Does a bursary scheme for students in low- to middle-income countries influence outcomes in a master’s programme in Public Health?

Introduction The People’s Open Access Education Initiative (Peoples-uni) provides online education for health professionals in Public Health at the master’s level. Although fees are low due to the use of volunteers and Open Educational Resources, a bursary scheme is provided to waive all or some of the fees. This study tests the hypothesis that student outcomes of completing and passing modules are higher among those given a bursary than others. Methods Data were retrieved for all students enrolling between 2009-2017, including demographics and module outcomes, where available. Multivariable logistic regression was used to identify factors associated with a successful bursary application, as well as to elicit whether a successful bursary application was associated with ever completing, or ever passing, a module. Results Data were obtained from 1499 students. Of these, 624 (42%) had ever completed a module, and 513 (34%) had ever passed a module. 503 students (34%) had applied for a bursary, of whom 285 (57%) were successful. After adjusting for demographic variables, employment status and education level, students who were given a bursary were more likely to ever pass a module (adjusted odds ratio [aOR] 2.3, 95% CI 1.7,3.3), as were those who applied for a bursary but were unsuccessful (aOR 1.9, 95% CI 1.3,2.8), compared with students who had not applied for a bursary. Similar results were obtained for the outcome of completing a module. Conclusions Students who were successful in gaining a bursary, as well as those who were not but still able to enroll, were more likely to complete or pass a module than those who did not apply. These results point to the success of the bursary scheme and give us confidence to continue to offer bursaries, in order to sustain the mission of improving population health through capacity building in low resource settings

"It went through the roof": an observation study exploring the rise in PrEP uptake among Zimbabwean female sex workers in response to adaptations during Covid-19

INTRODUCTION: Sisters with a Voice (Sisters), a programme providing community-led differentiated HIV prevention and treatment services, including condoms, HIV testing, pre-exposure prophylaxis (PrEP) and antiretroviral therapy linkage for sex workers, reached over 26,000 female sex workers (FSW) across Zimbabwe in 2020. Zimbabwe's initial Covid "lockdown" in March 2020 and associated movement restrictions interrupted clinical service provision for 6 weeks, particularly in mobile clinics, triggering the adaptation of services for the Covid-19 context and a scale up of differentiated service delivery (DSD) models. PrEP service delivery decentralized with shifts from clinical settings towards community/home-based, peer-led PrEP services to expand and maintain access. We hypothesize that peer-led community-based provision of PrEP services influenced both demand and supply-side determinants of PrEP uptake. We observed the effect of these adaptations on PrEP uptake among FSW accessing services in Sisters in 2020. METHODS: New FSW PrEP initiations throughout 2020 were tracked by analysing routine Sisters programme data and comparing it with national PrEP initiation data for 2020. We mapped PrEP uptake among all negative FSW attending services in Sisters alongside Covid-19 adaptations and shifts in the operating environment throughout 2020: prior to lockdown (January-March 2020), during severe restrictions (April-June 2020), subsequent easing (July-September 2020) and during drug stockouts that followed (October-December 2020). RESULTS AND DISCUSSION: PrEP uptake in 2020 occurred at rates <25% (315 initiations or fewer) per month prior to the emergence of Covid-19. In response to Covid-19 restrictions, DSD models were scaled up in April 2020, including peer demand creation, community-based delivery, multi-month dispensing and the use of virtual platforms for appointment scheduling and post-PrEP initiation support. Beginning May 2020, PrEP uptake increased monthly, peaking at an initiation rate of 51% (n = 1360) in September 2020. Unexpected rise in demand coincided with national commodity shortages between October and December 2020, resulting in restriction of new initiations with sites prioritizing refills. CONCLUSIONS: Despite the impact of Covid-19 on the Sisters Programme and FSW mobility, DSD adaptations led to a large increase in PrEP initiations compared to pre-Covid levels demonstrating that a peer-led, community-based PrEP service delivery model is effective and can be adopted for long-term use

Open access publication of public health research in African journals

There are many claims to the benefits of open access publishing in general and for Africa in particular. This study aimed to describe the characteristics of scholarly journals expected to publish articles on public health from a number of African countries. Using African Journals Online and African Index Medicus, 174 journals from 13 African countries were identified. The six countries above the group’s median gross domestic product (GDP) published 145 journals, while the seven countries at or below the median GDP published 29 journals. Two thirds of the journals were freely available to download, but only a third had a Creative Commons licence, and most were not indexed. Around half of the journals levied full article processing charges (APCs) – journals from countries at median GDP or below were less likely to charge APCs than those from countries above the median GDP. One of the key findings is that only a few journals were indexed, limiting the ability of potential readers to find the results of research performed in local settings. The results suggest a need to assist journals and researchers to make the work they publish more accessible to the audience who might want to use the results

How Can We Support the Use of Oral PrEP Among Young Women who Sell Sex? A PrEP Cascade Analysis.

