Search

The theoretical literature on the meaning of qualification standards depicts a variety of definitions. Some definitions describe properties of examinees, whilst others rely on cohort-level or system-level characteristics. Different definitions can be compatible or contradictory. In this study, stakeholders' views of the meaning of qualification standards in Scotland were collected, using focus groups (82 participants) and a questionnaire (918 participants). Almost 60% of questionnaire participants responded that standards tell us about performances on the assessment (criterion-referencing) and approximately 40% responded that they tell you about an underlying ability (construct-referencing). Few participants considered that maintaining statistical grade distributions every year were important. Discrepancies in views raise questions regarding how an examination board manages the political and technical process of maintaining public confidence in standards. Based upon this Scottish case, the authors argue that social settlements regarding qualification standards are a social contract, and a solely technocratic view of standards is conceptually inadequate.

Research in the UK is increasingly regulated by ethics review committees (RECs) which require researchers to seek ethics approval before commencing research. These RECs routinely expect researchers to anonymise data as part of standard ethical research practice. However, the anonymisation of data may sit in tension with participatory approaches to research which prioritise shared ownership of the research. In particular, the need to make decisions relating to ethics prior to the start of research makes it difficult for researchers to meaningfully share decision-making power with their participants--a fundamental principle of participatory approaches. This paper uses a participatory research study as a case study to explore this tension. In the study, the decision to anonymise data was made as part of the ethics approval process. However, over the course of the study, the researcher questioned whether this was the correct decision for this study. In order to afford researchers the flexibility required to involve participants in decision making, this paper argues for a dialogic and situational approach to ethics regulation. Allowing researchers to delay key decisions would mean that researchers could involve participants in the decision-making process rather than purely informing them of the results of decisions made on their behalf.

Scotland, traditionally, has high levels of confidence in teachers. Fairness and justice are key concepts in policy and practice in Scottish education. For more than 100 years, the high-stakes assessment system in Scotland, with the Scottish "Higher" qualification at its heart, has been crucial to that sense of opportunity and justice. However, in 2019-2020, public confidence in high-stakes assessment in Scotland, as in other United Kingdom countries, was dented. In Scotland, the COVID-19 pandemic meant that schools were closed, teachers provided online learning opportunities for pupils working at home and, for the first time in 130 years, it was not possible to run national examinations. To ensure that learners were not further disadvantaged, alternative approaches to gathering evidence for qualifications were instigated. However, these results were challenged as socially unjust and the results that had been nationally moderated were replaced by results based on locally moderated teachers' professional judgement. As Scotland looks to qualifications beyond COVID-19, trust must be re-built. This article reports on a participative research project that sought to understand public perceptions of standards and fairness across a range of key communities following this experience. Drawing on both qualitative and quantitative data, we analyse factors which affected trust in National Qualifications under the pandemic. The evidence suggests that when considering what matters for qualifications to be trusted, technocratic solutions are likely to be rejected by stakeholders. Understanding and responding to what led to the mistrust of qualifications in Scotland will be crucial to inform its future qualifications system.

