to suggest negative impacts on volume of HIV services. Facility respondents' perceptions about access and quality may be overly pessimistic, or they may signal forthcoming impacts. Unrelated to transition, declining retention on ART in Uganda is a cause for concern.
Published: 2019

38. Alternative financing mechanisms for ART programs in health facilities in Uganda: a mixed-methods approach

Author: Henry Zakumumpa, Sara Bennett, and Freddie Ssengooba
Subjects: Male, medicine.medical_specialty, Implementation research, Service delivery framework, Anti-HIV Agents, International Cooperation, HIV Infections, Funding Mechanism, Health informatics, Health Services Accessibility, Health administration, 03 medical and health sciences, 0302 clinical medicine, Health systems, Health facility, HIV funding, medicine, Financial Support, Humans, Uganda, 030212 general & internal medicine, health care economics and organizations, Qualitative Research, Finance, Mixed-methods, Global health initiatives, business.industry, 030503 health policy & services, Health Policy, Nursing research, Public health, Financing, Organized, 1. No poverty, ART scale-up, PEPFAR, Health Care Costs, Sustainability, Evaluation Studies as Topic, Global Health Initiatives, Female, Health Facilities, Health Expenditures, 0305 other medical science, business, Delivery of Health Care, Health Facilities, Proprietary, Research Article
Abstract: Background Sub-Saharan Africa is heavily dependent on global health initiatives (GHIs) for funding antiretroviral therapy (ART) scale-up. There are indications that global investments for ART scale-up are flattening. It is unclear what new funding channels can bridge the funding gap for ART service delivery. Many previous studies have focused on domestic government spending and international funding especially from GHIs. The objective of this study was to identify the funding strategies adopted by health facilities in Uganda to sustain ART programs between 2004 and 2014 and to explore variations in financing mechanisms by ownership of health facility. Methods A mixed-methods approach was employed. A survey of health facilities (N = 195) across Uganda which commenced ART delivery between 2004 and 2009 was conducted. Six health facilities were purposively selected for in-depth examination. Semi-structured interviews (N = 18) were conducted with ART Clinic managers (three from each of the six health facilities). Statistical analyses were performed in STATA (Version 12.0) and qualitative data were analyzed by coding and thematic analysis. Results Multiple funding sources for ART programs were common with 140 (72%) of the health facilities indicating at least two concurrent grants supporting ART service delivery between 2009 and 2014. Private philanthropic aid emerged as an important source of supplemental funding for ART service delivery. ART financing strategies were differentiated by ownership of health facility. Private not-for-profit providers were more externally-focused (multiple grants, philanthropic aid). For-profit providers were more client-oriented (fee-for-service, insurance schemes). Public facilities sought additional funding streams not dissimilar to other health facility ownership-types. Conclusion Over the 10-year study period, health facilities in Uganda diversified funding sources for ART service delivery. The identified alternative funding mechanisms could reduce dependence on GHI funding and increase local ownership of HIV programs. Further research evaluating the potential contribution of the identified alternative financing mechanisms in bridging the global HIV funding gap is recommended.
Published: 2016

39. What factors affect evidence-informed policymaking in public health? Protocol for a systematic review of qualitative evidence using thematic synthesis

