INCORPORATING ANTI-OPPRESSIVE PRINCIPLES INTO PUBLIC HEALTH PEDAGOGY – A QUALITATIVE INQUIRY

Introduction: Public health students are not systematically trained self-awareness of how positionality and power impact public health practice. A grounding in anti-oppression equips future practitioners with tools to recognize the impact of present and historical contexts, foster critical self-reflection, and address systems of oppression. Three aims guided this research: 1) summarize definitions of anti-oppression in peer-reviewed literature; 2) identity how faculty operationalize and apply anti-oppressive principles to public health education; and 3) identity how faculty apply anti-oppressive principles to public health research and practice. The goal of this research was to gather evidence of how anti-oppression is incorporated in public health teaching and research to inform future operationalization of anti-oppression for public health pedagogical practice. Methods: For Aim 1, a scoping review was conducted across seven databases. For Aims 2 and 3, purposive sampling was used to identify public health faculty across schools of public health espousing an explicit commitment to social justice within mission and vision statements. Snowball sampling and word-of-mouth approaches were also employed. Semi-structured in-depth interviews were conducted between January and April 2020 via Zoom; analyses were informed by Constructivist Grounded Theory and conducted using open coding. Results: The scoping review identified 39 unique definitions of anti-oppression of which practice, power, oppression, structures, and systems were core values. Twenty-six faculty from nine schools of public health and one school of medicine participated and highlighted ways in which to engage in anti-oppressive teaching and research while acknowledging challenges in doing so and shared institutional supports and barriers to anti-oppressive practice. Conclusions: Anti-oppression is an explicit framework that can be incorporated in training future public health practitioners to work towards dismantling systems of oppression through addressing issues of power and privilege. Findings from this study indicate that for anti-oppression to be incorporated into public health pedagogy and research, there must be: 1) a consistent and needs-based training of faculty on anti-oppressive practice and 2) a commitment from schools of public health to support an environment that will foster anti-oppressive values which includes but is not limited to offering a network of resources, funding, and administrative support for faculty

"I would really want to know that they had my back": Transgender women's perceptions of HIV cure-related research in the United States.

Forty-four percent of Black transgender women are living with HIV, and many face challenges with HIV care engagement. An HIV cure has much to offer this population, however little HIV cure-related research has included them. We conducted 19 face-to-face in-depth interviews with 10 Black transgender women living with HIV. Interviews were audio recorded, transcribed verbatim, coded, and analyzed using content analysis. Our interview guide contained three categories: 1) perceptions of HIV cure-related research and participation, 2) perceptions of HIV treatment and treatment interruptions, and 3) considerations for transgender women and HIV cure-related research. Salient themes included skepticism about HIV cure strategies and limited benefits compared with an undetectable viral load. Willingness to interrupt HIV treatment for research was low and linked to being able to go back on the same HIV treatment without consequence when the study ended. Concerns about being a test subject and perceptions of risks versus benefits of various strategies also affected willingness to take part in HIV cure-related research. Centering the dignity and autonomy of research participants as well as building upon and supporting existing social networks were identified as important facilitators for engaging Black transgender women in HIV cure-related research. Specific to Black transgender women, other concerns included the desire for gender-affirming research staff, community-building among transgender women, and safety issues associated with risk of transphobic violence when traveling to study visits. Participants stressed the importance of HIV cure-related researchers providing accessible and complete information and expressing genuine care and concern for transgender communities

Using antioppressive teaching principles to transform a graduate global health course at Johns Hopkins University

Education systems and pedagogical practices in global public health are facing substantive calls for change during the current and ongoing ‘decolonising global health’ movement. Incorporating antioppressive principles into learning communities is one promising approach to decolonising global health education. We sought to transform a four-credit graduate-level global health course at the Johns Hopkins Bloomberg School of Public Health using antioppressive principles. One member of the teaching team attended a year-long training designed to support changes in pedagogical philosophy, syllabus development, course design, course implementation, assignments, grading, and student engagement. We incorporated regular student self-reflections designed to capture student experiences and elicit constant feedback to inform real-time changes responsive to student needs. Our efforts at remediating the emerging limitations of one course in graduate global health education provide an example of overhauling graduate education to remain relevant in a rapidly changing global order

Efficacy, duration of protection, birth outcomes, and infant growth associated with influenza vaccination in pregnancy: a pooled analysis of three randomised controlled trials

© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license Background: Maternal influenza immunisation can reduce morbidity and mortality associated with influenza infection in pregnant women and young infants. We aimed to determine the vaccine efficacy of maternal influenza immunisation against maternal and infant PCR-confirmed influenza, duration of protection, and the effect of gestational age at vaccination on vaccine efficacy, birth outcomes, and infant growth up to 6 months of age. Methods: We did a pooled analysis of three randomised controlled trials done in Nepal (2011–2014), Mali (2011–2014), and South Africa (2011–2013). Pregnant women, gestational age 17–34 weeks in Nepal, 28 weeks or more in Mali, and 20–36 weeks in South Africa, were enrolled. Women were randomly assigned 1:1 to a study group, in which they received trivalent inactivated influenza vaccine (IIV) in all three trials, or a control group, in which they received saline placebo in Nepal and South Africa or quadrivalent meningococcal conjugate vaccine in Mali. Enrolment at all sites was complete by April 24, 2013. Infants and women were assessed for respiratory illness, and samples from those that met the case definition were tested for influenza by PCR testing. Growth measurements, including length and weight, were obtained at birth at all sites, at 24 weeks in South Africa, and at 6 months in Nepal and Mali. The three trials are registered with ClinicalTrials.gov, numbers NCT01430689, NCT01034254, and NCT02465190. Findings: 10 002 women and 9800 liveborn infants were included. Pooled efficacy of maternal vaccination to prevent infant PCR-confirmed influenza up to 6 months of age was 35% (95% CI 19 to 47). The pooled estimate was 56% (28 to 73) within the first 2 months of life, 39% (11 to 58) between 2 and 4 months, and 19% (–9 to 40) between 4 and 6 months. In women, from enrolment during pregnancy to the end of follow-up at 6 months postpartum, the vaccine was 50% (95% CI 32–63) efficacious against PCR-confirmed influenza. Efficacy was 42% (12 to 61) during pregnancy and 60% (36 to 75) postpartum. In women vaccinated before 29 weeks gestational age, the estimated efficacy was 30% (–2 to 52), and in women vaccinated at or after 29 weeks, efficacy was 71% (50 to 83). Efficacy was similar in infants born to mothers vaccinated before or after 29 weeks gestation (34% [95% CI 12 to 51] vs 35% [11 to 52]). There was no overall association between maternal vaccination and low birthweight, stillbirth, preterm birth, and small for gestational age. At 6 months of age, the intervention and control groups were similar in terms of underweight (weight-for-age), stunted (length-for-age), and wasted (weight-for-length). Median centile change from birth to 6 months of age was similar between the intervention and the control groups for both weight and length. Interpretation: The assessment of efficacy for women vaccinated before 29 weeks gestational age might have been underpowered, because the point estimate suggests that there might be efficacy despite wide CIs. Estimates of efficacy against PCR-confirmed influenza and safety in terms of adverse birth outcomes should be incorporated into any further consideration of maternal influenza immunisation recommendations. Funding: Bill & Melinda Gates Foundation

Three randomized trials of maternal influenza immunization in Mali, Nepal, and South Africa: Methods and expectations

© 2015 The Authors. Influenza infection in pregnancy can have adverse impacts on maternal, fetal, and infant outcomes. Influenza vaccination in pregnancy is an appealing strategy to protect pregnant women and their infants. The Bill & Melinda Gates Foundation is supporting three large, randomized trials in Nepal, Mali, and South Africa evaluating the efficacy and safety of maternal immunization to prevent influenza disease in pregnant women and their infants \u3c6 months of age. Results from these individual studies are expected in 2014 and 2015. While the results from the three maternal immunization trials are likely to strengthen the evidence base regarding the impact of influenza immunization in pregnancy, expectations for these results should be realistic. For example, evidence from previous influenza vaccine studies - conducted in general, non-pregnant populations - suggests substantial geographic and year-to-year variability in influenza incidence and vaccine efficacy/effectiveness. Since the evidence generated from the three maternal influenza immunization trials will be complementary, in this paper we present a side-by-side description of the three studies as well as the similarities and differences between these trials in terms of study location, design, outcome evaluation, and laboratory and epidemiological methods. We also describe the likely remaining knowledge gap after the results from these trials become available along with a description of the analyses that will be conducted when the results from these individual data are pooled. Moreover, we highlight that additional research on logistics of seasonal influenza vaccine supply, surveillance and strain matching, and optimal delivery strategies for pregnant women will be important for informing global policy related to maternal influenza immunization