Early Rollout Research Articles

U.S. COVID-19 Vaccination Challenges Go Beyond Supply.

A trio of current Annals articles each takes a different route to the same conclusion, which is the use initial supplies of coronavirus disease 2019 (COVID-19) vaccines to immunize as many persons as possible with a single-dose regimen may achieve more benefit than a more effective 2-dose regimen in a smaller population The model of Paltiel et al makes the case for a single-dose vaccine, even if it is somewhat less effective than a 2-dose regimen of another vaccine Barnabas and Wald argue for single-dose immunization campaigns involving the Pfizer/BioNTech and Moderna vaccines, despite the absence of long-term efficacy data from clinical trials The model from Tuite et al questions the practice of reserving the second dose for every person immunized Supported by strong public health systems, rapid vaccine production, and equitable vaccine distribution within the US and around the world, vaccination strategies driven by data can bring an end to COVID-19

PrEP rollout in Africa: status and opportunity.

Following recommendations by the World Health Organization in 2015, and key clinical trials, countries in sub-Saharan Africa, the region with the highest burden of human immunodeficiency virus (HIV), developed policies that incorporate pre-exposure prophylaxis (PrEP) into national HIV-prevention strategies. By the end of 2019, more than one third of people receiving PrEP globally were in Africa. Crucial understandings gained from early rollout among at-risk populations, such as HIV-serodiscordant couples, adolescent girls and young women, female sex workers, and men who have sex with men, include the importance of strategies for maintaining persistent adherence to PrEP and novel approaches to making PrEP services accessible, simplified and efficient. This Perspective will discuss the current status of these programs and how to further widen their implementation.

Factors influencing uptake, continuation, and discontinuation of oral PrEP among clients at sex worker and MSM facilities in South Africa.

BackgroundSouth Africa became the first country in Africa to introduce oral PrEP in June 2016. The National Department of Health has used a phased approach to rollout, allowing for a dynamic learn-and-adapt process which will lead ultimately to scale-up. Phased rollout began with provision of oral PrEP at facilities providing services to sex workers in 2016 and was expanded in 2017, first to facilities providing services to MSM and then to students at selected university campus clinics, followed by provision at primary health care facilities. Programmatic data shows variability in initiation and continuation between these populations. This study examines factors related to PrEP initiation, continuation, and discontinuation at facilities providing services to sex workers and MSM during the national PrEP rollout.MethodsA cross-sectional survey was administered September 2017-January 2018 among clients (ages 18–62 and providers at 9 facilities implementing oral PrEP in South Africa, followed by in-depth interviews. The client survey captured PrEP initiation, continuation and discontinuation. Analysis was performed in STATA 13 for survey data and thematic analysis was performed in NViVO 11 for in-depth interview data.Results299 clients (203 from sex worker facilities, 96 from MSM facilities) participated in the survey and additionally, in-depth interviews were conducted with 29 clients. Participants self-identified as either current users (n = 94; 36.2%), past users (n = 80; 30.8%) and never users of PrEP (n = 86; 33.1%). Participants who had never used PrEP either cited not being offered PrEP by a provider (57%, n = 49) or declining PrEP (43%, n = 37) as reasons for lack of uptake. The primary reason for declining to use oral PrEP was fear of side effects (41.7%, n = 15). The primary reasons for initiating and continuing on oral PrEP were all related to perceived risk associated with sexual activity. The majority of participants (87.9%, n = 153) also noted that printed IEC materials influenced their decision to initiate PrEP. Qualitative data suggested that several clients initiated on PrEP because they wanted additional protection beyond using condoms due to challenges such as partners refusing to use condoms, having partners with unknown HIV status, having multiple partners, involvement in sex work, or having a partner living with HIV. The majority (73.8%, n = 59) of participants who discontinued oral PrEP cited side effects as the primary reason for discontinuation, followed by feeling stigmatized (18.8%, n = 15).ConclusionThis study provides valuable insights on early rollout of PrEP of how clients perceive oral PrEP and where to target efforts to improve the uptake of this highly effective HIV prevention product. By identifying strengths and areas for improvement, the ACCESS study has generated evidence that can be used to guide high quality scale-up in South Africa and may be instructive for other countries’ efforts to expand quality access to oral PrEP.

A truth universally acknowledged: moving to Universal Credit leads to large debt and poor mental health.