Author: Paul Montgomery, Ben Verboom, and Sara Bennett
Subjects: medicine.medical_specialty, Evidence-based practice, Medicine (miscellaneous), Context (language use), 03 medical and health sciences, 0302 clinical medicine, Knowledge translation, Evidence-to-policy processes, Qualitative research, Global health, Protocol, Medicine, Humans, 030212 general & internal medicine, Policy Making, Health policy, Public health, Qualitative evidence synthesis, business.industry, 030503 health policy & services, Public relations, Evidence-informed policy, Evidence use, Conceptual framework, Research Design, Public health policy, Evidence-Based Practice, 0305 other medical science, business, Systematic Reviews as Topic
Abstract: Background Claims of and calls for evidence-informed policymaking pervade public health journals and the literature of governments and global health agencies, yet our knowledge of the arrangements most conducive to the appropriate use of evidence is incomplete and fragmented. Designing interventions to encourage evidence use by policymakers requires an understanding of the processes through which officials access, assess and use research, including technical and political factors related to evidence uptake, and the ways in which the policymaking context can affect these processes. This review aims to systematically locate, synthesise and interpret the existing qualitative work on the process of evidence use in public health policymaking, with the aim of producing an empirically derived taxonomy of factors affecting evidence use. Methods/design This review will include primary qualitative studies that examined the use of research evidence by policymakers to inform decisions about public health. To locate studies, we will search nine bibliographic databases, hand-search nine public health and policy journals and scan the websites of relevant organisations and the reference lists of previous reviews of evidence use in policymaking. Two reviewers will independently screen studies, apply inclusion criteria and appraise the quality of included studies. Data will be coded inductively and analysed using thematic synthesis. An augmented version of the CASP Qualitative Checklist will be used to appraise included studies, and the CERQual tool will be used to assess confidence in the review’s findings. The review’s results will be presented narratively and in tabular form. Synthesis findings will be summarised as a taxonomy of factors affecting evidence use in public health policymaking. A conceptual framework explaining the relationships between key factors will be proposed. Implications and recommendations for policy, practice and future research will be discussed. Discussion This review will be the most comprehensive to date to synthesise the qualitative literature on evidence use by public health policymakers and will be the first to apply a formal method of qualitative metasynthesis to this body of evidence. Its results will be useful both to scholars of evidence use and knowledge translation and to decision-makers and academics attempting to influence public health policy. Electronic supplementary material The online version of this article (doi:10.1186/s13643-016-0240-6) contains supplementary material, which is available to authorized users.
Published: 2016

40. The Human Capital of Knowledge Brokers: An analysis of attributes, capacities and skills of academic teaching and research faculty at Kenyan schools of public health

Author: Nasreen S. Jessani, Caitlin E. Kennedy, and Sara Bennett
Subjects: Knowledge broker, Capacity Building, Schools, Public Health, Health Personnel, Interprofessional Relations, Human capital, Health administration, 03 medical and health sciences, 0302 clinical medicine, Nursing, Medicine, Experiential knowledge, Humans, Social consciousness, 030212 general & internal medicine, Personnel Selection, Policy Making, Health policy, Capacity, business.industry, 030503 health policy & services, Health Policy, Teaching, Research, Evidence-to-policy, Health services research, Administrative Personnel, Schools of public health, Public relations, Faculty, Kenya, Organizational Policy, Research Personnel, Leadership, Knowledge, Interdisciplinary Communication, Health Services Research, Public Health, Skill, Thematic analysis, 0305 other medical science, business, Qualitative, Attribute
Abstract: Background Academic faculty involved in public health teaching and research serve as the link and catalyst for knowledge synthesis and exchange, enabling the flow of information resources, and nurturing relations between ‘two distinct communities’ – researchers and policymakers – who would not otherwise have the opportunity to interact. Their role and their characteristics are of particular interest, therefore, in the health research, policy and practice arena, particularly in low- and middle-income countries. We investigated the individual attributes, capacities and skills of academic faculty identified as knowledge brokers (KBs) in schools of public health (SPH) in Kenya with a view to informing organisational policies around the recruitment, retention and development of faculty KBs. Methods During April 2013, we interviewed 12 academics and faculty leadership (including those who had previously been identified as KBs) from six SPHs in Kenya, and 11 national health policymakers with whom they interact. Data were qualitatively analyzed using inductive thematic analysis to unveil key characteristics. Results Key characteristics of KBs fell into five categories: sociodemographics, professional competence, experiential knowledge, interactive skills and personal disposition. KBs’ reputations benefitted from their professional qualifications and content expertise. Practical knowledge in policy-relevant situations, and the related professional networks, allowed KB’s to navigate both the academic and policy arenas and also to leverage the necessary connections required for policy influence. Attributes, such as respect and a social conscience, were also important KB characteristics. Conclusion Several changes in Kenya are likely to compel academics to engage increasingly with policymakers at an enhanced level of debate, deliberation and discussion in the future. By recognising existing KBs, supporting the emergence of potential KBs, and systematically hiring faculty with KB-specific characteristics, SPHs can enhance their collective human capital and influence on public health policy and practice. Capacity strengthening of tangible skills and recognition of less tangible personality characteristics could contribute to enhanced academic–policymaker networks. These, in turn, could contribute to the relevance of SPH research and teaching programs as well as evidence-informed public health policies.
Published: 2016

