Lokale, regionale, og nasjonale aktørers perspektiver og prioriteringer om villreinforvaltning i Snøhetta villreinområde

Sammendrag Kvalitetsnorm for villrein av 2022 ga resultatet middels kvalitet i fire av ti nasjonale villreinområder, og dårlig kvalitet i de seks resterende (Rolandsen et al., 2022). Én av tre delnormer omhandler leveområder og menneskelig påvirkning, hvor Snøhetta villreinområde fikk dårlig vurdering ettersom ferdselen er på et punkt hvor den forstyrrer villreinens funksjonelle trekkruter (Rolandsen et al., 2022). Dette prosjektet baserer seg på ønsket om å finne ut hvilke syn ulike sentrale forvaltningsmyndigheter og aktører har til dagens situasjon, vurderingen av utfordringer mellom villrein og menneskelig ferdsel, og hvilke tiltak de ser som aktuelle å eventuelt iverksette. Problemstillingen er som følger: Hvordan stiller sentrale aktører seg til ulike virkemidler som kan redusere forstyrrelser av villrein som følge av friluftslivets bruk av Snøhetta villreinområde? Oppgaven baserer seg mye på to teoretiske rammeverk; konfliktteori som beskriver ulike typer konflikter, og virkemiddelpyramiden som beskriver ulike virkemidler tilpasset norske verneområder. Disse teoriene utgjør interessante rammeverk for diskusjon av funn fra resultatene. Prosjektet utgjør en kvalitativ metode med dokumentstudium og semistrukturerte dybdeintervju. Snøhetta villreinområde er et område som er mye forsket på, og dokumentstudiet samler sammen en rekke fagstoff for å lettere kunne utnytte dataene fra intervjuene. Dokumentstudiet inneholder blant annet bruken av området og lovverk. Det ble utført 31 semistrukturerte dybdeintervju med forvaltningsmyndigheter, næringsaktører, brukerinteresser og organisasjoner. Majoriteten av intervjuene ble utført fysisk, men det ble også utført en del digitale intervju i tillegg til enkelte skriftlige- og telefonintervju. Dataene ble transkribert og deretter analysert med både induktiv og deduktiv koding. Dokumentstudiet er omfattende med mange funn. De mest relevante hovedfunnene for intervjuene befinner seg innen menneskelig ferdsel, villreinens arealbruk og trekkruter, samt sentralt rammeverk for verneområdet. Det fremkommer av flere forskningsartikler at ferdselen på Hjerkinnplatået fører til arealunnvikelser og forstyrrer trekkruter for villreinen, særlig ferdselsårene langs Snøheimveien og Stroplsjødalen som utgjør en barriereeffekt i høysesong (Gundersen et al., 2013a). Snøhetta villreinområde inkludert randsonene er beregnet til 70 000 besøkende pr år, hvor 34-40 000 av disse regnes å være besøkende i nasjonalparken, med 12-13 000 årlig besøkende i kjerneområdet ved Snøheim og Snøhetta (Risan et al., 2021). Funn fra dybdeintervjuene inneholder også mange funn med ulike nyanseringer. De aller fleste av informantene mener at villreinen i Snøhetta blir forstyrret av den menneskelige ferdselen, og at det burde iverksettes tiltak. Hovedutfordringene som presenteres av informantene er ferdsel fra både organisert og uorganisert moskusturisme, ferdsel som genereres av DNTs hytter og stinettverk, og jegernes aktivitet under villreinjakta. De fleste informantene er enige i at utfordringene er komplekse, og at totalbelastningen som følge av all ferdselen i området er hovedproblemet. En del mener derfor at det må en dugnad til for å bøte med utfordringene. Fremtidige tiltak som foreslås er strengere regulering av moskusturisme, nedlegging/stenging av Snøheim, Snøheimveien, Reinheim og strengere regler eller profesjonalisering av villreinjakta. Få informanter peker på tiltak de selv kan bidra med til dugnaden. En stor andel av informantene ønsker strengere virkemiddel som ferdselsbegrensninger. Hvem, hvor og når eventuelle ferdselsforbud skal gjelde er det derimot uenighet om. Noen aktører ønsker å holde nivået på myke virkemidler slik det er i dag, men understreker at det trengs fler av disse. Det tegnes flere konflikter gjennom informantene, innad i forvaltningen, mellom aktører, og mellom aktører og forvaltning. Informanter fra den lokale forvaltningen mener at de har for lite ansvar, og at de ofte føler seg overkjørt av Miljødirektoratet når det kommer til tiltak i verneområdet. Flere informanter forteller om konflikt mellom organisert og uorganisert ferdsel, hvor organiserte grupper holder avstand av hensyn til vilt, mens private grupper beveger seg nærmere og forstyrrer viltet. Det presenteres også konflikter mellom jegere og andre brukergrupper i villreinjakta, da det er stor ferdsel på Hjerkinnplatået av en rekke brukergrupper som forstyrrer jegerne og reinen under jakta. I tillegg virker det til å være noen geografiske forskjeller mellom hvor fornøyd de lokale er med forvaltningen, og fremstår som om lokalbefolkning og næringsaktører i Lesja og til en viss grad Sunndal har en mistillit til forvaltningen som ikke fremkommer av informanter fra Dovre og Oppdal. Hvordan brukerne vil stille seg til eventuelle virkemidler vil vi ikke få svar på i vårt prosjekt. Det er et klart behov for videre forskning på hva angår både effekt av ulike virkemidler, særlig ferdselsbegrensinger, og ønske om sterkere virkemidler.Abstract The quality norm of the ten national wild reindeer areas in Norway resulted in mid quality for four of the ten areas, and bad