Value and effectiveness of National Immunization Technical Advisory Groups in low- and middle-income countries : A qualitative study of global and national perspectives

© The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.The Global Vaccine Action Plan proposes that every country establish or have access to a National Immunization Technical Advisory Group (NITAG) by 2020. The NITAG role is to produce evidence-informed recommendations that incorporate local context, to guide national immunization policies and practice. This study aimed to explore the value and effectiveness of NITAGs in low- and middle-income countries (LMICs), identifying areas in which NITAGs may require further support to improve their functionality and potential barriers to global investment. A multi-methods study design was used, comprising 134 semi-structured interviews and 82 literature review sources that included 38 countries. Interviews were conducted with 53 global/regional and 81 country-level participants able to provide insight into NITAG effectiveness, including NITAG members, national immunization programme staff, and global agency representatives (e.g. the World Health Organisation, the Bill and Melinda Gates Foundation, Gavi the Vaccine Alliance). The review, including published and unpublished sources on NITAGs in LMICs, was conducted to supplement and corroborate interview findings. Data were analysed thematically. NITAGs were described as valuable in promoting evidence-informed vaccination decision-making, with NITAG involvement enhancing national immunization programme strength and sustainability. Challenges to NITAG effectiveness included: (1) unreliable funding; (2) insufficient diversity of member expertise; (3) inadequate conflicts of interest management procedures; (4) insufficient capacity to access and use evidence; (5) lack of transparency; and (6) limited integration with national decision-making processes that reduced the recognition and incorporation of NITAG recommendations. LMIC NITAGs have developed significantly in the past decade. Well-functioning NITAGs were trusted national resources that enhanced country ownership of immunization provision. However, many LMIC NITAGs require additional technical and funding support to strengthen quality and effectiveness, while maintaining impartiality and ensuring sufficient integration with national decision-making processes. Barriers to sustainable global support need to be addressed for LMIC NITAGs to both continue and develop further.Peer reviewedFinal Published versio

Vaccination uptake and health service access amongst Polish and Romanian communities in England: a qualitative interview study – research summary

At the London School of Hygiene and Tropical Medicine, we are conducting a study to explore vaccination uptake and health service access amongst Polish and Romanian communities in England. In this summary, we provide the rationale for conducting this research and an overview of the study design

Cereal Breakfast Foods

"After writing this thesis I have drawn for my conclusion that cereal breakfast foods as a class are nutritious, convenient, and reasonably economical foods and should have a very important place in the diet."--Conclusio

Are HIV services in England accessible and acceptable to adults diagnosed with HIV at age 50 years and over? A mixed-methods study

In the UK, new HIV diagnoses are increasing in adults aged 50 years and over, a group that also has a higher likelihood of testing at an advanced stage of disease than younger people. Despite this, limited research has examined the pathway to HIV diagnosis and treatment experienced by this age group, or looked more broadly at the impact of living with HIV after diagnosis at this age. Using a mixed-methods approach, this thesis explores the acceptability and accessibility of HIV services in England to adults diagnosed at age 50+ years, from the perspective of these service users and healthcare professionals (HCPs) working in sexual health/HIV services and involved in caring for this age group. This thesis draws on semi-structured interviews with service users; an online survey and semi-structured interviews with HCPs; as well as national data on sexual health/GUM clinic attendance, HIV test coverage, and new HIV diagnoses by age. Adults aged 50+ years are found to experience often complex and non-linear journeys to HIV testing, particularly if they do not belong to a ‘risk group’ targeted in HIV prevention and testing efforts. Barriers to prompt HIV diagnosis include (i) the non-specific nature of HIV symptoms and their misattribution as being age-related, (ii) an age-associated decline in risk perception, and (iii) the decreased likelihood of HIV test offer in advancing age. Both service users and HCPs perceive HIV treatment services to provide exceptional care, which is associated with the benefits of closer health monitoring, clinician expertise in HIV, and consistency in care. General practitioners (GPs) by contrast appear to be underutilised in the management of older people with HIV, which may be particularly detrimental as these service users often develop additional, age-related morbidities, which extend beyond the remit of HIV clinician knowledge. The thesis concludes by highlighting a need to reconsider the model of HIV care in England, especially with respect to the role of GPs in HIV service provision. It is likely that increased GP involvement would optimise care and encourage the normalisation of HIV, which would promote testing and reduce stigma

The role of National Immunisation Technical Advisory Groups (NITAGs) in strengthening national vaccine decision-making: A comparative case study of Armenia, Ghana, Indonesia, Nigeria, Senegal and Uganda.

