A discrete choice experiment to assess people living with HIV’s (PLWHIV’s) preferences for GP or HIV clinic appointments

Objectives: To understand which aspects of general practitioner (GP) and HIV clinic appointments people living with HIV (PLWHIV) most value when seeking advice for new health problems. Methods: A discrete choice experiment using a convenience sample of people diagnosed with HIV. Participants were recruited from 14 general HIV clinics in the South East of England between December 2014 and April 2015. ORs were calculated using conditional logit (CLOGIT) and latent class models (LCMs). Results: A total of 1106 questionnaires were returned. Most participants were male (85%), white (74%) and were men who have sex with men (69%). The CLOGIT analysis showed people particularly valued shorter appointment waiting times (ORs between 1.52 and 3.62, p<0.001 in all instances). The LCM analysis showed there were two distinct classes, with 59% and 41% of respondents likely to be in each. The first class generally preferred GP to HIV clinic appointments and particularly valued ‘being seen quickly’. For example, they had strong preferences for shorter appointment waiting times and longer GP opening hours. People in the second class also valued shorter waiting times, but they had a strong general preference for HIV clinic rather than GP appointments. Conclusions: PLWHIV value many aspects of care for new health problems, particularly short appointment waiting times. However, they appear split in their general willingness to engage with GPs

Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: a qualitative study

Background: Increasing routine HIV testing among key populations is a public health imperative, so improving access to acceptable testing options for those in need is a priority. Despite increasing targeted distribution and uptake of HIV self-sampling kits (SSKs) among men who have sex with men in the UK, little is known about why targeted SSK interventions for black African users are not as wide-spread or well-used. This paper addresses this key gap, offering insight into why some groups may be less likely than others to adopt certain types of SSK interventions in particular contexts. These data were collected during the development phase of a larger study to explore the feasibility and acceptability of targeted distribution of SSKs to black African people. Methods: We undertook 6 focus groups with members of the public who self-identified as black African (n = 48), 6 groups with specialists providing HIV and social services to black African people (n = 53), and interviews with HIV specialist consultants and policy-makers (n = 9). Framework analysis was undertaken, using inductive and deductive analysis to develop and check themes. Results: We found three valuable components of targeted SSK interventions for this population: the use of settings and technologies that increase choice and autonomy; targeted offers of HIV testing that preserve privacy and do not exacerbate HIV stigma; and ensuring that the specific kit being used (in this case, the TINY vial) is perceived as simple and reliable. Conclusions: This unique and rigorous research offers insights into participants’ views on SSK interventions, offering key considerations when targeting this population.. Given the plethora of HIV testing options, our work demonstrates that those commissioning and delivering SSK interventions will need to clarify (for users and providers) how each kit type and intervention design adds value. Most significantly, these findings demonstrate that without a strong locus of control over their own circumstances and personal information, black African people are less likely to feel that they can pursue an HIV test that is safe and secure. Thus, where profound social inequalities persist, so will inequalities in HIV testing uptake – by any means

High‐risk behaviours, and their associations with mental health, adherence to antiretroviral therapy and HIV parameters, in HIV ‐positive men who have sex with men

Objectives To investigate the patterns and frequency of multiple risk behaviours (alcohol, drugs, smoking, higher risk sexual activity) among men who have sex with men (MSM) living with HIV. Methods Cross sectional study. Results 819 HIV-positive MSM exhibited a high-risk phenotype (defined as >3 of smoking, excess alcohol, sexually transmitted infection and recent recreational drug use). This phenotype was associated with younger age, depressive symptoms and <90% adherence in multivariable logistic regression. Conclusion In a cohort of MSM, a small, but significant proportion exhibited multiple concurrent risk behaviours

Labour after Land Reform: The Precarious Livelihoods of Former Farmworkers in Zimbabwe

What happens to labour when major redistributive land reform restructures a system of settler colonial agriculture? This article examines the livelihoods of former farmworkers on large‐scale commercial farms who still live in farm compounds after Zimbabwe's land reform. Through a mix of surveys and in‐depth biographical interviews, four different types of livelihood are identified, centred on differences in land access. These show how diverse, but often precarious, livelihoods are being carved out, representing the ‘fragmented classes of labour’ in a restructured agrarian economy. The analysis highlights the tensions between gaining new freedoms, notably through access to land, and being subject to new livelihood vulnerabilities. The findings are discussed in relation to wider questions about the informalization of the economy and the role of labour and employment in a post‐settler agrarian economy, where the old ‘farmworker’ label no longer applies

Social Value at Universities: Policy and Practice Guidance

Universities globally can be major hubs of social and economic activity which drive change in society. We know that they can create multiple and diverse routes into employment, can have significant purchasing power which can inform standards across supply chains, can create learning opportunities which directly nourish and enrich local communities, and can deliver research and innovation which impact health for the better. However, the measurable difference these make to lives – and how universities and the funding bodies account for this impact - is still unknown. We created the Global Symposia for Social Value at Universities in 2022, as a way to accelerate the movement. Over 130 joined from 12 countries to contribute to the analysis, from different disciplines such as health, arts, environmental sciences, alongside private, public and third sector stakeholders. There were two symposiums. The first was related to understanding policy and practice across disciplines at universities; the second was focused on one of the biggest sectors, business and management studies. This report presents the findings from both symposiums from the perspective of different stakeholders: 1. what is currently being done that is valued 2. recommendations for improvement The Global Symposia at Universities 2022 was co-hosted between Social Value UK and Liverpool John Moores University, the British Academy of Management (Sustainable and Responsible Business SIG), Principles for Responsible Management Education (Working Group on Poverty), University Vocational Awards Council, Social Value International, The Academy of Business in Society, American International Accreditation Association for Schools and Colleges, and the National Society for Experiential Education. Maddy England and Clare Bentley at Social Value UK were also central to delivering this guidance. Supported by Liverpool John Moores University’s Quality Research Funds