for the remaining six (Rolandsen et al., 2022). One of the subnorms evaluated are habitat area and human impact, where Snøhetta wild reindeer area is classified as bad, due to the disturbance human traffic cause the migratory routes. This project is based on finding out how central natural resource management authority and other stakeholders view the current situation, evaluate wild reindeer and human disturbance challenges, and what management actions they view as appropriate to possibly implement. Main research question: What does central stakeholders think about different management actions as a goal of reducing human disturbance to wild reindeer? Some of the thesis is based on two theoretical frameworks; conflict theory which describes different types of conflicts, and the management actions pyramid which describes different types of management actions adapted for Norwegian protected areas. These theories compose interesting frameworks for discussing findings from the results. The project composes a qualitative method with a document analysis and semi-structured in-depth interviews. Snøhetta wild reindeer area has been extensively researched, and the document analysis gather a great amount of material which makes it easier to discuss data from the interviews. The document analysis, among other things, includes how the area is used, as well as the areas regulations and laws. 31 semi-structured in-depth interviews were conducted including management authorities, tourism operators, user interests and organizations. The majority of interviews were held physically, some digitally, and a few written and telephone interviews. The data was transcribed and then analyzed by both inductive and deductive coding. The document analysis is extensive with several findings. The most relevant main finding is within human use, the wild reindeer habitat use and migration routes, as well as the central law framework for the conservation area. Several research articles write that the human use of Hjerkinnplatået leads to area avoidance and disrupt migration routes for wild reindeer, especially the human use along Snøheimveien and Stroplsjødalen, which constitute a barrier effect in high seasons (Gundersen et al., 2013a). The Snøhetta wild reindeer area including the buffer zones is calculated for 70,000 visitors per year, of which 34-40,000 area considered to be visitors of the national park, with 12-13,000 annual visitors in the core area at Snøheim and Snøhetta (Risan et al., 2021). Finding from the in-depth interviews also contain many findings with different nuances. Most of the informants believe that the wild reindeer in Snøhetta are disturbed by human traffic, and that management actions should be implemented. The main challenges presented by the informants are traffic from both organized and unorganized muskox tourism, human use generated by the Norwegian Trekking Association’s cabins and trails, and hunters’ disturbance during the wild reindeer hunt. Most of the informants agree that the challenges are complex, and that the total load as a result of all human use in the wild reindeer area is the main problem. Some therefore pose that everyone using the area must take some responsibility to reduce their negative impact. Future management actions that are proposed are stricter regulations for muskox tourism, close down Snøheim and Snøheimveien, and implement stricter rules or professionalization of the wild reindeer hunting. Few informants suggest how they themselves can contribute to reduce their negative impact. A large proportion of the informants want stricter management actions such as human use restrictions. On the other hand, there is disagreement among who, where and when any use restrictions should apply. Some informants want to maintain the level of soft management actions as they are today but emphasize that more of these are needed. Several conflicts are drawn through the interviews, within the management, between stakeholders, and between management and stakeholders. Informants from the local management believe that they have too little responsibility, and that they often feel overrun by the Norwegian Environment Agency regarding management actions in the conservation area. Several informants tell of conflict between organized and unorganized human use, where organized groups keep distance considerate to the game, while private groups walk closer and disturb the animals. Conflicts are also presented between hunters and other user groups in the wild reindeer hunt, as there is a lot of traffic at Hjerkinnplatået by a number of users groups that disturb the hunters and reindeer during the hunt. In addition, there seem to be some geographical variations between how satisfied the locals are with the natural resource management, and it appears as if the local population and business operators in Lesja and partially Sunndal have a distrust to the management that is not revealed by informants from Dovre and Oppdal. We will not get an answer to how users will react to any management actions in our project. There is a clear need for further research regarding both the effect of various management actions, particularly traffic restrictions, and desire for stronger management actions