41. Sustainability of donor programs: evaluating and informing the transition of a large HIV prevention program in India to local ownership

Author: JS Kang, Sachiko Ozawa, Suneeta Singh, Sara Bennett, Nhan Tran, and Bill and Melinda Gates Foundation
Subjects: Economic growth, Capacity Building, National Health Programs, Institutionalisation, India, HIV Infections, Acquired immunodeficiency syndrome (AIDS), Donor exit, HIV/AIDS, sustainability, Global health, Humans, Medicine, Community Health Services, Government, evaluation, Study Design Article, business.industry, Health Policy, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, Capacity building, Community ownership, lcsh:RA1-1270, Public relations, Global Health: Health Systems, medicine.disease, sustainability, Scale (social sciences), Sustainability, HIV/AIDS, business, Foundations, Program Evaluation
Abstract: Background: Sustainability is the holy grail of many development projects, yet there is limited evidence about strategies that effectively support transition of programs from donor funding to national governments. The first phase of Avahan, the India AIDS Initiative supported by the Bill and Melinda Gates Foundation (2003-2009), aimed to demonstrate an HIV/AIDS prevention program at scale, primarily targeted at highrisk groups. During the second phase (2009-2013), this large-scale program will be transitioned to its natural owners: the Government of India and local communities. This paper describes the evaluation design for the Avahan transition strategy. Methods/Design: A detailed logic model for the transition was developed. The Avahan transition strategy focuses on three activities: (1) enhancing capacities among communities, non-governmental organizations (NGOs), and government entities, in line with India’s national AIDS control strategy; (2) aligning technical and managerial aspects of Avahan programs with government norms and standards; and (3) promoting and sustaining commitment to services for most-at-risk populations. It is anticipated that programs will then transfer smoothly to government and community ownership, become institutionalized within the government system, and support a sustained HIV/AIDS response. The research design evaluates the implementation and effectiveness of (1) activities undertaken by the program; (2) intermediate effects including the process of institutionalization and the extent to which key Avahan organizational procedures and behaviors are integrated into government systems; and (3) overarching effects namely the impact of the transition process on the sustained delivery of HIV/AIDS prevention services to high-risk groups. Both qualitative and quantitative research approaches are employed so that the evaluation will both assess outcomes and explain why they have occurred. Conclusions: It is unusual for donor-supported projects in low- and middle-income countries to carefully plan transition processes, and prospectively evaluate these. This evaluation is designed so as to both inform decision making throughout the transition process and answer larger questions about the transition and sustainability of donor programs. Keywords: sustainability; evaluation; HIV/AIDS (Published: 14 December 2011) Citation: Global Health Action 2011, 4 : 7360 - DOI: 10.3402/gha.v4i0.7360
Published: 2011

42. Priorities for research into human resources for health in low- and middle-income countries

Author: Mickey Chopra, Michael Kent Ranson, Salla Atkins, Mario R Dal Poz, and Sara Bennett
Subjects: medicine.medical_specialty, Internationality, Developing country, Global Health, World Health Organization, Education, Environmental protection, Health care, medicine, Global health, Humans, Health Workforce, Human resources, Poverty, Health policy, Quality of Health Care, Health Services Needs and Demand, Geography, business.industry, Health Policy, Research, Public health, Public Health, Environmental and Occupational Health, Health services research, Public relations, Incentive, Socioeconomic Factors, Health Services Research, business
Abstract: OBJECTIVE: To identify the human resources for health (HRH) policy concerns and research priorities of key stakeholders in low- and middle-income countries; to assess the extent to which existing HRH research addresses these concerns and priorities; and to develop a prioritized list of core research questions requiring immediate attention to facilitate policy development and implementation. METHODS: The study involved interviews with key informants, including health policy-makers, researchers and community and civil society representatives, in 24 low- and middle-income countries in four regions, a literature search for relevant reviews of research completed to date, and the assessment of interview and literature search findings at a consultative multinational workshop, during which research questions were prioritized. FINDINGS: Twenty-one research questions emerged from the key informant interviews, many of which had received little or no attention in the reviewed literature. The questions ranked as most important at the consultative workshop were: (i) To what extent do incentives work in attracting and retaining qualified health workers in underserviced areas? (ii) What is the impact of dual practice and multiple employment? and (iii) How can incentives be used to optimize efficiency and the quality of health care? CONCLUSION: There was a clear consensus about the type of HRH policy problems faced by different countries and the nature of evidence needed to tackle them. Coordinated action to support and implement research into the highest priority questions identified here could have a major impact on health worker policies and, ultimately, on the health of the poor.
Published: 2010