Zimbabwe’s land reform: challenging the myths

Most commentary on Zimbabwe’s land reform insists that agricultural production has almost totally collapsed, that food insecurity is rife, that rural economies are in precipitous decline, that political ‘cronies’ have taken over the land and that farm labour has all been displaced. This paper however argues that the story is not simply one of collapse and catastrophe; it is much more nuanced and complex, with successes as well as failures. The paper provides a summary of some of the key findings from a ten-year study in Masvingo province and the book Zimbabwe’s Land Reform: Myths and Realities. The paper documents the nature of the radical transformation of agrarian structure that has occurred both nationally and within the province, and the implications for agricultural production and livelihoods. A discussion of who got the land shows the diversity of new settlers, many of whom have invested substantially in their new farms. An emergent group ‘middle farmers’ is identified who are producing, investing and accumulating. This has important implications – both economically and politically – for the future, as the final section on policy challenges discusses.ESR

High-risk behaviours, and their associations with mental health, adherence to antiretroviral therapy and HIV parameters, in HIV-positive men who have sex with men

OBJECTIVES: To investigate the patterns and frequency of multiple risk behaviours (alcohol, drugs, smoking, higher risk sexual activity) among men who have sex with men (MSM) living with HIV. METHODS: Cross sectional study. RESULTS: 819 HIV-positive MSM exhibited a high-risk phenotype (defined as >3 of smoking, excess alcohol, sexually transmitted infection and recent recreational drug use). This phenotype was associated with younger age, depressive symptoms and <90% adherence in multivariable logistic regression. CONCLUSION: In a cohort of MSM, a small, but significant proportion exhibited multiple concurrent risk behaviours

Validation of a Novel Multivariate Method of Defining HIV-Associated Cognitive Impairment

Background. The optimum method of defining cognitive impairment in virally suppressed people living with HIV is unknown. We evaluated the relationships between cognitive impairment, including using a novel multivariate method (NMM), patientreported outcome measures (PROMs), and neuroimaging markers of brain structure across 3 cohorts.Methods. Differences in the prevalence of cognitive impairment, PROMs, and neuroimaging data from the COBRA, CHARTER, and POPPY cohorts (total n = 908) were determined between HIV-positive participants with and without cognitive impairment defined using the HIV-associated neurocognitive disorders (HAND), global deficit score (GDS), and NMM criteria.Results. The prevalence of cognitive impairment varied by up to 27% between methods used to define impairment (eg, 48% for HAND vs 21% for NMM in the CHARTER study). Associations between objective cognitive impairment and subjective cognitive complaints generally were weak. Physical and mental health summary scores (SF-36) were lowest for NMM-defined impairment (P&lt;.05). There were no differences in brain volumes or cortical thickness between participants with and without cognitive impairment defined using the HAND and GDS measures. In contrast, those identified with cognitive impairment by the NMM had reduced mean cortical thickness in both hemispheres (P&lt;.05), as well as smaller brain volumes (P&lt;.01). The associations with measures of white matter microstructure and brain-predicted age generally were weaker.Conclusion. Different methods of defining cognitive impairment identify different people with varying symptomatology and measures of brain injury. Overall, NMM-defined impairment was associated with most neuroimaging abnormalities and poorer selfreported health status. This may be due to the statistical advantage of using a multivariate approach

HIV-1 drug resistance mutations emerging on darunavir therapy in PI-naive and -experienced patients in the UK

\ua9 The Author 2016. Background: Darunavir is considered to have a high genetic barrier to resistance. Most darunavir-associated drug resistance mutations (DRMs) have been identified through correlation of baseline genotype with virological response in clinical trials. However, there is little information on DRMs that are directly selected by darunavir in clinical settings. Objectives: We examined darunavir DRMs emerging in clinical practice in the UK. Patients and methods: Baseline and post-exposure protease genotypes were compared for individuals in the UK Collaborative HIV Cohort Study who had received darunavir; analyses were stratified for PI history. A selection analysis was used to compare the evolution of subtype B proteases in darunavir recipients and matched PInaive controls. Results: Of 6918 people who had received darunavir, 386 had resistance tests pre- and post-exposure. Overall, 2.8% (11/386) of these participants developed emergent darunavir DRMs. The prevalence of baseline DRMs was 1.0% (2/198) among PI-naive participants and 13.8% (26/188) among PI-experienced participants. Emergent DRMs developed in 2.0% of the PI-naive group (4 mutations) and 3.7% of the PI-experienced group (12 mutations). Codon 77 was positively selected in the PI-naive darunavir cases, but not in the control group. Conclusions: Our findings suggest that although emergent darunavir resistance is rare, it may be more common among PI-experienced patients than those who are PI-naive. Further investigation is required to explore whether codon 77 is a novel site involved in darunavir susceptibility