Aligning business processes and IT of multiple collaborating organisations

When multiple organisations want to collaborate with one another they have to integrate their business processes. This requires aligning the collaborative business processes and the underlying IT (Information Technology). Realizing the required alignment is, however, not trivial and is the subject of this thesis. We approached the issue of alignment in three steps. First, we explored business-IT alignment problems in detail in a real-life business case. This is done in order to clarify what alignment of business processes and IT systems across a collaboration network entails. Second, we provided a business-IT alignment framework called BITA* (pronounce bita-star). The framework provides modelling abstractions for alignment. Third, we applied the framework in two real-life case studies, including the real-life business case used in step one. By applying the framework in practice we showed that the framework can, in fact, help to address the business-IT alignment problems that we identified in the first step. The work presented in this thesis is conducted over a number of years in the context of four large EU sponsored research projects. The projects focused on alignment problems in two very distinct application areas. Two projects were about realizing transparency systems for meat supply chains and constitute the first case study. The other two projects were about realizing multidisciplinary modelling collaboration systems and constitute the second case study. Although the projects were conducted sequentially the research questions were addressed iteratively over the years. The research methodology that shows how the framework is designed and how the case studies are applied is discussed in detail in chapter 2. In chapter 3 we present BITA*, a Business-IT Alignment framework for multiple collaborating organisations. The main challenges in designing BITA* have been what models to consider for alignment and how to compare them in order to make explicit statements about alignment. We addressed this problem by introducing allocation and alignment modelling constructs to help the alignment process, and the concept of business collaboration model to represent the models that have to be aligned. We identified three groups of stakeholders for whom we designed explicit design viewpoints and associated allocation and alignment models. The Business Process to Business Process (BP2BP) alignment viewpoint is designed for business analysts who have to align diverse business collaboration process models. The IT to IT (IT2IT) alignment viewpoint is designed for software architects to align the distribution of data and IT systems across a collaboration network. The Business Process to IT (BP2IT) alignment viewpoint is designed for an interdisciplinary team of business analysts and software architects who have to align the different ways of supporting business collaboration processes with distributed IT system. An essential element of this thesis has been elaborating how business-IT alignment problems occur in the context of multi-organisational collaboration. The case studies were used to demonstrate business-IT alignment concerns. Particularly, the details of the first case study presented in chapters 4 and 5 were used in chapter 3 to help derive the alignment framework. The case study presented an ideal problem scenario since realizing transparency across supply chains is intrinsically a collaborative effort. The second case study was used to enhance the validity of our approach. The results of the second case study are presented in chapter 6. The alignment framework was designed during the iterative process we followed when realizing a generic transparency system for meat supply chains. To realize the required generic transparency system we needed a reference architecture. To derive the reference architecture we adapted an already existing and broadly-accepted generic reference architecture. We have to adapt the generic reference architecture in order to address specific requirements of the meat sector that were not considered in the generic reference architecture. The adaptation process made it clear that we needed models for representing business collaborations. We, therefore, introduced the notion of business collaboration model, which we used both to model reference architectures and to adapt them. Adaptation required aligning the generic reference architecture with the diverse business collaboration models adopted by the organisations that have to collaborate. The alignment framework is thus used for adapting a generic reference architecture in order to create a reference architecture that the collaborating organisations can, and are willing to, adopt. We identified three types of business collaboration models: business collaboration process model, business collaboration IT model, and a model for representing the relationship between these two. A business collaboration process model is a business process model that spans a collaboration network. A business collaboration IT model is a model of the distribution of the IT across the collaboration network. A business collaboration process-IT model is a model of the relationships between the elements of the business collaboration processes and the elements of the distributed IT. Each organisation is considered to adopt its own business collaboration models. For instance, different actors in meat supply chains have different views on how chain-wide transparency should be realized. Which business processes and IT systems each organisation has to deploy and use depends on the business collaboration models each food operator adopts. If two different food operators adopt the same set of business collaboration models, they are aligned; otherwise they are misaligned. Hence, alignment entails comparing the different business collaboration models adopted by the participating organisations. The results of the alignment process are explicit statements about how convergent or divergent the organisations are from the chosen generic reference architecture. The explicit statements of alignment guide how best the generic and the corresponding organisational business collaboration models can be adapted to create a better state of alignment. To further enhance the validity of the overall approach the second case study was conducted. The second case study was a retrospective investigation of two past research projects focusing on aligning environmental modelling processes and IT systems. A retrospective case study was chosen because launching a new business-IT alignment project involving multiple collaborating organisations was not feasible. The projects were undertaken to support the European Water Framework Directive, which mandated, among other things, participatory, multidisciplinary, river-basin wide and model-based studies to manage the water resources of Europe. The directive particularly required a collaborative approach to building environmental decision support systems and to deriving methodologies for applying existing decision support systems. We applied BITA* to aligning environmental modelling processes and IT systems in order to evaluate the suitability of the framework to addressing alignment problems in other application areas. The contributions of the thesis are summarized in chapter 7. The contributions include a number of design artefacts, which can be grouped into four categories: constructs, models, methods, and instantiations. The contribution in the first category includes the conceptualization of allocation and alignment. The contributions in the second category include allocation and alignment models, and reference architectures. Allocation models are representations of business collaboration models in a form that can be compared and are the basis for alignment modelling. The main contribution in the third category is the BITA* systematic approach to alignment modelling. The contributions in the fourth category are the software systems developed with the help of the reference architectures.</p