BackgroundApproaches that allow easy access to pre-exposure prophylaxis (PrEP), such as over-the-counter provision at pharmacies, could facilitate risk-informed PrEP use and lead to lower HIV incidence, but their cost-effectiveness is unknown. We aimed to evaluate conditions under which risk-informed PrEP use is cost-effective.MethodsWe applied a mathematical model of HIV transmission to simulate 3000 setting-scenarios reflecting a range of epidemiological characteristics of communities in sub-Saharan Africa. The prevalence of HIV viral load greater than 1000 copies per mL among all adults (HIV positive and negative) varied from 1·1% to 7·4% (90% range). We hypothesised that if PrEP was made easily available without restriction and with education regarding its use, women and men would use PrEP, with sufficient daily adherence, during so-called seasons of risk (ie, periods in which individuals are at risk of acquiring infection). We refer to this as risk-informed PrEP. For each setting-scenario, we considered the situation in mid-2021 and performed a pairwise comparison of the outcomes of two policies: immediate PrEP scale-up and then continuation for 50 years, and no PrEP. We estimated the relationship between epidemic and programme characteristics and cost-effectiveness of PrEP availability to all during seasons of risk. For our base-case analysis, we assumed a 3-monthly PrEP cost of US$29 (drug $11, HIV test $4, and $14 for additional costs necessary to facilitate education and access), a cost-effectiveness threshold of $500 per disability-adjusted life-year (DALY) averted, an annual discount rate of 3%, and a time horizon of 50 years. In sensitivity analyses, we considered a cost-effectiveness threshold of $100 per DALY averted, a discount rate of 7% per annum, the use of PrEP outside of seasons of risk, and reduced uptake of risk-informed PrEP.FindingsIn the context of PrEP scale-up such that 66% (90% range across setting-scenarios 46-81) of HIV-negative people with at least one non-primary condomless sex partner take PrEP in any given period, resulting in 2·6% (0·9-6·0) of all HIV negative adults taking PrEP at any given time, risk-informed PrEP was predicted to reduce HIV incidence by 49% (23-78) over 50 years compared with no PrEP. PrEP was cost-effective in 71% of all setting-scenarios, and cost-effective in 76% of setting-scenarios with prevalence of HIV viral load greater than 1000 copies per mL among all adults higher than 2%. In sensitivity analyses with a $100 per DALY averted cost-effectiveness threshold, a 7% per year discount rate, or with PrEP use that was less well risk-informed than in our base case, PrEP was less likely to be cost-effective, but generally remained cost-effective if the prevalence of HIV viral load greater than 1000 copies per mL among all adults was higher than 3%. In sensitivity analyses based on additional setting-scenarios in which risk-informed PrEP was less extensively used, the HIV incidence reduction was smaller, but the cost-effectiveness of risk-informed PrEP was undiminished.InterpretationUnder the assumption that making PrEP easily accessible for all adults in sub-Saharan Africa in the context of community education leads to risk-informed use, PrEP is likely to be cost-effective in settings with prevalence of HIV viral load greater than 1000 copies per mL among all adults higher than 2%, suggesting the need for implementation of such approaches, with ongoing evaluation.FundingUS Agency for International Development, US President's Emergency Plan for AIDS Relief, and Bill & Melinda Gates Foundation.

Phylogenetic analysis of pathogens is an increasingly powerful way to reduce the spread of epidemics, including HIV. As a result, phylogenetic approaches are becoming embedded in public health and research programmes, as well as outbreak responses, presenting unique ethical, legal, and social issues that are not adequately addressed by existing bioethics literature. We formed a multidisciplinary working group to explore the ethical issues arising from the design of, conduct in, and use of results from HIV phylogenetic studies, and to propose recommendations to minimise the associated risks to both individuals and groups. We identified eight key ethical domains, within which we highlighted factors that make HIV phylogenetic research unique. In this Review, we endeavoured to provide a framework to assist researchers, public health practitioners, and funding institutions to ensure that HIV phylogenetic studies are designed, done, and disseminated in an ethical manner. Our conclusions also have broader relevance for pathogen phylogenetics.

In this study, we assessed a possible correlation of CD4 counts with the low-cost progression markers neopterin, 132-microglobulin (B2M), total lymphocyte count (TLC) and hemoglobin, and we investigated associations between progression :narkers and clinical parameters in HIV -1 seropositive Zambians. Of 147 HIV- 1 seropositive patients presenting to an outpatient clinic in Lusaka, blood was taken for CD4 counts, serum progression markers and full blood count. A detailed clinical history and medical examination was taken at that point, and the patients were seen 3··monthly over the following 12 months. Further CD4 counts were taken after 6 and 12 months. Neopterin, B2M: lymphocyte count, and hemoglobin showed a strong correlation with CD4 count. Of the serum progression markers, neopterin was more sensitive than B2M to detect HIV related symptoms and to predict weight loss and death in the follow-up period. Lymphocyte count and hemoglobin were significantly lower in patients with oral candidiasis and those falling sick or dying in the follow-up period. Hemoglobin was also associated with past diarrhoea. When stratified by sex, the associations of hemoglobin were very strong in males, but weaker in females . In conclusion, neopterin and B2M correlate well with CD 4 counts in this African population. Neopterin appears to be more sensitive for the clinical evaluation o: the patients in this study. Hemoglobin might only be useful as a progression marker in male individuals .

