Assessing linkages between local ecological knowledge, HIV/AIDS and the commercialisation of natural resources across Southern Africa

That natural resources (NRs) are important to those experiencing adversity, and, especially, vulnerability associated with HIV/AIDS, is well documented, particularly with respect to food and energy security. What is unclear is where HIV/AIDS ranks in terms of its significance in comparison to other household shocks, the role local ecological knowledge may (LEK) play in households' response to shock, a propos the types of coping strategies that are employed. Consequently, this research aims to bridge the knowledge gap between HIV/AIDS and the degree to which it is contributing to the expansion of NR commercialisation and to explore the unknowns surrounding the influence of LEK on people's choice of coping strategy. A two phase study was designed to provide quantitative rigour with qualitative depth. Phase one was an extensive, rapid survey of NR traders within urban and rural settings in five southern Africa countries. The principle objective was to profile the trade, the livelihoods of those involved and their reasons for entering the trade, to ultimately establish to what degree HIV/AIDS may have been a catalyst for this. Almost one third of the sample entered the trade in response to illness and/or death in their households, with 80% of deaths being of breadwinners. The findings illustrated considerable dependence on the sale of NRs; for almost 60% of the sample it was their household's only source of income. There was evidently increased blurring of the lines between rural and urban NR use with a greater diversity of products being traded in urban areas. Phase two involved in-depth interviews and work with a smaller sample at two sites selected based on the findings from the first phase. It incorporated three groups of households; non-trading, inexperienced trading and experienced trading households. Key areas of focus were household shocks, coping strategies employed in response to these and the role LEK may be playing in the choice of coping strategies. Within a two year period, 95% of households registered at least one shock, of which 80% recorded AIDS-related proxy shocks. Non-trading households were significantly worse-off in this regard, while in the case of non-AIDS proxy shocks, there was no such difference between groups. The most frequently employed coping strategy was the consumption and sale of NRs and was of particular importance when households were faced with AIDS proxy shocks. Trading households emerged as having superior levels of LEK in comparison to non-trading households, even for non-traded NRs, suggesting that prior LEK of NRs opened up opportunities to trade in NR as a coping strategy. Further inspection of the latter group however revealed that the portion of non-trading households who traded on a very ad hoc basis actually had comparable levels of LEK to the trading households. Despite the ad hoc trading households' vulnerable state and their disproportionately high level of AIDS proxy measures, they had at their disposal, sufficient LEK to unlock certain key coping strategies, namely the NR trade. In this sense there are apparent linkages between LEK, HIV/AIDS and the expansion of the commercialisation of NRs

Participatory mapping in a developing country context: Lessons from South Africa

Digital participatory mapping improves accessibility to spatial information and the way in which knowledge is co-constructed and landscapes co-managed with impoverished communities. However, many unintended consequences for social and epistemic justice may be exacerbated in developing country contexts. Two South African case studies incorporating Direct-to-Digital participatory mapping in marginalized communities to inform land-use decision-making, and the ethical challenges of adopting this method are discussed. Understanding the past and present context of the site and the power dynamics at play is critical to develop trust and manage expectations among research participants. When employing unfamiliar technology, disparate literacy levels and language barriers create challenges for ensuring participants understand the risks of their involvement and recognize their rights. The logistics of using this approach in remote areas with poor infrastructure and deciding how best to leave the participants with the maps they have co-produced in an accessible format present further challenges. Overcoming these can however offer opportunity for redressing past injustices and empowering marginalized communities with a voice in decisions that affect their livelihoods

Participatory mapping in a developing country context: Lessons from South Africa

Digital participatory mapping improves accessibility to spatial information and the way in which knowledge is co-constructed and landscapes co-managed with impoverished communities. However, many unintended consequences for social and epistemic justice may be exacerbated in developing country contexts. Two South African case studies incorporating Direct-to-Digital participatory mapping in marginalized communities to inform land-use decision-making, and the ethical challenges of adopting this method are discussed. Understanding the past and present context of the site and the power dynamics at play is critical to develop trust and manage expectations among research participants. When employing unfamiliar technology, disparate literacy levels and language barriers create challenges for ensuring participants understand the risks of their involvement and recognize their rights. The logistics of using this approach in remote areas with poor infrastructure and deciding how best to leave the participants with the maps they have co-produced in an accessible format present further challenges. Overcoming these can however offer opportunity for redressing past injustices and empowering marginalized communities with a voice in decisions that affect their livelihoods

Assessing linkages between local ecological knowledge, HIV/AIDS and the commercialisation of natural resources across Southern Africa

