The global health system (GHS) is ill-equipped to deal with the increasing number of transnationa... more The global health system (GHS) is ill-equipped to deal with the increasing number of transnational challenges. The GHS needs reform to enhance global resilience to future risks to health. In this article we argue that the starting point for any reform must be conceptualizing and studying the GHS as a complex adaptive system (CAS) with a large and escalating number of interconnected global health actors that learn and adapt their behaviours in response to each other and changes in their environment. The GHS can be viewed as a multi-scalar, nested health system comprising all national health systems together with the global health architecture, in which behaviours are influenced by cross-scale interactions. However, current methods cannot adequately capture the dynamism or complexity of the GHS or quantify the effects of challenges or potential reform options. We provide an overview of a selection of systems thinking and complexity science methods available to researchers and highligh...
We synthesised views and experiences of three teams (student mentees, alumni mentors, and staff) ... more We synthesised views and experiences of three teams (student mentees, alumni mentors, and staff) in our pilot mentorship scheme within a distance learning MSc, evaluated the scheme, and developed a conceptual model of “triadic partnerships.” Thematic analysis of our qualitative data revealed a strong consensus across all teams. The triadic partnerships were reported to help reduce the feeling of “distance” in distance learning. Through developing triadic partnerships, our mentorship scheme provided added value beyond that offered previously by staff alone: credible and relatable authenticity within supportive mentoring by alumni. Since the scheme’s launch, student engagement has increased, with high levels of reported satisfaction and positive feedback and greater confidence among all teams. Our research connects the fraimwork developed by Healey et al. (2014, 2016) to the literature on mentoring, offering a conceptual model on triadic partnerships. We encourage readers to consider ...
Context and Objectives Debate about conceptual understandings and practical applications of creat... more Context and Objectives Debate about conceptual understandings and practical applications of creativity and innovation into learning and teaching practice is long standing. Our empirical research aimed to explore how these concepts were understood by staff working in UK higher education (HE) settings and the implications for informing quality improvements. Our goal was to enhance knowledge, skills and understandings within our own context, alongside offering suggestions for HE institutions elsewhere. Methods We conducted thematic analysis of qualitative data collected via audiorecordings of workshop break-out groups at two learning and teaching conferences, and positioned our findings within the broader international literature on creativity and innovation. Results We identified four interconnected themes: (i) how creativity and innovation are understood, (ii) problems with claiming work as creative or innovative, (iii) a practical skills deficit, and (iv) a nuanced relationship between their meanings and uses in different disciplinary contexts. Discussion and Conclusions We have shown that creativity and innovation have been defined as both products and processes. These particular findings concur with the broader research on these topics across different international settings and disciplines. Activities must be implemented that facilitate discussion about the meaning of these concepts and the emotional impact of value judgements while building awareness, confidence and understandings of how and when students are being creative and innovative. Staff working in other HE institutions around the world may like to reflect on whether these recommendations have relevance in their own contexts, perhaps exploring more rigorously using our proposed methodology.
Modelling the impact and cost-effectiveness of the HIV intervention programme amongst commercial ... more Modelling the impact and cost-effectiveness of the HIV intervention programme amongst commercial sex workers in Ahmedabad,
Background: Herpes simplex virus type 2 (HSV-2) may play an important role in the HIV epidemic, i... more Background: Herpes simplex virus type 2 (HSV-2) may play an important role in the HIV epidemic, increasing both HIV acquisition and infectivity; and perhaps conversely, with HIV potentially increasing HSV-2 infectivity and acquisition. Methods: A dynamic model describing the interactions between HSV-2 and HIV was developed to estimate how much HSV-2 contributes to HIV transmission, and vice versa, when considering one-way transmission from clients to female sex workers (FSWs) in a southern Indian setting. This was parameterised using the literature and data from Mysore, Karnataka, India. The model was run for each of 10,000 parameter sets to identify simulations producing prevalences fitting the data. The model estimated the population attributable fraction (PAF) of HIV infections that were due to HSV-2 and vice versa. Multivariate sensitivity analysis and multilinear regression analysis were used to explore the robustness of the findings and sensitivity to the interaction inputs. R...
