Considerations for preparing a randomized population health intervention trial: lessons from a South African–Canadian partnership to improve the health of health workers

Background: Community-based cluster-randomized controlled trials (RCTs) are increasingly being conducted to address pressing global health concerns. Preparations for clinical trials are well-described, as are the steps for multi-component health service trials. However, guidance is lacking for addressing the ethical and logistic challenges in (cluster) RCTs of population health interventions in low- and middle-income countries. Objective: We aimed to identify the factors that population health researchers must explicitly consider when planning RCTs within North–South partnerships. Design: We reviewed our experiences and identified key ethical and logistic issues encountered during the pre-trial phase of a recently implemented RCT. This trial aimed to improve tuberculosis (TB) and Human Immunodeficiency Virus (HIV) prevention and care for health workers by enhancing workplace assessment capability, addressing concerns about confidentiality and stigma, and providing onsite counseling, testing, and treatment. An iterative framework was used to synthesize this analysis with lessons taken from other studies. Results: The checklist of critical factors was grouped into eight categories: 1) Building trust and shared ownership; 2) Conducting feasibility studies throughout the process; 3) Building capacity; 4) Creating an appropriate information system; 5) Conducting pilot studies; 6) Securing stakeholder support, with a view to scale-up; 7) Continuously refining methodological rigor; and 8) Explicitly addressing all ethical issues both at the start and continuously as they arise. Conclusion: Researchers should allow for the significant investment of time and resources required for successful implementation of population health RCTs within North–South collaborations, recognize the iterative nature of the process, and be prepared to revise protocols as challenges emerge

Understanding the evolution of interspecies interactions in microbial communities

ISSN:0962-8436ISSN:1471-2970ISSN:0080-462

Comparative Evaluation of Public-Private Partnerships in Roadway Preservation

In a bid to reduce overall costs, manage risks, and attract private capital, highway agencies worldwide strive to increase private-sector participation in road infrastructure development, particularly at the developmental phases of construction and preservation. A common mechanism for private-sector participation is the concept of a public-private partnership (PPP). As agencies grapple with the decision about whether to adopt a specific PPP or the traditional contracting approach for a specific project, they lack a rational decision-support structure. In addressing this major gap in PPP-related literature, this paper presents a framework by which an agency may assess the performance (relative benefits) of different PPP contracting approaches for highway preservation. For the purposes of this paper, performance is expressed in relation to the likelihood and intensity of cost savings calculated with data from domestic (U.S.) and international projects. In addition, the influence of project and contract attributes (such as the expected project duration, work type, and project size) on PPP project performance is investigated. The framework can be used or duplicated by highway-related agencies and international organizations for identifying the superior contracting option for a given road preservation project on the basis of project characteristics and for quantifying the consequences of such choices for cost savings or other performance criteria