43. Salaries and incomes of health workers in sub-Saharan Africa

Author: Barbara McPake, Sara Bennett, Brook K. Baker, Tim Ensor, David McCoy, Bob Pond, Sudeep Chand, Jeff Gow, and Sophie Witter
Subjects: Incentive, business.industry, International comparisons, Public sector, Developing country, Distribution (economics), Demographic economics, General Medicine, Business, Salary, Cost of living, Private sector
Abstract: Public-sector health workers are vital to the functioning of health systems. We aimed to investigate pay structures for health workers in the public sector in sub-Saharan Africa; the adequacy of incomes for health workers; the management of public-sector pay; and the fiscal and macroeconomic factors that impinge on pay policy for the public sector. Because salary differentials affect staff migration and retention, we also discuss pay in the private sector. We surveyed historical trends in the pay of civil servants in Africa over the past 40 years. We used some empirical data, but found that accurate and complete data were scarce. The available data suggested that pay structures vary across countries, and are often structured in complex ways. Health workers also commonly use other sources of income to supplement their formal pay. The pay and income of health workers varies widely, whether between countries, by comparison with cost of living, or between the public and private sectors. To optimise the distribution and mix of health workers, policy interventions to address their pay and incomes are needed. Fiscal constraints to increased salaries might need to be overcome in many countries, and non-financial incentives improved.
Published: 2008

44. iCCM policy analysis: strategic contributions to understanding its character, design and scale up in sub-Saharan Africa

Author: Kumanan Rasanathan, Neal Brandes, Sara Bennett, Asha George, and Daniela C. Rodríguez
Subjects: Community Health Workers, Male, Economic growth, medicine.medical_specialty, business.industry, Unintended consequences, Health Policy, Public health, Child Health, Developing country, Policy analysis, Child mortality, Framing (social sciences), Child, Preschool, Accountability, Medicine, Humans, Female, Community Health Services, business, Policy Making, Case Management, Health policy, Africa South of the Sahara
Abstract: Pneumonia, diarrhoea and malaria remain leading causes of death for children under 5 years of age and access to effective and appropriate treatment for sick children is extremely low where it is needed most. Integrated community case management (iCCM) enables community health workers to provide basic lifesaving treatment for sick children living in remote communities for these diseases. While many governments in sub-Saharan Africa recently changed policies to support iCCM, large variations in implementation remain. As a result, the collaboration represented in this supplement examined the policy processes underpinning iCCM through qualitative case study research in six purposively identified countries (Niger, Burkina Faso, Mali, Kenya, Malawi and Mozambique) and the global context. We introduce the supplement, by reviewing how policy analysis can inform: (a) how we frame iCCM and negotiate its boundaries, (b) how we tailor iCCM for national health systems and (c) how we foster accountability and learning for iCCM. In terms of framing, iCCM boundaries reflect how an array of actors use evidence to prioritize particular aspects of child mortality (lack of access to treatment), and how this underpins the ability to reach consensus and legitimate specific policy enterprises. When promoted at national level, contextual health system factors, such as the profile of CHWs and the history of primary health care, cannot be ignored. Adaptation to these contextual realities may lead to unintended consequences not forseen by technical or managerial expertize alone. Further scaling up of iCCM requires understanding of the political accountabilities involved, how ownership can be fostered and learning for improved policies and programs sustained. Collectively these articles demonstrate that iCCM, although often compartmentalized as a technical intervention, also reflects the larger and messier real world of health politics, policy and practice, for which policy analysis is vital, as an integral component of public health programming.
Published: 2015

