A new precedent in international health cooperation from African public health leaders

Peer Reviewe

From “getting things right” to “getting things right now”: Developing COVID-19 guidance under time pressure and knowledge uncertainty

Background - At the start of the COVID-19 pandemic, guidance was needed more than ever to direct frontline healthcare and national containment strategies. Rigorous guidance based on robust research was compromised by the emergence of the pandemic and the urgency of need for guidance. Rather than aiming to “get guidance right”, guidance developers needed to “get guidance right now”. Aim - To examine how guidance developers have responded to the need for credible guidance at the start of the COVID-19 pandemic. Methods - An exploratory mixed-methods study was conducted among guidance developers. A web-based survey and follow-up interviews were used to examine the most pertinent challenges in developing COVID-19 guidance, strategies used to address these, and perspectives on the implications of the COVID-19 pandemic on future guidance development. Results - The survey was completed by 46 guidance developers. Survey findings showed that conventional methods of guidance development were largely unsuited for COVID-19 guidance, with 80% (n = 37) of respondents resorting to other methods. From the survey and five follow-up interviews, two themes were identified to bolster the credibility of guidance in a setting of extreme uncertainty: (1) strengthening end-user involvement and (2) conjoining evidence review and recommendation formulation. 70% (n = 32) of survey respondents foresaw possible changes in future guidance production, most notably shortening development time, by reconsidering how to balance between rigour and speed for different types of questions. Conclusion - “Getting guidance right” and “getting guidance right now” are not opposites, rather uncertainties are always part of guidance development and require guidance developers to balance scientific robustness with usability, acceptability, adequacy and contingency. This crisis points to the need to acknowledge uncertainties of scientific evidence more explicitly and points to mechanisms to live with such uncertainty, thus extending guidance development methods and processes more widely

PRECEPT: an evidence assessment framework for infectious disease epidemiology, prevention and control

Decisions in public health should be based on the best available evidence, reviewed and appraised using a rigorous and transparent methodology. The Project on a Framework for Rating Evidence in Public Health (PRECEPT) defined a methodology for evaluating and grading evidence in infectious disease epidemiology, prevention and control that takes different domains and question types into consideration. The methodology rates evidence in four domains: disease burden, risk factors, diagnostics and intervention. The framework guiding it has four steps going from overarching questions to an evidence statement. In step 1, approaches for identifying relevant key areas and developing specific questions to guide systematic evidence searches are described. In step 2, methodological guidance for conducting systematic reviews is provided; 15 study quality appraisal tools are proposed and an algorithm is given for matching a given study design with a tool. In step 3, a standardised evidence-grading scheme using the Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) methodology is provided, whereby findings are documented in evidence profiles. Step 4 consists of preparing a narrative evidence summary. Users of this framework should be able to evaluate and grade scientific evidence from the four domains in a transparent and reproducible way.Funding Agencies|European Centre for Disease Prevention and Control (ECDC) [2012/040, 2014/008]</p

Different knowledge, different styles of reasoning: a challenge for guideline development

The development, monitoring, and reporting of indicator measures that describe standard of care provide the gold standard for assessing quality of care and patient outcomes. Although indicator measures have been reported, little evidence of their use in measuring and benchmarking performance is available. A standard set, defining numerator, denominator, and risk adjustments, will enable global benchmarking of quality of care.SW received funding from the European Union Seventh Framework Programme (FP7‐PEOPLE‐2013‐COFUND), Grant/ Award Number: 609020. TZJ received funding from a fellowship in the Future Research Leaders program of Linköping University. The OA fee was paid for by the Guidelines International Network

Epidemiology of HPV Genotypes among HIV Positive Women in Kenya: A Systematic Review and Meta-Analysis

