Research Article (New England Journal of Medicine) A trial of a 7-valent pneumococcal conjugate vaccine in HIV-infected adults

Background: Streptococcus pneumoniae is a leading and serious coinfection in  adults with human immunodeficiency virus (HIV) infection, particularly in Africa. Prevention of this disease by vaccination with the current 23-valent polysaccharide vaccine is suboptimal. Protein conjugate vaccines offer a further option for protection, but data on their clinical efficacy in adults are needed.Methods: In this double-blind, randomized, placebo-controlled clinical efficacy trial, we studied the efficacy of a 7-valent conjugate pneumococcal vaccine in predominantly HIV-infected Malawian adolescents and adults who had recovered from documented invasive pneumococcal disease. Two doses of vaccine were given 4 weeks apart. The primary end point was a further episode of pneumococcal infection caused by vaccine serotypes or serotype 6A.Results: From February 2003 through October 2007, we followed 496 patients (of whom 44% were male and 88% were HIV-seropositive) for 798 person-years of observation. There were 67 episodes of pneumococcal disease in 52 patients, all in the HIV-infected subgroup. In 24 patients, there were 19 episodes that were caused by vaccine serotypes and 5 episodes that were caused by the 6A serotype. Of these episodes, 5 occurred in the vaccine group and 19 in the placebo group, for a vaccine efficacy of 74% (95% confidence interval [CI], 30 to 90). There were 73 deaths from any cause in the vaccine group and 63 in the placebo group (hazard ratio in the vaccine group, 1.18; 95% CI, 0.84 to 1.66). The number of serious adverse events within 14 days after vaccination was significantly lower in the  vaccine group than in the placebo group (3 vs. 17, P = 0.002), and the number of minor adverse events was significantly higher in the vaccine group (41 vs. 13, P = 0.003).Conclusions: The 7-valent pneumococcal conjugate vaccine protected HIV-infected adults from recurrent pneumococcal infection caused by vaccine serotypes or serotype 6A. (Current Controlled Trials number, ISRCTN54494731.

Measuring Regional Policy Change and Pro-Poor Health Policy Success: A PRARI Toolkit of Indicators for the Southern African Development Community (SADC)

PRARI is a social development research project that looks at world-regional social governance, politics, and policy. PRARI brings together an international team of researchers studying the scope for enhancing the effectiveness of the contributions of Southern regional organisations to poverty reduction. It receives funding from the ESRC

Critical agency and development: applying Freire and Sen to ICT4D in Zambia and Brazil

This paper draws upon critical theories and the capability approach. It argues for a conceptualization of development as a process designed to enable people to free themselves from structural disadvantage. Amartya Sen has argued that people’s “critical-agency” to question and reject unjust social norms is “pivotal” to human development and important for tackling inequalities of any kind. Freire’s critical pedagogy, and critical feminism, go further by providing disadvantaged people with the practical means to do this; to identify the structural root causes of unjust social norms and the critical-agency to challenge and change them. Two empirical case studies of ICT4D are presented, from Zambia and Brazil, which draw upon these critical approaches but use them in different ways. The paper argues that ICT4D must go beyond addressing people’s immediate practical needs for access to ICT tools and skills, to also address their strategic interest in identifying and tackling the root causes of disadvantage