Zimbabwean women and HIV care access analysis of UK immigration and health policies

Background: NHS Regulations were amended in 2004, restricting access to secondary healthcare for refused asylum applicants. In recent years there have been substantial numbers of unsuccessful asylum applications from Zimbabwean nationals. HIV-positive Zimbabweans with insecure immigration status in the UK occupy a precarious medico-legal position, especially since HAART is not available to most in Zimbabwe. There has been little research on these policies or their effects on the lives of Zimbabwean HIV-positive women in the UK. Objectives: This thesis examines the development and implementation of UK policy relating to access to HIV-related services by Zimbabwean HIV-positive women with insecure immigration status, and explores how these policies influence women's healthcare. Methods: Three separate strategies were used for data collection. Policy analysis scrutinised 35 publicly available documents and additional material obtained through Freedom of Information (FOI) requests. Data for policy analysis were also collected through semistructured interviews with 24 HIV/immigration key informants. Further qualitative data were collected through semi-structured interviews with 13 Zimbabwean HIV-positive women with insecure immigration status. These different approaches allowed for data 'triangulation'. Results: Policy restricting access to healthcare for migrants is situated within three immigration control strategies of deterrence, internal control, and 'enforced discomfort'. Implementation of the policy has been limited by staff who interpret it to suit their own agendas. Access to HIV-care for Zimbabwean women seems to bear little relation to these policies, but their access to other health services and their wellbeing was influenced by a number of other socio-structural barriers associated with their immigration status. Conclusions: These results offer new evidence and theoretical models on the politics of immigration policy, the role of street-level bureaucrats as mediators of the gap between policy and practice, and on access to healthcare for migrants. There is a disjuncture between policy on entitlement and clinical practice, which may reflect a conflict between clinicians' duty of care and UK policy. Zimbabwean women's HIV- and migrant-status places them in a periphery, reducing the resources available to them that could mitigate some of the barriers they face

Suspicious Behavior Detection with Temporal Feature Extraction and Time-Series Classification for Shoplifting Crime Prevention

The rise in crime rates in many parts of the world, coupled with advancements in computer vision, has increased the need for automated crime detection services. To address this issue, we propose a new approach for detecting suspicious behavior as a means of preventing shoplifting. Existing methods are based on the use of convolutional neural networks that rely on extracting spatial features from pixel values. In contrast, our proposed method employs object detection based on YOLOv5 with Deep Sort to track people through a video, using the resulting bounding box coordinates as temporal features. The extracted temporal features are then modeled as a time-series classification problem. The proposed method was tested on the popular UCF Crime dataset, and benchmarked against the current state-of-the-art robust temporal feature magnitude (RTFM) method, which relies on the Inflated 3D ConvNet (I3D) preprocessing method. Our results demonstrate an impressive 8.45-fold increase in detection inference speed compared to the state-of-the-art RTFM, along with an F1 score of 92%,outperforming RTFM by 3%. Furthermore, our method achieved these results without requiring expensive data augmentation or image feature extraction

Health care worker vaccination against Ebola: Vaccine acceptance and employment duration in Sierra Leone.

Health care workers (HCW) are at high risk of Ebola virus disease (EVD) infection during epidemics and may contribute to onward transmission, and therefore HCW-targeted prophylactic vaccination strategies are being considered as interventions. To assess the feasibility of preventive HCW vaccination, we conducted a pilot survey on staff turnover and vaccine acceptance amongst 305 HCW in Freetown and Kambia districts of Sierra Leone. Multivariable logistic regression demonstrated which demographic and behavioural factors were associated with acceptance of a hypothetical new vaccine. We quantified the duration of employment of HCW, and used multivariable gamma regression to detect associations with duration of employment in current or any health care position. Finally, we simulated populations of HCW, to determine the likely future immunisation coverage amongst HCW based on our estimates of vaccine acceptance and employment duration. Most HCW we surveyed had a positive opinion of EVD vaccination (76.3%). We found that being a volunteer HCW (vs being on the government payroll) was associated with increased vaccine acceptance. We found that HCW have stable employment, with a mean duration of employment in the health sector of 10.9 years (median 8.0 years). Older age and being on the government payroll (vs volunteer HCW) were associated with a longer duration of employment in the health sector. Assuming a single vaccine campaign, with 76.3% vaccine acceptance, 100% vaccine efficacy and no waning of vaccine-induced protection, immunisation coverage was sustained over 50% until 6 years after a vaccination campaign. If vaccine-induced immunity wanes at 10% per year, then the immunisation coverage among HCW would fall below 50% after 3 years. Vaccinating HCW against EVD could be feasible as employment appeared stable and vaccine acceptance high. However, even with high vaccine efficacy and long-lasting immunity, repeated campaigns or vaccination at employment start may be necessary to maintain high coverage