INTRODUCTION: Improving evidence informed decision-making in immunisation is a global health priority and many low and middle-income countries have established National Immunisation Technical Advisory Groups (NITAGs) as independent technical advisory bodies for this purpose. NITAG development and strengthening has received financial and technical support over the past decade, but relatively little evaluation. This study examined NITAGs in six low and middle-income countries (i.e. Armenia, Ghana, Indonesia, Nigeria, Senegal, Uganda), to examine functionality, quality of recommendation development, and integration with national decision-making bodies and processes. METHODS: A mixed-method case-series design, used semi-structured interviews, NITAG meeting observations, and document review. Data were analysed thematically. RESULTS: Five NITAGs had been legally established with terms of reference and appeared well functioning, with Ghana's in development. All NITAGs had standard operating procedures and nomination procedures to ensure a range of expertise, generally comprising 10-15 core, 1-5 secretariat, and several ex-officio members. Aside from economics, NITAGs reported a wide range of member expertise. Newer NITAGs had particular concerns about funding. Four used formal conflict of interest procedures, although some commented that implications were not always understood. NITAGs valued local data, and limited evidence suggested NITAG presence might reinforce data production through surveillance and local research studies. All observed meetings demonstrated due process and evidence-based decision-making processes were generally followed, with a critical role played by working-group data syntheses and assessments. NITAGs were seen as well integrated with ministry of health (MoH) decision-making and MoH interviewees were positive about NITAG contributions, indicating NITAGs had an important role. Collaboration with other bodies was more limited, but mitigated by NITAG members' cross-membership in other bodies. CONCLUSIONS: NITAGs have an important and valued role within national immunisation decision-making. However, their position remains insecure, with the need for sustainable technical and financial support

''It sounded a lot simpler on the job description'': A qualitative study exploring the role of social prescribing link workers and their training and support needs (2020)

Jenna Rhodes - ORCID: 0000-0002-9973-4383 https://orcid.org/0000-0002-9973-4383Social prescribing is an increasingly popular approach to promoting health and well‐being, by addressing the wider determinants of health such as physical inactivity, social isolation and financial insecurity. Social prescribing link workers (SPs) connect people to local, non‐clinical services. As part of the NHS Long Term Plan, NHS England aims to recruit 1,000 SPs across England by 2021. Understanding the role of SPs, including challenging aspects of the role and the types of training and support needed by SPs is crucial to optimising the effectiveness of social prescribing. Semi‐structured qualitative interviews were conducted with nine SPs from five NHS and voluntary sector organisations in London to explore the role of SPs and identify SP training and support needs. Interviews were analysed thematically and three key themes emerged for which SPs needed particular support: defining and promoting their role; supporting clients with complex needs and coping with the emotional demands of their role. SP perceptions of training and future training needs is presented as a fourth theme. Most SPs felt that the initial training received for their role did not prepare them for the most demanding aspects of their roles. The findings of this study support the assertion that the social prescribing link worker role is complex and challenging. SPs are required to have in‐depth knowledge of local services, which is built over time and makes retention in the role of high importance. Steps have been taken to develop online resources to support SPs, however, there may be a need for more comprehensive training, especially in mental health. SPs benefit from access to peer or one‐to‐one support to help them manage the emotional demands of the role and could benefit from the formation of local networks, especially for SPs working in isolation.https://doi.org/10.1111/hsc.1335829pubpub

Effects of Lewis Acid Catalysts on the Hydrogenation and Cracking of Two-Ring Aromatic and Hydroaromatic Structures Related to Coal

An investigation was carried out of the hydrogenation and cracking of two-ring aromatic and hydroaromatic compounds catalyzed by ZnCl{sub 2} and AlCl{sub 3}. The rates of both processes are strongly affected by the Bronsted acidity of the active catalyst [e.g., H{sup +}(MX{sub n}Y){sup -}] and the Bronsted basicity of the aromatic portions of the reactant, the latter characteristic being enhanced by either methyl or hydroxyl substitution. The source of hydrogen used for hydrogenation depends on the choice of catalyst. In the presence of AlCl{sub 3}, Scholl condensation of aromatic nuclei serves as the principle source of hydrogen. Molecular hydrogen is used exclusively, though, when hydrogenation is catalyzed by ZnCl{sub 2}. The formation of reaction products and the trends in reactant reactivity are discussed on the basis of carbonium ion mechanisms

Parents' and guardians' views on the acceptability of a future COVID-19 vaccine: A multi-methods study in England.