BACKGROUND: We constructed self-reported pre-exposure prophylaxis (PrEP) cascades and explored factors associated with and barriers to PrEP use to inform efforts to support PrEP use among young women who sell sex. METHODS: Using self-reported data from HIV-negative young women who sell sex enrolled into a cohort study using respondent-driven sampling in Zimbabwe, we constructed PrEP cascades assessing knowledge of, ever offered, ever used, and current PrEP use in 2017 and 2019. We used logistic regression to examine factors associated with PrEP use by 2019. Through qualitative interviews with 43 women enrolled in the cohort, we investigated barriers to PrEP use. RESULTS: At enrollment, 50% of women had heard of PrEP, 12% had ever been offered PrEP, and 7% ever used PrEP. Over time, all cascade domains: 96% of women had heard of and 55% reported an active offer of PrEP. Among women retained in the study in 2019 (56%; n = 538), 34% ever took PrEP by 2019. PrEP use was associated with, at enrollment, reporting more clients in the past month (10+: 45% vs 1-3: 27% adjOR = 1.71 95% CI: 1.06 to 2.76), duration of selling sex (24% <2 years vs 38% 2-3 years; adjOR = 0.51 95% CI: 0.32 to 0.83), and having visited a female sex worker program in the past 12 months (55% vs 27%; adjOR = 2.92 95% CI: 1.91 to 4.46). Qualitative interviews revealed fear of disclosing sex work, HIV-related/ART-related stigma, and (opportunity) costs of accessing PrEP as barriers to use. CONCLUSION: PrEP use was associated with factors known to increase HIV risk. Fear of stigma, disclosure, and supply-side barriers need to be addressed to increase women's ability to use PrEP

Curriculum Reform: The Exclusive Advanced Level Divinity vis-a-vis the Inclusive Updated Family and Religious Studies

This paper is a phenomenological discourse on the teaching and learning of Family and Religious studies at Advanced Level. It unravels the ontological turn of the teaching and learning of Family and Religious Studies (FRS) at Advanced Level. The recommendations of the 1999 Presidential commission of inquiry into education and training (CIET) called for the reorientation and reorganization of the syllabi content, aims and pedagogical teachings. The thrust of the recommendations was on the introduction of a multi-cultural approach to the teaching of religious studies in schools. This paper is a comparative analysis of the erstwhile exclusive Divinity syllabus aims, objectives, content and teaching methods vis-a-vis the updated multi-faith Family and Religious Syllabus. This comparative analysis helps to identify the shortcomings of the exclusive curriculum and then the reasons why adoption of multiculturalism was long overdue. It is important to note that the subject has a new title, the first time that it has taken a homogeneous title from form one up-to Advanced Level. Various stakeholders were consulted on the ‘inclusive’ updated 2017-2022 broader curriculum. However, focus of the consultations was on multi-cultural Family and Religious Studies curriculum. The qualitative approach was used in the analysis of data. The research was carried out from March 2017 up to September 2017. As a result, six high schools (church and government run schools) from the Harare Metropolitan Province were randomly sampled; one hundred and fifty religious education learners, twenty parents and twenty teachers (inclusive of five retired Divinity teachers interviewed) were given questionnaires. The six school heads, parents, Minister of Primary and Secondary Education, Scripture Union personnel, retired Religious Education teachers and one FRS curriculum developer were interviewed. The study revealed that stakeholders with a Christian background were against the multi-faith curriculum particularly its inclusion of Islam and African indigenous religion. The inclusion of the two religions is metaphorically and negatively perceived as elephants in the living room. The paper recommends wider awareness on the significance of a multi-cultural study of Family and Religious studies

Perceived value of applying Information Communication Technology to implement guidelines in developing countries; an online questionnaire study among public health workers

INTRODUCTION: Practice guidelines can be used to support healthcare decision making. We sought to identify the use, and barriers to the implementation, of electronic based guidelines to support decision-making in maternal and child healthcare (MCH) and the rational use of medicines, in developing countries. METHODS: Graduates who had gained the Master of Public Health degree through the Peoples-uni (postgraduate public health education in developing countries) were sent an online survey questionnaire which had been piloted. Two reminders were sent to non-respondents at intervals of 10 days. Results were explored using descriptive analyses. RESULTS: 44 of the potential 48 graduates from 16 countries responded – most were from Africa. 82% and 89% of respondents were aware of guidelines on MCH and the rational use of medicines respectively. Electronic guidelines were more available in university hospitals than in provincial hospitals or rural care. All respondents thought that guidelines could improve the delivery of quality care, and 42 (95%) and 41 (93%) respectively thought that computers and mobile or smartphones could increase the use of guidelines in service delivery. Lack of access to computers, need to buy phone credit, need for training in the use of either computerized or phone based guidelines and fear of increased workload were potential barriers to use. CONCLUSION: There is support for the use of electronic guidelines despite limited availability and barriers to use in developing countries. These findings, and other literature, provide a guide as to how the further development of ICT based guidelines may be implemented to improve health care decision making

Compatibility between agendas for improving human development and wildlife conservation outside protected areas: Insights from 20 years of data

The UN Sustainable Development Goals (SDGs) include economic, social and environmental dimensions of human development and make explicit commitments to all of life on Earth. Evidence of continuing global biodiversity loss has, at the same time, led to a succession of internationally agreed conservation targets. With multiple targets (even within one policy realm, e.g. the CBD Aichi Targets for biodiversity), it is possible for different indicators to respond in the same direction, in opposite directions or to show no particular relationship. When considering the different sectors of the SDGs, there are many possible relationships among indicators that have been widely discussed, but rarely analysed in detail. Here, we present a comparative cross‐national analysis exploring temporally integrated linkages between human development indicators and wildlife conservation trends. The results suggest that in lower income countries there are negative relationships between measures of human population growth and bird and mammal population abundance trends outside protected areas. The results also suggest a positive relationship between economic growth and wildlife population trends in lower income countries. We stress, however, the need for future research to further explore the relationships between economic growth and natural resource‐based imports. Our results highlight a clear potential for compatibility of the conservation and development agendas and support the need for further integration among sustainable development strategies