That natural resources (NRs) are important to those experiencing adversity, and, especially, vulnerability associated with HIV/AIDS, is well documented, particularly with respect to food and energy security. What is unclear is where HIV/AIDS ranks in terms of its significance in comparison to other household shocks, the role local ecological knowledge may (LEK) play in households' response to shock, a propos the types of coping strategies that are employed. Consequently, this research aims to bridge the knowledge gap between HIV/AIDS and the degree to which it is contributing to the expansion of NR commercialisation and to explore the unknowns surrounding the influence of LEK on people's choice of coping strategy. A two phase study was designed to provide quantitative rigour with qualitative depth. Phase one was an extensive, rapid survey of NR traders within urban and rural settings in five southern Africa countries. The principle objective was to profile the trade, the livelihoods of those involved and their reasons for entering the trade, to ultimately establish to what degree HIV/AIDS may have been a catalyst for this. Almost one third of the sample entered the trade in response to illness and/or death in their households, with 80% of deaths being of breadwinners. The findings illustrated considerable dependence on the sale of NRs; for almost 60% of the sample it was their household's only source of income. There was evidently increased blurring of the lines between rural and urban NR use with a greater diversity of products being traded in urban areas. Phase two involved in-depth interviews and work with a smaller sample at two sites selected based on the findings from the first phase. It incorporated three groups of households; non-trading, inexperienced trading and experienced trading households. Key areas of focus were household shocks, coping strategies employed in response to these and the role LEK may be playing in the choice of coping strategies. Within a two year period, 95% of households registered at least one shock, of which 80% recorded AIDS-related proxy shocks. Non-trading households were significantly worse-off in this regard, while in the case of non-AIDS proxy shocks, there was no such difference between groups. The most frequently employed coping strategy was the consumption and sale of NRs and was of particular importance when households were faced with AIDS proxy shocks. Trading households emerged as having superior levels of LEK in comparison to non-trading households, even for non-traded NRs, suggesting that prior LEK of NRs opened up opportunities to trade in NR as a coping strategy. Further inspection of the latter group however revealed that the portion of non-trading households who traded on a very ad hoc basis actually had comparable levels of LEK to the trading households. Despite the ad hoc trading households' vulnerable state and their disproportionately high level of AIDS proxy measures, they had at their disposal, sufficient LEK to unlock certain key coping strategies, namely the NR trade. In this sense there are apparent linkages between LEK, HIV/AIDS and the expansion of the commercialisation of NRs

Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design.

IMPORTANCE: The prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or Long COVID) in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults. OBSERVATIONS: We describe the protocol for the Pediatric Observational Cohort Study of the NIHs REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of four cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study (n = 10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n = 6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n = 6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n = 600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science. CONCLUSIONS AND RELEVANCE: RECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions. CLINICAL TRIALS.GOV IDENTIFIER: Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011

Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design

Importance: SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. Methods: RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. Discussion: RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options

Researching COVID to enhance recovery (RECOVER) pediatric study protocol: Rationale, objectives and design.

ImportanceThe prevalence, pathophysiology, and long-term outcomes of COVID-19 (post-acute sequelae of SARS-CoV-2 [PASC] or "Long COVID") in children and young adults remain unknown. Studies must address the urgent need to define PASC, its mechanisms, and potential treatment targets in children and young adults.ObservationsWe describe the protocol for the Pediatric Observational Cohort Study of the NIH's REsearching COVID to Enhance Recovery (RECOVER) Initiative. RECOVER-Pediatrics is an observational meta-cohort study of caregiver-child pairs (birth through 17 years) and young adults (18 through 25 years), recruited from more than 100 sites across the US. This report focuses on two of four cohorts that comprise RECOVER-Pediatrics: 1) a de novo RECOVER prospective cohort of children and young adults with and without previous or current infection; and 2) an extant cohort derived from the Adolescent Brain Cognitive Development (ABCD) study (n = 10,000). The de novo cohort incorporates three tiers of data collection: 1) remote baseline assessments (Tier 1, n = 6000); 2) longitudinal follow-up for up to 4 years (Tier 2, n = 6000); and 3) a subset of participants, primarily the most severely affected by PASC, who will undergo deep phenotyping to explore PASC pathophysiology (Tier 3, n = 600). Youth enrolled in the ABCD study participate in Tier 1. The pediatric protocol was developed as a collaborative partnership of investigators, patients, researchers, clinicians, community partners, and federal partners, intentionally promoting inclusivity and diversity. The protocol is adaptive to facilitate responses to emerging science.Conclusions and relevanceRECOVER-Pediatrics seeks to characterize the clinical course, underlying mechanisms, and long-term effects of PASC from birth through 25 years old. RECOVER-Pediatrics is designed to elucidate the epidemiology, four-year clinical course, and sociodemographic correlates of pediatric PASC. The data and biosamples will allow examination of mechanistic hypotheses and biomarkers, thus providing insights into potential therapeutic interventions.Clinical trials.gov identifierClinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT05172011

Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design.

IMPORTANCE: SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. METHODS: RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. DISCUSSION: RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options. REGISTRATION: NCT05172024

Researching COVID to Enhance Recovery (RECOVER) adult study protocol: Rationale, objectives, and design.

ImportanceSARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis.MethodsRECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms.DiscussionRECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options.RegistrationNCT05172024