Assessment of the IGME methods of estimating infant mortality rate and neonatal mortality rate from under-five mortality rate in countries affected by HIV

Includes abstract.Includes bibliographical references.This study assesses the UN Inter-agency Group for Child Mortality Estimation (IGME) methods of estimating the infant and neonatal mortality rates from the under-five mortality rates in countries affected by HIV/AIDS. It uses Botswana, Malawi and South Africa as case studies. The assessment is made by comparing the IGME results with estimates from projection models and empirical results computed from survey data and vital statistics data corrected for the level of incompleteness for the countries included in the study. In addition, relevant literature is reviewed in order to determine the reasonableness and impact (on the results produced) of the assumptions made by the method

A model public toilet service in an urban context that improves management and income for the urban poor: Field action report

Background: In Ethiopia, public toilets are commonly provided and managed by municipalities or designated government structures. This traditional model of public toilet management is limited in its ability to generate income for upkeep. To address this, USAID’s Strengthening Ethiopia’s Urban Health Program developed a public toilet management model with an integrated business approach and multiple construction design options. Objectives: To demonstrate a sustainable model for public toilet management that ensures the provision of high-quality and equitable services. Method: A public toilet management model and engineering design with three typologies were developed after a multi-sectoral team of experts conducted studies to identify the key challenges to current management. The management model and engineering design were tested in Kombolcha and Kemisse. Results: From February to August 2018, 5,099 and 18,795 people used the public toilet and shower services in Kombolcha and Kemisse towns, respectively. Of these users, 338 (3.6%) and 318 (3.4%) have a disability. In Kombolcha, four women organized as a medium and small enterprise (MSE) are managing the toilet and shower services; each member receives a 700 birr monthly salary. In Kemisse, five women organized as an MSE are managing the facility; each member receives a 2,500 birr monthly salary. They have a savings of 29,000 birr in the MSE’s account. Conclusion: The developed model helps to strengthen the management of public toilet service quality and sustainability by creating business opportunities. [Ethiop. J. Health Dev. 2020; 34(Special issue 2):42-48] Keywords: Public toilet, model, urban, income, urban poo

Epidemiology of Mycobacterium tuberculosis lineages and strain clustering within urban and peri-urban settings in Ethiopia.