45. Do academic knowledge brokers exist? Using social network analysis to explore academic research-to-policy networks from six schools of public health in Kenya

Author: Nasreen S. Jessani, Sara Bennett, and Marc Boulay
Subjects: Counseling, Economic growth, Knowledge management, Schools, Public Health, social network analysis, schools of public health, Health Personnel, Decision Making, Information needs, Translational Research, Biomedical, 03 medical and health sciences, Evidence-informed decision-making, 0302 clinical medicine, Betweenness centrality, Knowledge translation, Medicine, Humans, 030212 general & internal medicine, evidence-to-policy, Social network analysis, Health policy, Government, business.industry, knowledge broker, 030503 health policy & services, Health Policy, Administrative Personnel, Social Support, Peer group, Original Articles, Kenya, Evidence-Based Practice, Health Services Research, Knowledge broker, 0305 other medical science, business
Abstract: The potential for academic research institutions to facilitate knowledge exchange and influence evidence-informed decision-making has been gaining ground. Schools of public health (SPHs) may play a key knowledge brokering role—serving as agencies of and for development. Understanding academic-policymaker networks can facilitate the enhancement of links between policymakers and academic faculty at SPHs, as well as assist in identifying academic knowledge brokers (KBs). Using a census approach, we administered a sociometric survey to academic faculty across six SPHs in Kenya to construct academic-policymaker networks. We identified academic KBs using social network analysis (SNA) in a two-step approach: First, we ranked individuals based on (1) number of policymakers in their network; (2) number of academic peers who report seeking them out for advice on knowledge translation and (3) their network position as ‘inter-group connectors’. Second, we triangulated the three scores and re-ranked individuals. Academic faculty scoring within the top decile across all three measures were classified as KBs. Results indicate that each SPH commands a variety of unique as well as overlapping relationships with national ministries in Kenya. Of 124 full-time faculty, we identified 7 KBs in 4 of the 6 SPHs. Those scoring high on the first measure were not necessarily the same individuals scoring high on the second. KBs were also situated in a wide range along the ‘connector/betweenness’ measure. We propose that a composite score rather than traditional ‘betweenness centrality’, provides an alternative means of identifying KBs within these networks. In conclusion, SNA is a valuable tool for identifying academic-policymaker networks in Kenya. More efforts to conduct similar network studies would permit SPH leadership to identify existing linkages between faculty and policymakers, shared linkages with other SPHs and gaps so as to contribute to evidence-informed health policies.
Published: 2015

46. 'From me to HIV': a case study of the community experience of donor transition of health programs

Author: Suneeta Singh, Meghan A. Bohren, Vandana Tripathi, Vibha Chhabra, Amy Paul, Daniela C. Rodríguez, Kriti Singh, and Sara Bennett
Subjects: Financing, Government, Population, Psychological intervention, India, HIV Infections, Health Promotion, Medicine, Healthcare Financing, Humans, Longitudinal Studies, education, Qualitative Research, Government, education.field_of_study, business.industry, Community ownership, Public relations, Focus Groups, Focus group, language.human_language, Infectious Diseases, Health promotion, Tamil, language, business, Delivery of Health Care, Qualitative research, Research Article, Foundations
Abstract: Background Avahan, a large-scale HIV prevention program in India, transitioned over 130 intervention sites from donor funding and management to government ownership in three rounds. This paper examines the transition experience from the perspective of the communities targeted by these interventions. Methods Fifteen qualitative longitudinal case studies were conducted across all three rounds of transition, including 83 in-depth interviews and 45 focus group discussions. Data collection took place between 2010 and 2013 in four states: Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu. Results We find that communication about transition was difficult at first but improved over time, while issues related to employment of peer educators were challenging throughout the transition. Clinical services were shifted to government providers resulting in mixed experiences depending on the population being targeted. Lastly, the loss of activities aimed at community ownership and mobilization negatively affected the beneficiaries’ view of transition. Conclusions While some programmatic changes resulted in improvements, additional opportunity costs for beneficiaries may pose barriers to accessing HIV prevention services. Communicating and engaging community stakeholders early on in future such transitions may mitigate negative feelings and lead to more constructive relationships and dialogue.
Published: 2015