Background: There is a scarcity of data on the distribution of human papillomavirus (HPV) genotypes in the HIV positive population and in invasive cervical cancer (ICC) in Kenya. This may be different from genotypes found in abnormal cytology. Yet, with the advent of preventive HPV vaccines that target HPV 16 and 18, and the nonavalent vaccine targeting 90% of all ICC cases, such HPV genotype distribution data are indispensable for predicting the impact of vaccination and HPV screening on prevention. Even with a successful vaccination program, vaccinated women will still require screening to detect those who will develop ICC from other High risk (HR) HPV genotypes not prevented by current vaccines. The aim of this review is to report on the prevalence of pHR/HR HPV types and multiple pHR/HR HPV genotypes in Kenya among HIV positive women with normal, abnormal cytology and ICC. Methods: PUBMED, EMBASE, SCOPUS, and PROQUEST were searched for articles on HPV infection up to August 2nd 2016. Search terms were HIV, HPV, Cervical Cancer, Incidence or Prevalence, and Kenya. Results: The 13 studies included yielded a total of 2116 HIV-infected women, of which 89 had ICC. The overall prevalence of pHR/HR HPV genotypes among HIV-infected women was 64% (95%CI: 50%-77%). There was a borderline significant difference in the prevalence of pHR/HR HPV genotypes between Female Sex workers (FSW) compared to non-FSW in women with both normal and abnormal cytology. Multiple pHR/HR HPV genotypes were highly prominent in both normal cytology/HSIL and ICC. The most prevalent HR HPV genotypes in women with abnormal cytology were HPV 16 with 26%, (95%CI: 23.0%-30.0%) followed by HPV 35 and 52, with 21% (95%CI: 18%-25%) and 18% (95%CI: 15%-21%), respectively. In women with ICC, the most prevalent HPV genotypes were HPV 16 (37%; 95%CI: 28%-47%) and HPV 18 (24%; 95%CI: 16%-33%). Conclusion: HPV 16/18 gains prominence as the severity of cervical disease increases, with HPV 16/18 accounting for 61% (95%CI: 50.0%-70.0%) of all ICC cases. A secondary prevention program will be necessary as this population harbors multiple pHR/HR HPV co-infections, which may not be covered by current vaccines. A triage based on FSW as an indicator may be warranted

Poor self-reported adherence to COVID-19-related quarantine/isolation requests, Norway, April to July 2020.

To limit SARS-CoV-2 spread, quarantine and isolation are obligatory in several situations in Norway. We found low self-reported adherence to requested measures among 1,704 individuals (42%; 95% confidence interval: 37-48). Adherence was lower in May-June-July (33-38%) compared with April (66%), and higher among those experiencing COVID-19-compatible symptoms (71%) compared with those without (28%). These findings suggest that consideration is required of strategies to improve people's adherence to quarantine and isolation

Erfaringar etter handteringa av smitte og utbrot av covid-19 i Noreg hausten 2021 og vinteren 2022 i utvalde kommunar

Source at https://www.fhi.no/.Kommunane har hatt ei avgjerande rolle i handteringa av smitte og utbrot gjennom pandemien. Kommunane har gjort dette i samarbeid med nabokommunar, statsforvaltarar og nasjonale helsestyresmakter. Dette gjeld også for kommunane som deltok i denne gjennomgangen. Denne rapporten har ved hjelp av intervju med eit utval kommunar hausta erfaringar om korleis ulike kommunar har oppdaga og handtert utbrot og tiltak knytt til situasjonen lokalt, regionalt og nasjonalt. Målet har vore å hausta erfaringar for så å kunna trekka lærdom av handteringa av covid19 i kommunane. Studieperioden har vore frå august 2021 (frå skulestart med innføring av test for karantene) til februar 2022 (då nasjonale tiltak vart oppheva). Fokusområda i denne gjennomgangen har vore på kontaktreduserande tiltak, TISK (testing, isolering, smittesporing og karantene), og tiltak i skular

Erfaringsgjennomgang etter utvalgte utbrudd av covid-19 i Norge, desember 2020 – mars 2021

Source at https://www.fhi.no/Denne rapporten beskriver en erfaringsgjennomgang av utvalgte covid-19 utbrudd i Norge, desember 2020 – mars 2021. Rapporten har blitt ledet av en intern arbeidsgruppe ved Folkehelseinstituttet (FHI) og er gjennomført i samarbeid med Helsedirektoratet, utvalgte kommuner og tilhørende statsforvaltere våren 2021. Hensikten har vært å oppsummere erfaringer og lære underveis, særlig knyttet til håndtering av utbrudd med den engelske virusvarianten og bruk av forsterket TISK (testing, isolering, smittesporing og karantene). Denne prosessen har gitt relevant innsikt