BACKGROUND: The availability of a COVID-19 vaccine has been heralded as key to controlling the COVID-19 pandemic. COVID-19 vaccination programme success will rely on public willingness to be vaccinated. METHODS: We used a multi-methods approach - involving an online cross-sectional survey and semi-structured interviews - to investigate parents' and guardians' views on the acceptability of a future COVID-19 vaccine. 1252 parents and guardians (aged 16 + years) who reported living in England with a child aged 18 months or under completed the survey. Nineteen survey participants were interviewed. FINDINGS: Most survey participants reported they would likely accept a COVID-19 vaccine for themselves (Definitely 55.8%; Unsure but leaning towards yes 34.3%) and their child/children (Definitely 48.2%; Unsure but leaning towards yes 40.9%). Less than 4% of survey participants reported that they would definitely not accept a COVID-19 vaccine. Survey participants were more likely to accept a COVID-19 vaccine for themselves than their child/children. Participants that self-reported as Black, Asian, Chinese, Mixed or Other ethnicity were almost 3 times more likely to reject a COVID-19 vaccine for themselves and their children than White British, White Irish and White Other participants. Survey participants from lower-income households were also more likely to reject a COVID-19 vaccine. In open-text survey responses and interviews, self-protection from COVID-19 was reported as the main reason for vaccine acceptance. Common concerns identified in open-text responses and interviews were around COVID-19 vaccine safety and effectiveness, mostly prompted by the newness and rapid development of the vaccine. CONCLUSION: Information on how COVID-19 vaccines are developed and tested, including their safety and efficacy, must be communicated clearly to the public. To prevent inequalities in uptake, it is crucial to understand and address factors that may affect COVID-19 vaccine acceptability in ethnic minority and lower-income groups who are disproportionately affected by COVID-19

Parents’ and guardians’ views and experiences of accessing routine childhood vaccinations during the coronavirus (COVID-19) pandemic: A mixed-methods study in England

AbstractObjectiveTo explore parents’ and guardians’ views and experiences of accessing National Health Service (NHS) general practices for routine childhood vaccinations during the coronavirus (COVID-19) pandemic in England.DesignMixed methods approach involving an online cross-sectional survey (conducted between 19th April and 11th May 2020) and semi-structured telephone interviews (conducted between 27th April and 27th May 2020).Participants1252 parents and guardians (aged 16+ years) who reported living in England with a child aged 18 months or under completed the survey. Nineteen survey respondents took part in follow-up interviews.ResultsThe majority of survey respondents (85.7%) considered it important for their children to receive routine vaccinations on schedule during the COVID-19 pandemic; however, several barriers to vaccination were identified. These included a lack of clarity around whether vaccination services were operating as usual, particularly amongst respondents from lower income households and those self-reporting as Black, Asian, Chinese, Mixed or Other ethnicity; difficulties in organising vaccination appointments; and fears around contracting COVID-19 while attending general practice.Concerns about catching COVID-19 while accessing general practice were weighed against concerns about children acquiring a vaccine-preventable disease if they did not receive scheduled routine childhood vaccinations. Many parents and guardians felt their child’s risk of acquiring a vaccine-preventable disease was low as the implementation of stringent physical distancing measures (from March 23rd 2020) meant they were not mixing with others.ConclusionTo promote routine childhood vaccination uptake during the current COVID-19 outbreak, further waves of COVID-19 infection, and future pandemics, prompt and sustained national and general practice level communication is needed to raise awareness of vaccination service continuation and the importance of timely vaccination, and invitation-reminder systems for vaccination need to be maintained. To allay concerns about the safety of accessing general practice, practices should communicate the measures being implemented to prevent COVID-19 transmission.</jats:sec