BackgroundPrevious work has shown differential predominance of certain Mycobacterium tuberculosis (M. tb) lineages and sub-lineages among different human populations in diverse geographic regions of Ethiopia. Nevertheless, how strain diversity is evolving under the ongoing rapid socio-economic and environmental changes is poorly understood. The present study investigated factors associated with M. tb lineage predominance and rate of strain clustering within urban and peri-urban settings in Ethiopia.MethodsPulmonary Tuberculosis (PTB) and Cervical tuberculous lymphadenitis (TBLN) patients who visited selected health facilities were recruited in the years of 2016 and 2017. A total of 258 M. tb isolates identified from 163 sputa and 95 fine-needle aspirates (FNA) were characterized by spoligotyping and compared with international M.tb spoligotyping patterns registered at the SITVIT2 databases. The molecular data were linked with clinical and demographic data of the patients for further statistical analysis.ResultsFrom a total of 258 M. tb isolates, 84 distinct spoligotype patterns that included 58 known Shared International Type (SIT) patterns and 26 new or orphan patterns were identified. The majority of strains belonged to two major M. tb lineages, L3 (35.7%) and L4 (61.6%). The observed high percentage of isolates with shared patterns (n = 200/258) suggested a substantial rate of overall clustering (77.5%). After adjusting for the effect of geographical variations, clustering rate was significantly lower among individuals co-infected with HIV and other concomitant chronic disease. Compared to L4, the adjusted odds ratio and 95% confidence interval (AOR; 95% CI) indicated that infections with L3 M. tb strains were more likely to be associated with TBLN [3.47 (1.45, 8.29)] and TB-HIV co-infection [2.84 (1.61, 5.55)].ConclusionDespite the observed difference in strain diversity and geographical distribution of M. tb lineages, compared to earlier studies in Ethiopia, the overall rate of strain clustering suggests higher transmission and warrant more detailed investigations into the molecular epidemiology of TB and related factors

Progress towards the UNAIDS 95-95-95 targets among pregnant women in South Africa : results from the 2017 and 2019 national Antenatal HIV Sentinel Surveys

OJECTIVES : The UNAIDS 95-95-95 global targets for epidemic control aim to ensure by 2030 that 95% of HIV-positive people know their HIV status, 95% of people diagnosed with HIV receive sustained antiretroviral therapy (ART), and 95% of people on ART have viral suppression. While data on the first and second 95 targets are routinely reported nationally, data on the third 95 target are not available for pregnant women in South Africa. The lack of data on the third 95 target limits the inclusion of low viral suppression as one of the contributing factors in MTCT root cause analyses. This study assessed progress towards the 95-95-95 targets among pregnant women between the ages of 15–49 years attending public health facilities in South Africa. METHOD : Data were obtained from two consecutive national cross-sectional antenatal HIV sentinel surveys conducted between 1 October and 15 November in both 2017 and 2019. In each survey, data on age, knowledge of HIV status, ART initiation, and geographical location (province) were extracted from medical records. A blood specimen was collected from each woman and tested for HIV. Viral load tests were performed on HIV-positive specimens. Descriptive and multiple logistic regression analyses were performed to examine association between province and viral suppression (defined as viral load <50 copies/mL) using the combined dataset (i.e., both 2017 and 2019 data combined). All analyses considered the survey design. RESULTS : Of 10 065 and 11 321 HIV-positive women included in the 2017 and 2019 surveys, respectively, 96.0% (95% confidence interval (CI): 95.6–96.4%) and 97.6% (95% CI: 97.3–97.8%) knew their HIV-positive status; 86.6% (95% CI: 85.9–87.3%) and 96.0% (95% CI: 95.6– 96.4%) of those who knew their HIV status were receiving ART; while 64.2% (95% CI: 63.2– 65.2%) and 66.0% (95% CI: 65.1–66.8%) of those receiving ART were virally suppressed. Achievement of the third 95 target significantly varied by province ranging from 33.9–72.6% in 2017 and 43.4–77.3% in 2019. Knowledge of HIV-positive status, ART initiation, and viral suppression increased in both 15–24 and 25–49 year age groups between 2017 and 2019. In a multivariable analysis adjusting for survey year, gravidity, and education, the odds of viral suppression significantly varied by province (except KwaZulu-Natal and Western Cape, other provinces were less likely to attain viral suppression compared to Gauteng), age (adjusted odds ratio (AOR) for 15–24 years vs 25–49 years: 0.7, 95% CI: 0.6–0.8), and timing of ART initiation (AOR for ART initiation during pregnancy vs before pregnancy: 0.4, 95% CI: 0.5–0.6). CONCLUSION : Although in 2019 the first and second 95 targets were achieved among pregnant women, meeting the third 95 target remains a challenge. This study highlighted the importance of promoting early ART initiation and the need to target young women in efforts to improve progress towards the third 95 target. Additionally, the provincial variation in viral suppression could be further investigated in future studies to identify and address the root causes underlying these differences.DATA AVAILABILITY STATEMENT : Access to primary data is subject to restrictions owing to privacy and ethics policies set by the South African Government. Requests for access to the data can be made to the National Health Laboratory Services directly (http://www.nhls.ac.za/) and require a full protocol submission. Inquiries can be made to Academic Affairs and Research at NHLS at [email protected] received funding from: the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreement 5 NU2GGH001631, https:// www.cdc.gov/. In addition, World Health organization (WHO), South African Medical Research Council (SAMRC), National Department of Health (NDoH), and NICD funded the data collection for the survey. Disclaimer: The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the official position of the funding agencies. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscripthttp://www.plosone.orgdm2022Statistic