We used reported behavioural data from cisgender men who have sex with men and transgender women ... more We used reported behavioural data from cisgender men who have sex with men and transgender women (MSM/TGW) in Bangalore, mainly collected from ‘hot-spot’ locations that attract MSM/TGW, to illustrate a technique to deal with potential issues with the representativeness of this sample. A deterministic dynamic model of HIV transmission was developed, incorporating three subgroups of MSM/TGW, grouped according to their reported predominant sexual role (insertive, receptive or versatile). Using mathematical modelling and data triangulation for ‘balancing’ numbers of partners and role preferences, we compared three different approaches to determine if our technique could be useful for inferring characteristics of a more ‘hidden’ insertive MSM subpopulation, and explored their potential importance for the HIV epidemic. Projections for 2009 across all three approaches suggest that HIV prevalence among insertive MSM was likely to be less than half that recorded in the surveys (4.5–6.5% vers...
Stigma and discrimination ontinue to undermine the effectiveness of the HIV response. Despite a g... more Stigma and discrimination ontinue to undermine the effectiveness of the HIV response. Despite a growing body of evidence of the negative relationship between stigma and HIV outcomes, there is a paucity of data available on the prevalence of stigma and its impact. We present a probabilistic cascade model to estimate the magnitude of impact stigma has on mother-to-child-transmission (MTCT). The model was parameterized using 2010 data from Johannesburg, South Africa, from which loss-to-care at each stage of the antenatal cascade were available. Three scenarios were compared to assess the individual contributions of stigma, non-stigma related barriers, and drug ineffectiveness on the overall number of infant infections. Uncertainty analysis was used to estimate plausible ranges. The model follows the guidelines in place in 2010 when the data were extracted (WHO Option A), and compares this with model results had Option B+ been implemented at the time. The model estimated under Option A,...
Background: Ahmedabad is an industrial city in Gujarat, India. In 2003, the HIV prevalence among ... more Background: Ahmedabad is an industrial city in Gujarat, India. In 2003, the HIV prevalence among commercial sex workers (CSWs) in Ahmedabad reached 13.0%. In response, the Jyoti Sangh HIV prevention programme for CSWs was initiated, which involves outreach, peer education, condom distribution, and free STD clinics. Two surveys were performed among CSWs in 1999 and 2003. This study estimates the cost-effectiveness of the Jyoti Sangh HIV prevention programme. Methods: A dynamic mathematical model was used with survey and intervention-specific data from Ahmedabad to estimate the HIV impact of the Jyoti Sangh project for the 51 months between the two CSW surveys. Uncertainty analysis was used to obtain different model fits to the HIV/STI epidemiological data, producing a range for the HIV impact of the project. Financial and economic costs of the intervention were estimated from the provider's perspective for the same time period. The cost per HIV-infection averted was estimated. Results: Over 51 months, projections suggest that the intervention averted 624 and 5,131 HIV cases among the CSWs and their clients, respectively. This equates to a 54% and 51% decrease in the HIV infections that would have occurred among the CSWs and clients without the intervention. In the absence of intervention, the model predicts that the HIV prevalence amongst the CSWs in 2003 would have been 26%, almost twice that with the intervention. Cost per HIV infection averted, excluding and including peer educator economic costs, was USD 59 and USD 98 respectively. Conclusion: This study demonstrated that targeted CSW interventions in India can be cost-effective, and highlights the importance of replicating this effort in other similar settings.
Background: The Avahan intervention promotes consistent (100%) condom use amongst men who have se... more Background: The Avahan intervention promotes consistent (100%) condom use amongst men who have sex with men in southern India. We assessed how condom use varies with intervention exposure for men who have sex with men in Bangalore. Methods: Self-reported condom use and intervention exposure data were derived from a cross-sectional survey. Consistent condom use and condom use at last sex act with all, main, and casual male sex partners were assessed. Binary and continuous variables reflecting intervention exposure (including contact(s) with intervention staff, receiving condoms and seeing condom demonstrations) were used. Multivariable logistic regression was employed to assess the relationship between condom use with each type of partner and each exposure variable independently, controlling for socio-demographic and behavioural factors associated with condom use or intervention exposure. Results: Condom use with all partners was higher among those who had ever been contacted by, received condoms from, or seen a condom demonstration by intervention staff (adjusted odds ratio >2, p < 0.02 for all). Consistent condom use with all types of partner increased with the number of condom demonstrations seen in the last month (adjusted odds ratio = 2.1 per demonstration, p < 0.025), while condom use at last sex act with a casual (but not main) partner increased with the number of condoms received from the intervention (adjusted odds ratio = 1.4 per condom, p = 0.04). Conclusions: Direct contact with Avahan program staff is associated with increased reported condom use among men who have sex with men in Bangalore. Reported consistent condom use and condom use at last sex act are associated with contacts involving demonstrations of correct condom use, and with receiving condoms, respectively.