Abstracts of the 20th College of Medicine Research Dissemination Conference

No Abstract

A systematic literature review of preference-based health related quality-of-life measures applied and validated for use in childhood and adolescent populations in sub-Saharan Africa

Objectives: Consideration of health status in children and adolescents now includes broader concepts such as health-related quality-of-life (HRQoL). Globally, there is a need for relevant preference-based HRQoL measures (PBMs) for use in children and adolescents, yet measurement of HRQoL in these groups presents particular challenges. This article systematically reviews the available generic childhood PBMs and their application and cross-cultural validation in sub-Saharan African (sSA). Methods: A systematic review of published literature from January 1, 1990, to February 8, 2017, was conducted using MEDLINE (through OvidSP), EMBASE (OvidSP), EconLit (EBSCOhost), PsycINFO, Web of Science, and PubMed. Results: A total of 220 full-text articles were included in a qualitative synthesis. Ten generic childhood PBMs were identified, of which 9 were adapted from adult versions and only 1 was developed specifically for children. None of the measures were originally developed in sSA or other resource-constrained settings. The Health Utilities Index Mark 3 (HUI3) and the EQ-5D-Y were the only measures that had been applied in sSA settings. Further, the HUI3 and the EQ-5D-Y were the only generic childhood PBM that attempted to establish cross-cultural validation in sSA. Five of the 6 of these validation studies were conducted using the EQ-5D-Y in a single country, South Africa. Conclusions: The findings show that application of generic childhood PBMs in sSA settings has hitherto been limited to the HUI3 and EQ-5D-Y. Most adaptations of existing measures take an absolutist approach, which assumes that measures can be used across cultures. Nevertheless, there is also need to ensure linguistic and conceptual equivalence and undertake validation across a range of sSA cultural contexts

Costs of facility-based HIV testing in Malawi, Zambia and Zimbabwe.

BACKGROUND: Providing HIV testing at health facilities remains the most common approach to ensuring access to HIV treatment and prevention services for the millions of undiagnosed HIV-infected individuals in sub-Saharan Africa. We sought to explore the costs of providing these services across three southern African countries with high HIV burden. METHODS: Primary costing studies were undertaken in 54 health facilities providing HIV testing services (HTS) in Malawi, Zambia and Zimbabwe. Routinely collected monitoring and evaluation data for the health facilities were extracted to estimate the costs per individual tested and costs per HIV-positive individual identified. Costs are presented in 2016 US dollars. Sensitivity analysis explored key drivers of costs. RESULTS: Health facilities were testing on average 2290 individuals annually, albeit with wide variations. The mean cost per individual tested was US$5.03.9 in Malawi, US$4.24 in Zambia and US$8.79 in Zimbabwe. The mean cost per HIV-positive individual identified was US$79.58, US$73.63 and US$178.92 in Malawi, Zambia and Zimbabwe respectively. Both cost estimates were sensitive to scale of testing, facility staffing levels and the costs of HIV test kits. CONCLUSIONS: Health facility based HIV testing remains an essential service to meet HIV universal access goals. The low costs and potential for economies of scale suggests an opportunity for further scale-up. However low uptake in many settings suggests that demand creation or alternative testing models may be needed to achieve economies of scale and reach populations less willing to attend facility based services