Association between viral suppression during the third trimester of pregnancy and unintended pregnancy among women on antiretroviral therapy : results from the 2019 antenatal HIV Sentinel Survey, South Africa

OBJECTIVES : About half of the pregnancies among women living with HIV (WLWH) receiving antiretroviral therapy (ART) in sub-Saharan African countries are reported to be unintended. Unintended pregnancy is associated with late initiation of antenatal care (ANC), and may delay provision of viral load monitoring services, antenatal adherence counselling and support, and other services that promote sustained viral suppression throughout pregnancy. This study examines the association between unsuppressed viral load during the third trimester of pregnancy and unintended pregnancy among women who initiated ART before pregnancy. METHODS : This was an analysis of data from a national antenatal survey conducted at 1 589 public health facilities in South Africa between 1 October and 15 November 2019. Consenting pregnant women aged 15–49 years attending ANC during the survey period were enrolled. Demographic and clinical data were collected through interview and medical record review. Pregnancy intention was assessed using two questions from the London Measure of Unplanned Pregnancy, and responses were categorized as “unintended,” “undecided,” and “intended.” Blood specimens were collected from all women and tested for HIV; and if positive, a viral load test was performed. A survey domain-based poisson regression model examined the association between unsuppressed viral load during the third trimester of pregnancy and unintended pregnancy among women who initiated ART before pregnancy. Viral suppression was defined as viral load <50 copies/mL. RESULTS : Of 10 901 WLWH with viral load data available, 63.3% (95% confidence interval (CI): 62.4%-64.1%) were virally suppressed. Among the 2 681 women (representing 24.1% of all WLWH with viral load data) who initiated ART before pregnancy and were in their third trimester at the time of enrolment, 74.4% (95% CI: 73.0%-75.8%) were virally suppressed. In the same population, the proportion virally suppressed was lower among women whose current pregnancies were unintended (72.1%, 95% CI: 70.1%-74.1%) compared to women whose pregnancies were intended (78.3%, 95% CI: 75.9%-80.5%). In multivariable analyses adjusted for age, gravity, marital status, education, location of facility and syphilis status, unintended pregnancy was associated with unsuppressed viral load during the third trimester (adjusted relative risk: 1.3, 95% CI: 1.1–1.4) among women who initiated ART before pregnancy. CONCLUSION : The identified association between unsuppressed viral load and unintended pregnancy among pregnant women who initiated ART before pregnancy highlights the need to strengthen routine assessment of fertility preferences and provision of contraceptive services to reproductive age WLWH receiving ART.The President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreement 5 NU2GGH001631, https:// www.cdc.gov/; World Health organization (WHO), South African Medical Research Council (SAMRC), National Department of Health (NDoH), and NICD.http://www.plosone.orgdm2022Statistic

The prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa, a national antenatal survey, 2019

To describe the prevalence of unintended pregnancy and its association with HIV status among pregnant women in South Africa. A cross-sectional survey was conducted between October and mid-November 2019 among pregnant women aged 15–49 years in 1589 selected public antenatal care facilities. Pregnancy intention was assessed using two questions from the London Measure of Unplanned Pregnancy. Survey logistic regression examined factors associated with unintended pregnancy. Among 34,946 participants, 51.6% had an unintended pregnancy. On multivariable analysis, the odds of unintended pregnancy was higher among women who knew their HIV-positive status before pregnancy but initiated treatment after the first antenatal visit (adjusted odds ratio [aOR], 1.5 [95% confidence interval (CI):1.2–1.8]), women who initiated treatment before pregnancy (aOR, 1.3 [95% CI:1.2–1.3]), and women with a new HIV diagnosis during pregnancy (aOR, 1.2 [95% CI:1.1–1.3]) compared to HIV-negative women. Women who were single, in a non-cohabiting or a cohabiting relationship, and young women (15–24 years) had significantly higher risk of unintended pregnancy compared to married women and women aged 30–49 years, respectively. A comprehensive approach, including regular assessment of HIV clients’ pregnancy intention, and adolescent and youth-friendly reproductive health services could help prevent unintended pregnancy.The President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC).http://www.nature.com/srep/index.htmlStatistic

Longitudinal adherence to maternal antiretroviral therapy and infant Nevirapine prophylaxis from 6 weeks to 18 months postpartum amongst a cohort of mothers and infants in South Africa.