As GPs working or supporting those at the Deep End in Sheffield,1 we are bracing ourselves on behalf of patients for the introduction of Universal Credit over the coming winter. At the most difficult time of the year to be living in poverty, Citizens Advice has told us that the transition will affect 63 000 Sheffield residents. We know, from areas where Universal Credit has already been introduced, that the process is likely to incur delays for claimants, with subsequent increased debt for some of our most vulnerable patients.2 This has been backed up by the National Audit Office, who describe people who ‘… have suffered difficulties and hardship during the rollout of the full service’. 3 It also reflects some of our patients’ chaotic experiences who have been part of the early rollout (3000 Sheffield residents). We have heard from a trusted community group that a ‘loan shark’ has already moved in to one estate in the city and is getting ready for new customers …

Australian local governments and the early national broadband network roll-out: an online survey

A recent decision by the Australian Federal Government to reassess the scale of the National Broadband Network (NBN) will leave the country with a patchwork of different levels of access to the infrastructure. This intensifies the need to investigate and evaluate the implications of telecommunication at the local level. The paper opens a discussion on the different approaches taken by local government authorities towards the NBN in the early roll-out localities. Building upon the international literature, it analyses the empirical data collected from the Australian local governments involved with the early NBN roll-out using an online survey. The findings reveal an interesting diversity in the approaches taken at the local level, and show how decision-making at higher levels of government can impact local outcomes.

Political economy of telecommunication infrastructure: An investigation of the National Broadband Network early rollout and pork barrel politics in Australia

It has been argued that infrastructure unevenness rigidifies into more lasting structures of socio-economic and political privilege and advantage. This paper focuses on telecommunication infrastructure as the backbone of the fast-growing digital economy, and raises important questions about the early National Broadband Network (NBN) rollout in Australia. The paper asks whether there was any case of pork barrelling in the selection of early release sites that enjoyed a regional competitive advantage against other localities that had to wait several years to receive the infrastructure. The answer to this question then leads to a second question about the degree to which voting in the early NBN release sites has swung following the infrastructure rollout. In order to answer these questions the paper examines the voting patterns in the earlier NBN release sites versus all electorates in the Federal elections in 2007–2013 using the data available via Australian Electoral Commission. Findings show trends of politically targeted funding, followed by vote swing in the very next election.

Local Government Planning and High-Speed Broadband in Australia

The introduction of the Australian National Broadband Network (NBN) in 2009 raised questions about the potentials of the telecommunications infrastructure for Australian urban and regional planning. The recent decision by the Australian Federal Government to build the NBN, using a mix of technologies, has intensified the need to investigate the implications of telecommunications at the local level, as Australian local governments then need to respond differently based on the level of access provided in each case. The paper investigates such implications in the three areas of e-governance, socioeconomic development, and spatial planning. Building upon the international literature, and empirical data collected from the Australian local governments, it analyzes a raft of mostly unscrutinized policy initiatives developed, over the last few years, to guide the early rollout. The findings show some policy development regarding the socioeconomic implications of the new infrastructure, limited understanding of e-governance potentials, and lagging policy focus on spatial planning.

A snapshot of high-speed broadband responses at local government level in Australia: a marriage between federally funded initiatives and locally driven innovations?

The introduction of the Australian National Broadband Network (NBN) in 2009 posed a range of new questions about the potential of the telecommunication infrastructure for planning at different levels of government. This paper focuses on the local implications of the new infrastructure whether socio-economic, e-governance or otherwise. It reaches out to the NBN early rollout local government authorities (LGAs) and collects empirical data about their responses to the new infrastructure, so far. The findings explore the significant role of the federally funded initiatives aiming at the local level, while shedding light on some of the locally driven, mostly innovative approaches taken by the LGAs. The paper concludes by raising concerns about the current state of uncertainty around the future phases of broadband infrastructure rollout across the nation and its negative impact on strategic approaches in planning for and with telecommunication to capitalise on the digitally driven opportunities.

The spatial justice implications of telecommunication infrastructure: the socio-economic status of early national broadband network rollout in Australia

Since the formation of the Australian National Broadband Network Company (NBN Co.) in April 2009, the NBN rollout has been gradually announced following a range of engineering and logistic criteria. However, the early rollout gives the release sites a regional competitive advantage against other localities that might have to wait up to a decade to receive similar infrastructure. This leads to an important question about the socio-economic status of the NBN release sites, and the potential impact of the upcoming broadband infrastructure on the social discrepancy across the nation. The answer to this question then leads to a second question about the degree to which the NBN or any telecommunication infrastructure for that matter should be incorporated in planning and policy development for spatial justice. In an attempt to explore these questions, this paper examines the ranking of the 60 earlier NBN release sites in the socio-economic indexes for area, and accessibility/remoteness index of Australia. Findings are in line with the recent research that emphasises the role of infrastructure in intensifying social divisions.