47. 041: INVESTING IN RELATIONSHIPS AND STRATEGIES FOR ENGAGEMENT: THE CAPACITY OF ACADEMIA TO EFFECTIVELY INFLUENCE HEALTH POLICY IN KENYA

Author: Caitlin E. Kennedy, Nasreen S. Jessani, and Sara Bennett
Subjects: medicine.medical_specialty, Order (exchange), business.industry, Software deployment, Knowledge translation, Public health, medicine, Network mapping, Capacity building, Public relations, Customer relationship management, business, Health policy
Abstract: Background Universities aim to build technical capacity, generate new knowledge and use both for the advancement of society. However, challenges in bridging the gap between research, policy and practice often hinder this intended impact. The importance of relationships and effective strategies for academic-policymaker engagement to overcome these challenges, while important, often remain elusive, suffer from unmet expectations, and subject to mutual misperceptions. Objectives In order to strengthen the capacity of academia to effectively influence health policy, we explore the networks and experiences of academics and policymakers in Kenya. Methods We conducted a quantitative policy network mapping and analysis of academic faculty across 6 Schools of public health to identify knowledge brokers (KBs) and other key actors. We complemented this with semi-structured interviews with 12 academic faculty and 11 national health policymakers from within the network to uncover and explore key themes. Result Six academic-policymaker networks emerged, identifying 7 KBs across 124 faculty. Academic faculty employed a greater array of strategies for leveraging these relations and enhancing engagement compared to policymakers including traditional dissemination of research results, and more creative honorary appointments for policymakers, amongst others. While the intention and capacity to engage across both types of institutions varied greatly, policymakers highlighted multiple strategies underutilized by academia thereby confirming different worldviews on effective engagement. Conclusion Engagement between academics and policymakers in Kenya requires a delicate balance between leveraging individual relationships and establishing sustained institutional partnerships. Additionally, a combination of deliberate and opportunistic strategies is required from both sides. SPH deployment of personnel and skills for effective academic-policymaker engagement and deliberate investment in capacity building for relationship management and knowledge translation can enhance sustainable mechanisms for (i) increasing policymaker interest and investment in health systems research, (ii) moving innovations from research into action, (iii) recognizing academia as a source of socially-driven and practically-relevant knowledge, and (iv) reinforcing academic-policymaker partnerships.
Published: 2015

48. Management practices to support donor transition: lessons from Avahan, the India AIDS Initiative

Author: Sachiko Ozawa, Meghan A. Bohren, Sara Bennett, Suneeta Singh, Kriti Singh, Vibha Chhabra, and Daniela C. Rodríguez
Subjects: Acquired Immunodeficiency Syndrome, Financing, Government, Government, Economic growth, business.industry, Health Policy, Nursing research, Ownership, Psychological intervention, Change management, India, Developing country, HIV Infections, medicine.disease, Health informatics, Health administration, Acquired immunodeficiency syndrome (AIDS), Nursing, Hospital Restructuring, Humans, Medicine, Community Health Services, business, Research Article
Abstract: Background During 2009-2012, Avahan, a large donor funded HIV/AIDS prevention program in India was transferred from donor support and operation to government. This transition of approximately 200 targeted interventions (TIs), occurred in three tranches in 2009, 2011 and 2012. This paper reports on the management practices pursued in support of a smooth transition of the program, and addresses the extent to which standard change management practices were employed, and were useful in supporting transition. Results We conducted structured surveys of a sample of 80 TIs from the 2011 and 2012 rounds of transition. One survey was administered directly before transition and the second survey 12 month after transition. These surveys assessed readiness for transition and practices post-transition. We also conducted 15 case studies of transitioning TIs from all three rounds, and re-visited 4 of these 1-3 years later. Results Considerable evolution in the nature of relationships between key actors was observed between transition rounds, moving from considerable mistrust and lack of collaboration in 2009 toward a shared vision of transition and mutually respectful relationships between Avahan and government in later transition rounds. Management practices also evolved with the gradual development of clear implementation plans, establishment of the post of “transition manager” at state and national levels, identified budgets to support transition, and a common minimum programme for transition. Staff engagement was important, and was carried out relatively effectively in later rounds. While the change management literature suggests short-term wins are important, this did not appear to be the case for Avahan, instead a difficult first round of transition seemed to signal the seriousness of intentions regarding transition. Conclusions In the Avahan case a number of management practices supported a smooth transition these included: an extended and sequenced time frame for transition; co-ownership and planning of transition by both donor and government; detailed transition planning and close attention to program alignment, capacity development and communication; engagement of staff in the transition process; engagement of multiple stakeholders post transition to promote program accountability and provide financial support; signaling by actors in charge of transition that they were committed to specified time frames.
Published: 2015