Direct Compression Behavior of Low- and High-Methoxylated Pectins

The objective of this study was to evaluate possible usefulness of pectins for direct compression of tablets. The deformation behavior of pectin grades of different degree of methoxylation (DM), namely, 5%, 10%, 25%, 35%, 40%, 50%, and 60% were, examined in terms of yield pressures (YP) derived from Heckel profiles for both compression and decompression and measurements of elastic recovery after ejection. All pectin grades showed a high degree of elastic recovery. DM 60% exhibited most plastic deformation (YP 70.4 MPa) whereas DM 5% (104.6 MPa) and DM 10% (114.7 MPa) least. However, DM 60% gave no coherent tablets, whereas tablet tensile strengths for DM 5% and DM 10% were comparable to Starch 1500®. Also, Heckel profiles were similar to Starch 1500®. For sieved fractions (180–250 and 90–125 μm) of DM 25% and DM 40% originating from the very same batch, YPs were alike, indicating minor effects of particle size. These facts indicate that DM is important for the compaction behavior, and batch-to-batch variability should also be considered. Therefore, pectins of low degree of methoxylation may have a potential as direct compression excipients

Preferences for services in a patient’s first six months on antiretroviral therapy for HIV in South Africa and Zambia (PREFER): research protocol for a prospective observational cohort study [version 2; peer review: 2 approved]

Background For patients on HIV treatment in sub-Saharan Africa, the highest risk for loss from care remains the first six months after antiretroviral (ART) initiation, when patients are not yet eligible for differentiated service delivery (DSD) models that offer lower-burden, patient-centred care and thus improve treatment outcomes. To reduce early disengagement from care, the PREFER study will use a sequential mixed-methods approach to describe the characteristics, needs, concerns, and preferences of patients in South Africa and Zambia 0-6 months after ART initiation or re-initiation. Protocol PREFER is an observational, prospective cohort study of adults on ART for ≤6 months at 12 public healthcare facilities in Zambia and 18 in South Africa. Its objective is to describe and understand the needs and preferences of initiating and re-initiating ART clients to inform the design of DSD models for the early HIV treatment period, improve early treatment outcomes, and distinguish the barriers encountered by naïve patients from those facing re-initiators. It has four components: 1) survey of clients 0-6 months after ART initiation (identify characteristics and preferences of clients starting ART); 2) follow up through routinely collected medical records for <24 months after enrollment (describe resource utilization and patterns and predictors of engagement in care); 3) focus group discussions and discrete choice experiment (explore reported barriers to and facilitators of retention); and 4) in South Africa only, collection of blood samples (assess the prevalence of ARV metabolites indicating prior ART use). Conclusions PREFER aims to understand why the early treatment period is so challenging and how service delivery can be amended to address the obstacles that lead to early disengagement from care. It will generate information about client characteristics and preferences to help respond to patients’ needs and design better strategies for service delivery and improve resource allocation going forward

Preferences for services in a patient’s first six months on antiretroviral therapy for HIV in South Africa and Zambia (PREFER): research protocol for a prospective observational cohort study

Study protocol and supplementary files for protocol manuscript in Gates Open Research.BACKGROUND: For patients on HIV treatment in sub-Saharan Africa (SSA), the highest risk for loss from care consistently remains the first six months after antiretroviral (ART) initiation, when patients are not yet eligible for most existing differentiated service delivery (DSD) models. To reduce disengagement from care during this period, we must gain a comprehensive understanding of patients’ needs, concerns, resources, and preferences for service delivery during this period. The PREFER study will use a sequential mixed-methods approach to survey a sample of patients in South Africa and Zambia 0-6 months after ART initiation to develop a detailed profile of patient characteristics and needs. PROTOCOL: PREFER is an observational, prospective cohort study of adult patients on ART for ≤6 months at 12 public sector healthcare facilities in Zambia and 18 in South Africa that aims to inform the design of DSD models for the early HIV treatment period. It has four components: 1) survey of clients 0-6 months after ART initiation; 2) follow up through routinely collected medical records for <12 or <24 months after enrollment; 3) focus group discussions to explore specific issues raised in the survey; and 4) in South Africa only, collection of blood samples self-reported naïve participants to assess the prevalence of ARV metabolites indicating prior ART use. Results will include demographic and clinical characteristics of patients, self-reported HIV care histories, preferences for treatment delivery, and predictors of disengagement. CONCLUSIONS: PREFER aims to understand why the early treatment period is so challenging and how service delivery can be amended to address the obstacles that lead to early disengagement from care and to distinguish the barriers encountered by naïve patients to those facing re-initiators. The information collected by PREFER will help respond to patients’ needs and design better strategies for service delivery and improve resource allocation going forward.Bill & Melinda Gates Foundation, INV-031690 to Boston Universit

The cost effectiveness and optimal configuration of HIV self-test distribution in South Africa: a model analysis.