The Potential Impact of Improving Appropriate Treatment for Fever on Malaria and Non-Malarial Febrile Illness Management in Under-5s: A Decision-Tree Modelling Approach

BackgroundAs international funding for malaria programmes plateaus, limited resources must be rationally managed for malaria and non-malarial febrile illnesses (NMFI). Given widespread unnecessary treatment of NMFI with first-line antimalarial Artemisinin Combination Therapies (ACTs), our aim was to estimate the effect of health-systems factors on rates of appropriate treatment for fever and on use of ACTs.MethodsA decision-tree tool was developed to investigate the impact of improving aspects of the fever care-pathway and also evaluate the impact in Tanzania of the revised WHO malaria guidelines advocating diagnostic-led managementResultsModel outputs using baseline parameters suggest 49% malaria cases attending a clinic would receive ACTs (95% Uncertainty Interval:40.6–59.2%) but that 44% (95% UI:35–54.8%) NMFI cases would also receive ACTs. Provision of 100% ACT stock predicted a 28.9% increase in malaria cases treated with ACT, but also an increase in overtreatment of NMFI, with 70% NMFI cases (95% UI:56.4–79.2%) projected to receive ACTs, and thus an overall 13% reduction (95% UI:5–21.6%) in correct management of febrile cases. Modelling increased availability or use of diagnostics had little effect on malaria management outputs, but may significantly reduce NMFI overtreatment. The model predicts the early rollout of revised WHO guidelines in Tanzania may have led to a 35% decrease (95% UI:31.2–39.8%) in NMFI overtreatment, but also a 19.5% reduction (95% UI:11–27.2%), in malaria cases receiving ACTs, due to a potential fourfold decrease in cases that were untested or tested false-negative (42.5% vs.8.9%) and so untreated.DiscussionModelling multi-pronged intervention strategies proved most effective to improve malaria treatment without increasing NMFI overtreatment. As malaria transmission declines, health system interventions must be guided by whether the management priority is an increase in malaria cases receiving ACTs (reducing the treatment gap), reducing ACT waste through unnecessary treatment of NMFI or expanding appropriate treatment of all febrile illness.

Pre-figuring the 2020 NBN-enabled classroom: 'Zoo Connect', a case study

Central to discussions about NBN-enabled applications and services is the potential for innovative ways of learning, particularly in relation to online and interactive education. This paper reports on trials of the collaborative software tool Adobe Connect in NSW schools, and reports on two field studies for Zoo Connect, an interactive, multimedia, remotely-delivered class lesson. Results from the trials support those who advocate the NBN as a means to extend classroom learning, and provide evidence that may prompt educators to transition to virtual classrooms sooner rather than later. Recommendations are made for the wider development of NBN-style education programs, regardless of whether or not they fall into the early rollout category/regions, in order to fast track innovation, encourage educators and assist communities to better envisage how the NBN will impact the education domain.

Potential Myogenic Stem Cell Populations: Sources, Plasticity, and Application for Cardiac Repair

The ability of unspecialized stem cells to differentiate into mature, specialized cell types has made them attractive as potential agents for enhanced tissue repair and regenerative medicine. This is especially true of diseases and disorders for which no or only partially effective treatments are currently available. Recently, increased focus has been placed on the regenerative potential of satellite cells (myogenic precursor cells found in the adult skeletal muscle) in various muscular disorders, such as dystrophy and myocardial injury following ischemia. Animal studies and clinical trials are in progress using satellite cells as cellular candidates; however, this early rollout in the clinical setting has deflected attention from the potential of other less specialized, but potentially more maliable, stem cell sources. Published data is still lacking on the best methods for identification, isolation, and further expansion or nuclear manipulation of these cells in vitro. Also, although differentiation capacity has been proven in terms of protein expression patterns characteristic of myogenesis, proof of contractile and energetic compatibility between graft and host is more difficult to establish. In this regard, although future animal model studies will be invaluable, they must be designed with short- and long-term functional outcomes in mind. This review moves beyond initial excitement regarding the acknowledged potential of cell therapy and provides a realistic exposition of the themes and specific issues that should be considered in current experimental research study designs.