BACKGROUND: Despite improved policies to prevent mother-to-child HIV transmission (MTCT), adherence to maternal antiretroviral therapy (ART) and infant Nevirapine prophylaxis (NVP) is low in South Africa. We describe ART adherence amongst a cohort of HIV-positive mothers and HIV-exposed but uninfected infants from 6 weeks until 18 months post-delivery and identify risk factors for nonadherence. METHODS: Data were collected in 2012-2014 through a nationally representative survey of PMTCT effectiveness. Mother-infant pairs were enrolled during the infant's first immunization visit at 6 weeks. Mothers and HIV-exposed infants (2811 pairs) were followed to 18 months at 3-month intervals. Mothers who self-reported being on ART at 6 weeks postpartum (N = 1572 (55.9%)) and infants on NVP at 6 weeks (N = 2370 (84.3%)) were eligible for this analysis and information about their adherence was captured at each interview they attended thereafter. We defined nonadherence within each 3-month interval as self-report of missing > 5% of daily ART/NVP doses, estimated adherence using a Cox survival curve with Andersen & Gill setup for recurring events, and identified risk factors for nonadherence with an extended Cox regression model (separately for mothers and infants) in Stata 13. Results are not nationally representative as this is a subgroup analysis of the follow-up cohort. RESULTS: Amongst mothers on ART at 6 weeks postpartum, cumulative adherence to maternal ART until 18 months was 63.4%. Among infants on NPV at 6 weeks postpartum, adherence to NVP was 74.5%.. Risk factors for nonadherence to maternal ART, controlling for other factors, included mother's age (16-24 years vs. ≥34 years, adjusted Hazard Ratio (aHR): 1.9, 95% CI: 1.4-2.5), nondisclosure of HIV status to anyone (nondisclosure vs. disclosure: aHR: 1.7, 95% CI: 1.3-2.1), and timing of ART initiation (initiated ART after delivery vs. initiated ART before delivery: aHR: 1.6, 95% CI: 1.3-2.0). Provincial variation was seen in nonadherence to infant NVP, controlling for other factors. CONCLUSION: Maintaining ART adherence until 18 months postpartum remains a crucial challenge, with maternal ART adherence among the six week maternal ART cohort below 65% and infant NVP adherence among breastfeeding infants in this cohort below 75%.This is gravely concerning, given the global policy shift to lifelong ART amongst pregnant and lactating women, and the need for extended infant prophylaxis amongst mothers who are not virally suppressed. Our findings suggest that young mothers and mothers who do not disclose their status should be targeted with messages to improve adherence, and that late maternal ART initiation (after delivery) increases the risk of maternal nonadherence

Awareness of HIV-positive status and linkage to treatment prior to pregnancy in the "test and treat" era: A national antenatal sentinel survey, 2017, South Africa

Introduction Knowledge of HIV status in South Africa (SA) is reported to be 90% among people living with HIV. National level estimates could mask population-specific levels, which are critical to monitor program coverage and potential impact. Using data from the 2017 national antenatal sentinel survey, we assessed knowledge of HIV-positive status, initiation of antiretroviral therapy (ART), and socio-demographic characteristics associated with knowledge of HIVpositive status prior to the current pregnancy among women attending antenatal care. Methods Between 1 October and 15 November 2017, a nationally representative sample of 32,716 pregnant women were enrolled from 1,595 public health facilities selected from all districts of SA. Data on age, gravidity, knowledge of HIV-positive status and ART initiation prior to pregnancy were extracted from medical records. A blood sample was collected from each woman regardless of prior knowledge of HIV status or ART history, and tested for HIV in the laboratory. All HIV-positive pregnant women enrolled in the survey were eligible for inclusion in the analysis. Multivariable survey logistic regression was used to examine factors associated with knowledge of HIV-positive status prior to the current pregnancy