A snapshot of the practicality and barriers to COVID-19 interventions: Public health and healthcare workers' perceptions in high and low- and middle-income countries.

BACKGROUND: In response to the COVID-19 pandemic, governments have implemented a range of non-pharmaceutical interventions (NPIs) and pharmaceutical interventions (PIs) to reduce transmission and minimise morbidity and mortality, whilst maintaining social and economic activities. The perceptions of public health workers (PHWs) and healthcare workers (HCWs) are essential to inform future COVID-19 strategies as they are viewed as trusted sources and are at the forefront of COVID-19 response. The objectives of this study were to 1) describe the practicality of implementing NPIs and PIs and 2) identify potential barriers to implementation, as perceived by HCWs and PHWs. METHODS: We conducted a cross-sectional study of PHWs and HCWs perceptions of the implementation, practicality of, and barriers to implementation of NPIs and PIs using an online survey (28/9/2020-1/11/2020) available in English, French and Portuguese. We used descriptive statistics and thematic analysis to analyse quantitative and qualitative responses. RESULTS: In total, 226 respondents (67 HCWs and 159 PHWs) from 52 countries completed the survey and 222 were included in the final analysis. Participants from low and middle-income countries (LMICs) accounted for 63% of HCWs and 67% of PHWs, with the remaining from high-income (HICs). There was little difference between the perceptions of PHWs and HCWs in HICs and LMICs, with the majority regarding a number of common NPIs as difficult to implement. However, PHWs in HICs perceived restrictions on schools and educational institutions to be more difficult to implement, with a lack of childcare support identified as the main barrier. Additionally, most contact tracing methods were perceived to be more difficult to implement in HICs than LMICs, with a range of barriers reported. A lack of public support was the most commonly reported barrier to NPIs overall across both country income and professional groups. Similarly, public fear of vaccine safety and lack of vaccine supply were the main reported barriers to implementing a COVID-19 vaccine. However, PHWs and HCWs in LMICs perceived a lack of financial support and the vaccine being manufactured in another country as additional barriers. CONCLUSION: This snapshot provides insight into the difficulty of implementing interventions as perceived by PHWs and HCWs. There is no one-size-fits-all solution to implementing interventions, and barriers in different contexts do vary. Barriers to implementing a vaccine programme expressed here by HCWs and PHCWs have subsequently come to the fore internationally

A mixed-methods analysis of personal protective equipment used in Lassa fever treatment centres in Nigeria.

BACKGROUND: Lassa fever (LF) is a viral haemorrhagic fever endemic in West Africa. Lassa virus is maintained in and spread to humans from rodents, with occasional secondary human-to-human transmission. Present recommendations for personal protective equipment (PPE) for care of patients with LF generally follow those for filovirus diseases. However, the need for such high-level PPE for LF, which is thought to be considerably less transmissible between humans than filoviruses, is unclear. AIM: In Nigerian Lassa Treatment Centres (LTCs) we aimed to describe current PPE practices, identify barriers and facilitators to implementation of existing guidance, and assess healthcare workers' understanding. This would inform the development of future PPE guidelines for LF. METHODS: We performed a mixed-methods study, including short cross-sectional surveys of PPE used in LTCs, observations of practice, and in-depth interviews with key informants. We described the quantitative data and we conducted a thematic analysis of qualitative data. FINDINGS: Our survey of 74 HCWs found that approximately half reported problems with recommended PPE. In three LTCs PPE was used highly variably. Full PPE, as recommended in Nigeria CDC guidelines, was used in less than a quarter (21%) of interactions. In-depth interviews suggested this was based on availability and HCWs' own risk assessments. CONCLUSION: Without specific guidance on Lassa, the current approach is both resource and labour-intensive, where these are both limited. This has led to low adherence by health care workers, whose own experience indicates lower risk. The evidence-base to inform PPE required for LF must be improved to inform a more tailored approach

The response is like a big ship': community feedback as a case study of evidence uptake and use in the 2018-2020 Ebola epidemic in the Democratic Republic of the Congo.