49. Transitioning a Large Scale HIV/AIDS Prevention Program to Local Stakeholders: Findings from the Avahan Transition Evaluation

Author: Neeraj Dhingra, Suneeta Singh, Sara Bennett, Kriti Singh, Sachiko Ozawa, Daniela C. Rodríguez, and Vibha Chhabra
Subjects: Program evaluation, Institutionalisation, Program management, Human immunodeficiency virus (HIV), lcsh:Medicine, India, HIV Infections, medicine.disease_cause, Service coverage, Procurement, Acquired immunodeficiency syndrome (AIDS), medicine, Humans, lcsh:Science, Organizations, Multidisciplinary, business.industry, lcsh:R, Public relations, medicine.disease, Government Programs, lcsh:Q, Community member, business, Program Evaluation, Research Article
Abstract: Background Between 2009–2013 the Bill and Melinda Gates Foundation transitioned its HIV/AIDS prevention initiative in India from being a stand-alone program outside of government, to being fully government funded and implemented. We present an independent prospective evaluation of the transition. Methods The evaluation drew upon (1) a structured survey of transition readiness in a sample of 80 targeted HIV prevention programs prior to transition; (2) a structured survey assessing institutionalization of program features in a sample of 70 targeted intervention (TI) programs, one year post-transition; and (3) case studies of 15 TI programs. Findings Transition was conducted in 3 rounds. While the 2009 transition round was problematic, subsequent rounds were implemented more smoothly. In the 2011 and 2012 transition rounds, Avahan programs were well prepared for transition with the large majority of TI program staff trained for transition, high alignment with government clinical, financial and managerial norms, and strong government commitment to the program. One year post transition there were significant program changes, but these were largely perceived positively. Notable negative changes were: limited flexibility in program management, delays in funding, commodity stock outs, and community member perceptions of a narrowing in program focus. Service coverage outcomes were sustained at least six months post-transition. Interpretation The study suggests that significant investments in transition preparation contributed to a smooth transition and sustained service coverage. Notwithstanding, there were substantive program changes post-transition. Five key lessons for transition design and implementation are identified.
Published: 2015

50. Scaling up HIV/AIDS evaluation

Author: Sara Bennett, Ruairi Brugha, and J. Ties Boerma
Subjects: Program evaluation, Acquired Immunodeficiency Syndrome, Government, Economic growth, Treatment response, business.industry, Human immunodeficiency virus (HIV), General Medicine, World Health Organization, medicine.disease_cause, medicine.disease, Acquired immunodeficiency syndrome (AIDS), Evaluation Studies as Topic, Africa, medicine, Humans, business, Delivery of Health Care, Developed country, health care economics and organizations, Health policy, Malaria
Abstract: The HIV/AIDS pandemic shows little signs of abating with an estimated 38 million infections by the end of 2004 and 3 million deaths. Yet an effective expanded prevention and treatment response could avert as many as 29 million infections and 10 million deaths by 2020 in sub-Saharan Africa alone. The level of external funding for HIV/AIDS is on the right trajectory to achieve the goal of reversing the epidemic by 2015 through radically scaling up prevention treatment and care: US$1 billion since 2000 to the World Banks multicountry AIDS program (MAP) US$1.7 billion approved by the Global Fund to fight AIDS TB and malaria (2002-05); and the US Congress appropriation of US$2.4 billion in 2004 to the US Presidents emergency plan for AIDS relief (PEPFAR). In the high-prevalence low-income countries of southern and eastern Africa the combined commitments from these initiatives often amount to over half the countries total health budgets. The question remains however: will the increased funding achieve the anticipated outcomes? (excerpt)
Published: 2006

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