BACKGROUND: HIV self-testing (HIVST) has been shown to be acceptable, feasible and effective in increasing HIV testing uptake. Novel testing strategies are critical to achieving the UNAIDS target of 95% HIV-positive diagnosis by 2025 in South Africa and globally. METHODS: We modelled the impact of six HIVST kit distribution modalities (community fixed-point, taxi ranks, workplace, partners of primary healthcare (PHC) antiretroviral therapy (ART) patients), partners of pregnant women, primary PHC distribution) in South Africa over 20 years (2020-2039), using data collected alongside the Self-Testing AfRica Initiative. We modelled two annual distribution scenarios: (A) 1 million HIVST kits (current) or (B) up to 6.7 million kits. Incremental economic costs (2019 US$) were estimated from the provider perspective; assumptions on uptake and screening positivity were based on surveys of a subset of kit recipients and modelled using the Thembisa model. Cost-effectiveness of each distribution modality compared with the status-quo distribution configuration was estimated as cost per life year saved (estimated from life years lost due to AIDS) and optimised using a fractional factorial design. RESULTS: The largest impact resulted from secondary HIVST distribution to partners of ART patients at PHC (life years saved (LYS): 119 000 (scenario A); 393 000 (scenario B)). However, it was one of the least cost-effective modalities (A:$1394/LYS; B: $4162/LYS). Workplace distribution was cost-saving ($52-$76 million) and predicted to have a moderate epidemic impact (A: 40 000 LYS; B: 156 000 LYS). An optimised scale-up to 6.7 million tests would result in an almost threefold increase in LYS compared with a scale-up of status-quo distribution (216 000 vs 75 000 LYS). CONCLUSION: Optimisation-informed distribution has the potential to vastly improve the impact of HIVST. Using this approach, HIVST can play a key role in improving the long-term health impact of investment in HIVST

Costs of accessing HIV testing services among rural Malawi communities

ABSTRACTHIV testing is free in Malawi, but users may still incur costs that can deter or delay them accessing these services. We sought to identify and quantify these costs among HIV testing service clients in Malawi. We asked residents of communities participating in a cluster randomised trial investigating the impact of HIV self-testing about their past HIV testing experiences and the direct non-medical and indirect costs incurred to access HIV testing. We recruited 749 participants whose most recent HIV test was within the past 12 months. The mean total cost to access testing was US$2.45 (95$2.11–US$2.70). Men incurred higher costs (US$3.81; 95%CI: US$2.91–US$4.50) than women (US$1.83; 95$1.61–US$2.00). Results from a two-part multivariable regression analysis suggest that age, testing location, time taken to test, visiting a facility specifically for an HIV test and district of residence significantly affected the odds of incurring costs to testing. In addition, gender, wealth, age, education and district of residence were associated with significant user costs

Modelling costs of community-based HIV self-testing programmes in Southern Africa at scale: an econometric cost function analysis across five countries.

BACKGROUND: Following success demonstrated with the HIV Self-Testing AfRica Initiative, HIV self-testing (HIVST) is being added to national HIV testing strategies in Southern Africa. An analysis of the costs of scaling up HIVST is needed to inform national plans, but there is a dearth of evidence on methods for forecasting costs at scale from pilot projects. Econometric cost functions (ECFs) apply statistical inference to predict costs; however, we often do not have the luxury of collecting large amounts of location-specific data. We fit an ECF to identify key drivers of costs, then use a simpler model to guide cost projections at scale. METHODS: We estimated the full economic costs of community-based HIVST distribution in 92 locales across Malawi, Zambia, Zimbabwe, South Africa and Lesotho between June 2016 and June 2019. We fitted a cost function with determinants related to scale, locales organisational and environmental characteristics, target populations, and per capita Growth Domestic Product (GDP). We used models differing in data intensity to predict costs at scale. We compared predicted estimates with scale-up costs in Lesotho observed over a 2-year period. RESULTS: The scale of distribution, type of community-based intervention, percentage of kits distributed to men, distance from implementer's warehouse and per capita GDP predicted average costs per HIVST kit distributed. Our model simplification approach showed that a parsimonious model could predict costs without losing accuracy. Overall, ECF showed a good predictive capacity, that is, forecast costs were close to observed costs. However, at larger scale, variations of programme efficiency over time (number of kits distributed per agent monthly) could potentially influence cost predictions. DISCUSSION: Our empirical cost function can inform community-based HIVST scale-up in Southern African countries. Our findings suggest that a parsimonious ECF can be used to forecast costs at scale in the context of financial planning and budgeting