INTRODUCTION: The 2018-2020 Ebola outbreak in the Democratic Republic of the Congo (DRC) took place in the highly complex protracted crisis regions of North Kivu and Ituri. The Red Cross developed a community feedback (CF) data collection process through the work of hundreds of Red Cross personnel, who gathered unprompted feedback in order to inform the response coordination mechanism and decision-making. AIM: To understand how a new CF system was used to make operational and strategic decisions by Ebola response leadership. METHODS: Qualitative data collection in November 2019 in Goma and Beni (DRC), including document review, observation of meetings and CF activities, key informant interviews and focus group discussions. FINDINGS: The credibility and use of different evidence types was affected by the experiential and academic backgrounds of the consumers of that evidence. Ebola response decision-makers were often medics or epidemiologists who tended to view quantitative evidence as having more rigour than qualitative evidence. The process of taking in and using evidence in the Ebola response was affected by decision-makers' bandwidth to parse large volumes of data coming from a range of different sources. The operationalisation of those data into decisions was hampered by the size of the response and an associated reduction in agility to new evidence. CONCLUSION: CF data collection has both instrumental and intrinsic value for outbreak response and should be normalised as a critical data stream; however, a failure to act on those data can further frustrate communities

Characterising social contacts under COVID-19 control measures in Africa.

BACKGROUND: Early in the COVID-19 pandemic, countries adopted non-pharmaceutical interventions (NPIs) such as lockdowns to limit SARS-CoV-2 transmission. Social contact studies help measure the effectiveness of NPIs and estimate parameters for modelling SARS-CoV-2 transmission. However, few contact studies have been conducted in Africa. METHODS: We analysed nationally representative cross-sectional survey data from 19 African Union Member States, collected by the Partnership for Evidence-based Responses to COVID-19 (PERC) via telephone interviews at two time points (August 2020 and February 2021). Adult respondents reported contacts made in the previous day by age group, demographic characteristics, and their attitudes towards COVID-19. We described mean and median contacts across these characteristics and related contacts to Google Mobility reports and the Oxford Government Response Stringency Index for each country at the two time points. RESULTS: Mean reported contacts varied across countries with the lowest reported in Ethiopia (9, SD=16, median = 4, IQR = 8) in August 2020 and the highest in Sudan (50, SD=53, median = 33, IQR = 40) in February 2021. Contacts of people aged 18-55 represented 50% of total contacts, with most contacts in household and work or study settings for both surveys. Mean contacts increased for Ethiopia, Ghana, Liberia, Nigeria, Sudan, and Uganda and decreased for Cameroon, the Democratic Republic of Congo (DRC), and Tunisia between the two time points. Men had more contacts than women and contacts were consistent across urban or rural settings (except in Cameroon and Kenya, where urban respondents had more contacts than rural ones, and in Senegal and Zambia, where the opposite was the case). There were no strong and consistent variations in the number of mean or median contacts by education level, self-reported health, perceived self-reported risk of infection, vaccine acceptance, mask ownership, and perceived risk of COVID-19 to health. Mean contacts were correlated with Google mobility (coefficient 0.57, p=0.051 and coefficient 0.28, p=0.291 in August 2020 and February 2021, respectively) and Stringency Index (coefficient -0.12, p = 0.304 and coefficient -0.33, p=0.005 in August 2020 and February 2021, respectively). CONCLUSIONS: These are the first COVID-19 social contact data collected for 16 of the 19 countries surveyed. We find a high reported number of daily contacts in all countries and substantial variations in mean contacts across countries and by gender. Increased stringency and decreased mobility were associated with a reduction in the number of contacts. These data may be useful to understand transmission patterns, model infection transmission, and for pandemic planning

Role and effectiveness of telephone hotlines in outbreak response in Africa: A systematic review and meta-analysis.