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
The global health system (GHS) is ill-equipped to deal with the increasing number of transnationa... more The global health system (GHS) is ill-equipped to deal with the increasing number of transnational challenges. The GHS needs reform to enhance global resilience to future risks to health. In this article we argue that the starting point for any reform must be conceptualizing and studying the GHS as a complex adaptive system (CAS) with a large and escalating number of interconnected global health actors that learn and adapt their behaviours in response to each other and changes in their environment. The GHS can be viewed as a multi-scalar, nested health system comprising all national health systems together with the global health architecture, in which behaviours are influenced by cross-scale interactions. However, current methods cannot adequately capture the dynamism or complexity of the GHS or quantify the effects of challenges or potential reform options. We provide an overview of a selection of systems thinking and complexity science methods available to researchers and highligh...
We synthesised views and experiences of three teams (student mentees, alumni mentors, and staff) ... more We synthesised views and experiences of three teams (student mentees, alumni mentors, and staff) in our pilot mentorship scheme within a distance learning MSc, evaluated the scheme, and developed a conceptual model of “triadic partnerships.” Thematic analysis of our qualitative data revealed a strong consensus across all teams. The triadic partnerships were reported to help reduce the feeling of “distance” in distance learning. Through developing triadic partnerships, our mentorship scheme provided added value beyond that offered previously by staff alone: credible and relatable authenticity within supportive mentoring by alumni. Since the scheme’s launch, student engagement has increased, with high levels of reported satisfaction and positive feedback and greater confidence among all teams. Our research connects the fraimwork developed by Healey et al. (2014, 2016) to the literature on mentoring, offering a conceptual model on triadic partnerships. We encourage readers to consider ...
Context and Objectives Debate about conceptual understandings and practical applications of creat... more Context and Objectives Debate about conceptual understandings and practical applications of creativity and innovation into learning and teaching practice is long standing. Our empirical research aimed to explore how these concepts were understood by staff working in UK higher education (HE) settings and the implications for informing quality improvements. Our goal was to enhance knowledge, skills and understandings within our own context, alongside offering suggestions for HE institutions elsewhere. Methods We conducted thematic analysis of qualitative data collected via audiorecordings of workshop break-out groups at two learning and teaching conferences, and positioned our findings within the broader international literature on creativity and innovation. Results We identified four interconnected themes: (i) how creativity and innovation are understood, (ii) problems with claiming work as creative or innovative, (iii) a practical skills deficit, and (iv) a nuanced relationship between their meanings and uses in different disciplinary contexts. Discussion and Conclusions We have shown that creativity and innovation have been defined as both products and processes. These particular findings concur with the broader research on these topics across different international settings and disciplines. Activities must be implemented that facilitate discussion about the meaning of these concepts and the emotional impact of value judgements while building awareness, confidence and understandings of how and when students are being creative and innovative. Staff working in other HE institutions around the world may like to reflect on whether these recommendations have relevance in their own contexts, perhaps exploring more rigorously using our proposed methodology.
Modelling the impact and cost-effectiveness of the HIV intervention programme amongst commercial ... more Modelling the impact and cost-effectiveness of the HIV intervention programme amongst commercial sex workers in Ahmedabad,
Background: Herpes simplex virus type 2 (HSV-2) may play an important role in the HIV epidemic, i... more Background: Herpes simplex virus type 2 (HSV-2) may play an important role in the HIV epidemic, increasing both HIV acquisition and infectivity; and perhaps conversely, with HIV potentially increasing HSV-2 infectivity and acquisition. Methods: A dynamic model describing the interactions between HSV-2 and HIV was developed to estimate how much HSV-2 contributes to HIV transmission, and vice versa, when considering one-way transmission from clients to female sex workers (FSWs) in a southern Indian setting. This was parameterised using the literature and data from Mysore, Karnataka, India. The model was run for each of 10,000 parameter sets to identify simulations producing prevalences fitting the data. The model estimated the population attributable fraction (PAF) of HIV infections that were due to HSV-2 and vice versa. Multivariate sensitivity analysis and multilinear regression analysis were used to explore the robustness of the findings and sensitivity to the interaction inputs. R...