Objective To determine the population-based incidence of disseminated bacille Calmette-Guerin (BCG) disease in HIV-infected infants (aged [less than or equal to] 1 year) in a setting with a high burden of tuberculosis and HIV infection coupled with a well-functioning programme for the prevention of HIV infection in infants. Methods The numerator, or number of new cases of disseminated BCG disease, was derived from multicentre surveillance data collected prospectively on infants with a confirmed HIV infection during 2004-2006. The denominator, or total number of HIV-infected infants who were BCG-vaccinated, was derived from population-based estimates of the number of live infants and from reported maternal HIV infection prevalence, vertical HIV transmission rates and BCG vaccination rates. Findings The estimated incidences of disseminated BCG disease per 1 00 000 BCG-vaccinated, HIV-infected infants were as follows: 778 (95% confidence interval, CI: 361-1319) in 2004 (vertical HIV transmission rate: 10.4%); 1300 (95% CI: 587-2290) in 2005 (transmission rate; 6.1%); and 1013 (95% CI: 377-1895) in 2006 (transmission rate: 5.4%). The pooled incidence over the study period was 992 (95% CI: 567-1495) per 1 00 000. Conclusion Multicentre surveillance data showed that the risk of disseminated BCG disease in HIV-infected infants is considerably higher than previously estimated, although likely to be under-estimated. There is an urgent need for data on the risk-benefit ratio of BCG vaccination in HIV-infected infants to inform decision-making in settings where HIV infection and tuberculosis burdens are high. Safe and effective tuberculosis prevention strategies are needed for HIV-infected infants. Objectif Determiner l'incidence en population de l'infection disseminee par le bacille de Calmette-Guerin (BCG) chez les nourrissons infectes par le VIH (age [menor que o igual a] 1 an) dans une situation caracterisee par une forte charge de tuberculose et d'infections a VIH, mais aussi par un bon fonctionnement du programme de prevention de l'infection par le VIH chez les nourrissons. Methodes Le numerateur, ou nombre de nouveaux cas d'infection disseminee par le BCG, a ete determine a partir des donnees de surveillance multicentrique, collectees prospectivement au sujet des nourrissons presentant une infection a VIH confirmee au cours de la periode 2004-2006. Le denominateur, ou nombre total de nourrissons infectes par le VIH et vaccines par le BCG, a ete obtenu a partir d'estimations en population du nombre de nourrissons vivants et a partir de la prevalence rapportee des infections a VIH maternelles, des taux de transmission verticale du VIH et des taux de vaccination par le BCG. Resultats L'incidence de l'infection disseminee par le BCG pour 100 000 nourrissons vaccines par le BCG a ete estimee a: 778 cas (intervalle de confiance a 95 %, IC : 361-1319) en 2004 (taux de transmission verticale du VIH : 10,4 %) ; 1300 cas (IC a 95 % : 587-2290) en 2005 (taux de transmission : 6,1%) ; et 1013 cas (IC a 95 % : 377-1895) en 2006 (taux de transmission : 5,4 %). L'incidence globale sur l'ensemble de la periode etudiee etait de 992 (IC a 95 % : 567-1495) pour 100 000. Conclusion Les donnees de surveillance multicentrique ont montre que le risque d'infection disseminee par le BCG chez les nourrissons infectes par le VIH etait considerablement plus eleve qu'on ne l'avait estime auparavant, bien que probablement encore sous-estime. On a besoin d'urgence de donnees sur le rapport risque/benefice de la vaccination par le BCG chez les nourrissons infectes par le VIH pour etayer la prise de decisions dans des contextes ou les charges d'infection a VIH et de tuberculose sont importantes. Des strategies sures et efficaces de prevention de la tuberculose sont necessaires pour les nourrissons infectes par le VIH. Objetivo Determinar la incidencia poblacional de la infeccion diseminada por el bacilo de Calmette-Guerin (BCG) en lactantes (ninos [menor que o igual a] 1 anos) en un entorno de alta carga de tuberculosis e infeccion por VIH y de aplicacion satisfactoria de un programa de prevencion de la infeccion por VIH en los lactantes. Metodos El numerador, o numero de nuevos casos de infeccion diseminada por BCG, se calculo a partir de datos de vigilancia multicentricos reunidos prospectivamente sobre lactantes con infeccion confirmada por VIH durante 2004-2006. El denominador, o numero total de lactantes infectados por el VIH y vacunados con la BCG, se calculo a partir de estimaciones poblacionales del numero de lactantes vivos y de la prevalencia de infeccion materna por VIH, de las rasas de transmision vertical del VIH y de las tasas de vacunacion con BCG. Resultados Las incidencias estimadas de infeccion diseminada por BCG por 100 000 lactantes infectados por el VIH y vacunados con BCG fueron las siguientes: 778 (intervalo de confianza del 95%, IC95%: 361-1319) en 2004 (transmision vertical del VIH: 10,4%); 1300 (IC95%: 587-2290) en 2005 (tasa de transmision: 6,1%); y 1013 (IC95%: 377-1895) en 2006 (tasa de transmision: 5,4%). La incidencia combinada a lo largo del periodo estudiado fue de 992 (IC95%: 567-1495) por 100 000. Conclusion Los datos de la vigilancia multicentrica revelaron que el riesgo de infeccion diseminada por BCG en los lactantes infectados por el VIH era considerablemente superior al estimado anteriormente. Urge disponer de datos sobre la relacion riesgobeneficio de la vacunacion con BCG en los lactantes infectados por el VIH a fin de fundamentar la adopcion de decisiones en los entornos con alta carga de infeccion por VIH y de tuberculosis. Es preciso formular estrategias seguras y eficaces de prevencion de la tuberculosis para los lactantes infectados por el VIH., Introduction Vaccination with bacille Calmette-Guerin (BCG), alive attenuated strain of Mycobacterium bovis, is almost universally given in sub-Saharan African countries where the brunt of the global burden of paediatric infection [...]