BACKGROUND: In Africa, little is known about the role of telephone hotlines in outbreak response. We systematically reviewed the role and effectiveness of hotlines on outbreak response in Africa. METHOD: We used the Cochrane handbook and searched five databases. The protocol was registered on PROSPERO (CRD42021247141). Medline, Embase, PsycINFO, Global Health and Web of Science were searched from 30 June 2020 to August 2020 for studies on the use of telephone hotlines in outbreak response in Africa published between January 1995 and August 2020. The search was also repeated on 16 September 2022. Data on effectiveness (alerts generated, cases confirmed) were extracted from peer-reviewed studies. Meta-analysis of alerts generated, and proportion of cases confirmed was done using the random effects model. The quality of studies was assessed using the Joanna Briggs Institute (JBI) tools. The heterogeneity and publication bias were assessed using the Galbraith and funnel plots, respectively. RESULTS: Our search yielded 1251 non-duplicate citations that were assessed. 41 full texts were identified, and 21 studies were included in the narrative synthesis, while 12 were included in the meta-analysis. The hotlines were local (seven studies) or national (three studies). A combination of a local and national hotline was used in one study. The hotlines were set up for unusual respiratory events (one study), polio (one study), Ebola (10 studies), COVID-19 (two studies), malaria (one study), influenza-like illnesses (ILI) (one study) and rift valley fever in livestock (one study). Hotlines were mainly used for outbreak surveillance at the local level. A total of 332,323 alerts were generated, and 67,658 met the case definition, corresponding to an overall pooled proportion of alerts generated(sensitivity) of 38% (95%CI: 24-52%). The sensitivity was 41% (95% CI: 24-59%) for local hotlines and 26%(95%CI:5-47%) for national hotlines. Hotlines were also used for surveillance of rift valley fever in livestock (one study) vaccination promotion (one study), death reporting (five studies), rumour tracking and fighting misinformation (two studies) and community engagement (five studies). The studies were of low to moderate quality with high publication bias and heterogeneity(I2 = 99%). The heterogeneity was not explained by the sample size. CONCLUSION: These data suggest that telephone hotlines can be effective in outbreak disease surveillance in Africa. Further implementation research is needed to scale up telephone hotlines in rural areas

Role and effectiveness of telephone hotlines in outbreak response in Africa: A systematic review and meta-analysis

Background In Africa, little is known about the role of telephone hotlines in outbreak response. We systematically reviewed the role and effectiveness of hotlines on outbreak response in Africa. Method We used the Cochrane handbook and searched five databases. The protocol was registered on PROSPERO (CRD42021247141). Medline, Embase, PsycINFO, Global Health and Web of Science were searched from 30 June 2020 to August 2020 for studies on the use of telephone hotlines in outbreak response in Africa published between January 1995 and August 2020. The search was also repeated on 16 September 2022. Data on effectiveness (alerts generated, cases confirmed) were extracted from peer-reviewed studies. Meta-analysis of alerts generated, and proportion of cases confirmed was done using the random effects model. The quality of studies was assessed using the Joanna Briggs Institute (JBI) tools. The heterogeneity and publication bias were assessed using the Galbraith and funnel plots, respectively. Results Our search yielded 1251 non-duplicate citations that were assessed. 41 full texts were identified, and 21 studies were included in the narrative synthesis, while 12 were included in the meta-analysis. The hotlines were local (seven studies) or national (three studies). A combination of a local and national hotline was used in one study. The hotlines were set up for unusual respiratory events (one study), polio (one study), Ebola (10 studies), COVID-19 (two studies), malaria (one study), influenza-like illnesses (ILI) (one study) and rift valley fever in livestock (one study). Hotlines were mainly used for outbreak surveillance at the local level. A total of 332,323 alerts were generated, and 67,658 met the case definition, corresponding to an overall pooled proportion of alerts generated(sensitivity) of 38% (95%CI: 24–52%). The sensitivity was 41% (95% CI: 24–59%) for local hotlines and 26%(95%CI:5–47%) for national hotlines. Hotlines were also used for surveillance of rift valley fever in livestock (one study) vaccination promotion (one study), death reporting (five studies), rumour tracking and fighting misinformation (two studies) and community engagement (five studies). The studies were of low to moderate quality with high publication bias and heterogeneity(I2 = 99%). The heterogeneity was not explained by the sample size. Conclusion These data suggest that telephone hotlines can be effective in outbreak disease surveillance in Africa. Further implementation research is needed to scale up telephone hotlines in rural areas