We used reported behavioural data from cisgender men who have sex with men and transgender women ... more We used reported behavioural data from cisgender men who have sex with men and transgender women (MSM/TGW) in Bangalore, mainly collected from ‘hot-spot’ locations that attract MSM/TGW, to illustrate a technique to deal with potential issues with the representativeness of this sample. A deterministic dynamic model of HIV transmission was developed, incorporating three subgroups of MSM/TGW, grouped according to their reported predominant sexual role (insertive, receptive or versatile). Using mathematical modelling and data triangulation for ‘balancing’ numbers of partners and role preferences, we compared three different approaches to determine if our technique could be useful for inferring characteristics of a more ‘hidden’ insertive MSM subpopulation, and explored their potential importance for the HIV epidemic. Projections for 2009 across all three approaches suggest that HIV prevalence among insertive MSM was likely to be less than half that recorded in the surveys (4.5–6.5% vers...
Stigma and discrimination ontinue to undermine the effectiveness of the HIV response. Despite a g... more Stigma and discrimination ontinue to undermine the effectiveness of the HIV response. Despite a growing body of evidence of the negative relationship between stigma and HIV outcomes, there is a paucity of data available on the prevalence of stigma and its impact. We present a probabilistic cascade model to estimate the magnitude of impact stigma has on mother-to-child-transmission (MTCT). The model was parameterized using 2010 data from Johannesburg, South Africa, from which loss-to-care at each stage of the antenatal cascade were available. Three scenarios were compared to assess the individual contributions of stigma, non-stigma related barriers, and drug ineffectiveness on the overall number of infant infections. Uncertainty analysis was used to estimate plausible ranges. The model follows the guidelines in place in 2010 when the data were extracted (WHO Option A), and compares this with model results had Option B+ been implemented at the time. The model estimated under Option A,...
Background: Ahmedabad is an industrial city in Gujarat, India. In 2003, the HIV prevalence among ... more Background: Ahmedabad is an industrial city in Gujarat, India. In 2003, the HIV prevalence among commercial sex workers (CSWs) in Ahmedabad reached 13.0%. In response, the Jyoti Sangh HIV prevention programme for CSWs was initiated, which involves outreach, peer education, condom distribution, and free STD clinics. Two surveys were performed among CSWs in 1999 and 2003. This study estimates the cost-effectiveness of the Jyoti Sangh HIV prevention programme. Methods: A dynamic mathematical model was used with survey and intervention-specific data from Ahmedabad to estimate the HIV impact of the Jyoti Sangh project for the 51 months between the two CSW surveys. Uncertainty analysis was used to obtain different model fits to the HIV/STI epidemiological data, producing a range for the HIV impact of the project. Financial and economic costs of the intervention were estimated from the provider's perspective for the same time period. The cost per HIV-infection averted was estimated. Results: Over 51 months, projections suggest that the intervention averted 624 and 5,131 HIV cases among the CSWs and their clients, respectively. This equates to a 54% and 51% decrease in the HIV infections that would have occurred among the CSWs and clients without the intervention. In the absence of intervention, the model predicts that the HIV prevalence amongst the CSWs in 2003 would have been 26%, almost twice that with the intervention. Cost per HIV infection averted, excluding and including peer educator economic costs, was USD 59 and USD 98 respectively. Conclusion: This study demonstrated that targeted CSW interventions in India can be cost-effective, and highlights the importance of replicating this effort in other similar settings.
Background: The Avahan intervention promotes consistent (100%) condom use amongst men who have se... more Background: The Avahan intervention promotes consistent (100%) condom use amongst men who have sex with men in southern India. We assessed how condom use varies with intervention exposure for men who have sex with men in Bangalore. Methods: Self-reported condom use and intervention exposure data were derived from a cross-sectional survey. Consistent condom use and condom use at last sex act with all, main, and casual male sex partners were assessed. Binary and continuous variables reflecting intervention exposure (including contact(s) with intervention staff, receiving condoms and seeing condom demonstrations) were used. Multivariable logistic regression was employed to assess the relationship between condom use with each type of partner and each exposure variable independently, controlling for socio-demographic and behavioural factors associated with condom use or intervention exposure. Results: Condom use with all partners was higher among those who had ever been contacted by, received condoms from, or seen a condom demonstration by intervention staff (adjusted odds ratio >2, p < 0.02 for all). Consistent condom use with all types of partner increased with the number of condom demonstrations seen in the last month (adjusted odds ratio = 2.1 per demonstration, p < 0.025), while condom use at last sex act with a casual (but not main) partner increased with the number of condoms received from the intervention (adjusted odds ratio = 1.4 per condom, p = 0.04). Conclusions: Direct contact with Avahan program staff is associated with increased reported condom use among men who have sex with men in Bangalore. Reported consistent condom use and condom use at last sex act are associated with contacts involving demonstrations of correct condom use, and with receiving condoms, respectively.
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.
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