The emergence of antibiotic-resistant Streptococcus pneumoniae is an international health problem. Apart from South Africa few data on pneumococcal resistance are available for sub-Saharan Africa. This study examines the nasopharyngeal carriage and prevalence of antibiotic resistance in pneumococci isolated from 260 Zambian children aged [is less than] 6 years. Pneumococci were isolated from 71.9% of the children; the odds of carrying organisms were twice as high among children [is less than] 2 years of age compared with older children. Antibacterial resistance was found in 34.1% of the isolates; resistance to tetracycline, penicillin, sulfamethoxazole + trimethoprim, and chloramphenicol occurred in 23.0%, 14.3%, 12.7%, and 3.9% of the isolates, respectively. Only 4% of the isolates were resistant to three drugs. High-level resistance was found in all isolates resistant to tetracycline; but only intermediate level penicillin resistance was found. A total of 11.1 % of the isolates demonstrated intermediate resistance to sulfamethoxazole + trimethoprim. Children aged [is less than] 6 months were less likely to carry antibiotic-resistant organisms. Antibiotic resistance in S. pneumoniae appears to be an emerging public health problem in Zambia, and the national policy for the empirical treatment of pneumococcal meningitis and acute respiratory tract infections may need to be reevaluated. The establishment of ongoing surveillance to monitor trends in pneumococcal resistance should be considered., Introduction Pneumonia is a major cause of morbidity and mortality worldwide, particularly among children in developing countries, where half of the pneumonia-related deaths involve under-1-year-olds. In the pre-antibiotic era, 77% [...]

Purpose of the study: To determine factors associated with suppressed or unsuppressed HIV in adults receiving combination antiretroviral therapy (cART) in Zambia. Methods: This was a cross‐sectional study conducted between August 2008 and October 2009 in 16 Zambian communities nested within the ZAMSTAR trial [1]. Adult TB cases identified at a TB clinic of each community and their adult household members were invited to participate in the study. A structured interview was used to obtain information on the participants’ social, demographic and clinical characteristics. Socio‐economic position (SEP) was measured using household wealth indices used in demographic health surveys. Principal component analysis was used to determine the cut‐off for high (wealthy) and low (poor) SEP. Depression symptoms were measured using the Center for Epidemiological Studies Depression scale (CES‐D). A cut‐off of≥22 on the CES‐D was used to define current depression [2]. Participants were included in this analysis if they were found to be receiving cART for>90 days at the time of the interview. The outcome was HIV suppression (viral load≤300 copies/ml). In both univariable and multivariable analyses, log Poisson regression models with robust standard errors adjusted for the 16 communities were used to calculate the risk ratios (RR), 95% confidence intervals (CI) and p‐values of factors associated with HIV suppression. In multivariable analysis, each variable was independently assessed for its association with HIV suppression while minimally adjusting for a priori confounders (age, gender and education level). Summary of results: There were 520 patients receiving cART for>90 days. The median age was 35 years (inter‐quartile range: 31–41) and 328/520 (63.1%) were married (Table). HIV suppression HIV suppression vs. no suppression n=520 Yes No Unadjusted Adjusted N (column %) N (row %) N (row %) RR (95% CI) p‐value RR (95% CI) p‐value Age group, years 16 to 25 47 (9.0) 39 (83.0) 8 (17.0) 1 26 to 35 220 (42.3) 183 (83.2) 37 (16.8) 1.00 (0.85–1.18) 0.976 36 to 45 187 (36.0) 162 (86.6) 25 (13.4) 1.04 (0.91–1.20) 0.541 Above 45 66 (12.7) 58 (87.9) 8 (12.1) 1.06 (0.90–1.25) 0.503 Gender Men 204 (39.2) 169 (82.8) 35 (17.2) 1 Women 316 (60.8) 273 (86.4) 43 (13.6) 1.04 (0.97–1.12) 0.261 Education level None/Primary 241 (46.3) 200 (83.0) 41 (17.0) 1 Secondary 279 (53.7) 242 (86.7) 37 (13.3) 1.05 (0.95–1.15) 0.358 Socio‐economic position (SEP) Low 287 (55.2) 252 (87.8) 35 (12.2) 1 1 High 220 (42.3) 177 (80.5) 43 (19.5) 0.92 (0.86–0.98) 0.009 0.90 (0.84 – 0.96) 0.001 Missing 13 (2.5) 12 (92.3) 1 (7.7) Type of cART Tenofovir (TDF)+emtricitabine (FTC)+nevirapine (NVP) 61 (11.7) 48 (78.7) 13 (21.3) 1 1 TDF+FTC+efavirenz (EFV) 182 (35.0) 154 (84.6) 28 (15.4) 1.08 (0.95–1.22) 0.26 1.09 (0.96–1.25) 0.187 Stavudine (d4T)+lamivudine (3TC)+NVP 197 (37.9) 168 (85.3) 29 (14.7) 1.08 (0.97–1.21) 0.158 1.05 (0.94–1.18) 0.379 Zidovudine (ZDV)+3TC+EFV 78 (15.0) 70 (89.7) 8 (10.3) 1.14 (1.01–1.28) 0.027 1.11 (0.99–1.25) 0.071 Missing 2 (0.4) 2 (100.0) 0 (0.0) History of tuberculosis No 108 (20.8) 92 (85.2) 16 (14.8) 1 1 Yes 412 (79.2) 350 (85.0) 62 (15.0) 1.00 (0.89–1.11) 0.961 1.01 (0.91–1.13) 0.818 Current depression No 416 (80.0) 355 (85.3) 61 (14.7) 1 1 Yes 77 (14.8) 63 (81.8) 14 (18.2) 0.96 (0.84–1.09) 0.523 0.96 (0.84–1.09) 0.493 Missing 27 (5.2) 24 (88.9) 3 (11.1) Of the 520 patients, 442 (85.0%) had HIV suppression while 78 (15.0%) did not. At univariable analysis, having high SEP was negatively associated with HIV suppression while receiving ZDV+3TC+EFV was positively associated with HIV suppression. At multivariable analysis, patients with high SEP were less likely to have HIV suppression than those with low SEP. Conclusions: Patients with high SEP were found to be at risk of having unsuppressed HIV. There is need for targeted interventions that can improve HIV outcomes in this group of patients receiving cART in Zambia., References Ayles HM, Sismanidis C, Beyers N, Hayes RJ, Godfrey‐Faussett P. ZAMSTAR, The Zambia South Africa TB and HIV Reduction study: design of a 2 × 2 factorial community randomized [...]

Zambia, which has a population of 8 million and a 3.2% growth rate, is concerned about the high HIV seropositivity rate in the country. The highest seropositivity was observed in young adults, with women contracting AIDS at a younger age than men. The Zambian government is taking steps to propagate preventive measures such as using condoms.