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In the modern world, law is a central determinant of and influence on public health responses. Not only can law determine access to medical interventions like vaccines, it is often the mechanism used to implement traditional public health interventions such as quarantines, limits on social gatherings and social distancing requirements. In this way, laws can limit the type of actions a government can implement as well as determine how an intervention is adopted, acting as an intermediary between the scientific evidence about what should be done and how the government can implement this. Law also has a particular status in society, in many instances guiding how people know whether a behaviour is right or wrong – and also creating punishment or reward for acting in particular ways.\n \nThe COVID-19 pandemic is an example of this where many governments used laws to create lockdowns and introduce regulations with the goal of controlling the spread of the virus in a diversity of ways that changed and evolved over the response. As law can empower or enable a public health response, it can also be immensely disruptive. Legal challenges frequently tried to use the law to derail public health responses. Notwithstanding the centrality of law in shaping public health responses, its role is often under-studied or relegated to legal scholarship which limits our ability to understand how to use law to improve public health responses more generally. In addition, many evaluations of public health responses do not adequately grapple with how the law informed responses or how laws (and in turn responses) change over time. It is these gaps that this study aims to fill. \n\nThis study aims to use scientific research methods, including qualitative research and a community-based survey, to create data about how law influenced the COVID-19 response, drawing on the knowledge and experiences of key decision-makers and the public, and engaging these communities in the research process. This will include interviewing policymakers and public health experts about how they used the law in their decision-making and responded to legal disruptions. In addition, a survey will be used to reach different communities, including urban and rural, to understand how the COVID-19 laws influenced their behaviour (if at all) and what kinds of measures they found acceptable and appropriate. We will also build longitudinal legal datasets of COVID-19 responses in South Africa, the United Kingdom, Namibia and New Zealand which will be made publicly available for researchers to use in evaluations of COVID-19 responses. \n\nWe will convene concluding workshops for public health experts and decision-makers to communicate the results of the study and solicit their views on the recommendations. This will be compiled into a policy report with suggestions for reform to be submitted to key law-making bodies. In addition to conference presentations and publication outputs, we will also host community meetings feedback the results to community members.. This project has 4 key objectives:\n\n1. To create a timeline and legal map which identifies, describes and analyses how laws facilitated and\nobstructed the COVID-19 pandemic response (specifically non-pharmaceutical interventions and biological\ncountermeasures) in South Africa and develop comparative datasets for Namibia, New Zealand and the\nUnited Kingdom.\n2. To analyse the role of legal determinants in shaping the COVID-19 response in South Africa.\n3. To evaluate public perception and acceptability of the legal response to COVID-19 in South Africa.\n4. To develop a model for legal responses to a public health emergency and make recommendations for law\nreform in South Africa.\n \n ID: GB-GOV-10-GAF_01_305492\nTitle: NIHR GAF: Addressing disengagement from HIV care amongst vulnerable populations with a focus on mobile fishing communities in Malawi\nDescription: The NIHR Global Advanced Fellowship (GAF) scheme is a mid-career postdoctoral award that funds researchers undertaking research that aims to specifically and primarily benefit people in low- and middle-income countries (LMICs). The programme is open to researchers based in a Higher Education Institution (HEI) or Research Institute in a LMIC, or based in a HEI in the UK. The GAF funds research projects, training and development, and institutional capacity strengthening in LMICs.\n\nIn 2022, there were 39 million people living with Human Immunodeficiency Virus (HIV) globally, 25.6 million of whom were in Africa. Up to 29.8 million of people living with HIV were receiving antiretroviral therapy (ART), essential for individual health and prevention of onward HIV transmission. Despite this some people living with HIV continue to struggle to remain on ART due to mobility. Populations whose occupations require them to move from place to place such as fishing communities, seasonal workers and female sex workers face many challenges that lead to ART interruption. Increased ART interruption increases the overall community viral load among fishing communities in Africa, leading to new HIV cases and more people suffering ill-health. The implication of not addressing the needs of this vulnerable group is that they hold potential to reverse the gains related to UNAIDS targets. \n\nWorking with key stakeholders: affected mobile fishing communities, healthcare workers and policy makers, I will identify strategies to improve the health of mobile men and women living with HIV. I will explore the reasons leading to poor engagement and retention on HIV treatment. I will work with stakeholders to ensure that people engaged in fishing activities have the capability, opportunity, and motivation to adhere to and continue their ART. This work will inform national and international approaches to ensuring that people living with HIV who are often mobile are well supported to remain on HIV medication.\n\nThis project will take place in Mangochi, a district on the southern tip of Lake Malawi between 2025 and 2029 and will contribute evidence from user and provider perspectives to address gaps in current strategies for supporting ART adherence among fishing communities. The main participants will be men and women involved directly or indirectly in fishing activities (fishing or fish trading). The project will contain five key work packages. First, using formative qualitative methods to understand the underlying gendered reasons for treatment interruption among fishing communities we will conduct in-depth interviews with mobile fishing communities and policy makers and focus group discussions with health care workers. Second, we will assess user preferences using a discrete choice experiment. Third, through a series of iterative workshops we will co-design a potential strategy for supporting ART adherence with the stakeholders. Fourth, we will pilot the final user-chosen strategy among fishing communities to assess its potential effectiveness to control HIV. Finally, we will assess feasibility, acceptability and costs of the chosen strsategy.\n\nWe will establish a Community Engagement and Involvement Group to ensure community needs are addressed and monitor responsiveness of the co-developed strategies to support continued engagement in care. This project responds directly to community priorities and puts them at the centre of framing potential strategies that meet the needs they themselves define. . This project has four key objectives:\n1. Understand how mobile fishing communities navigate the complexity of Human Immunodeficiency Virus care and how this understanding may lead to better models of care that are responsive to their unique and gendered needs.\n2. Identify a preferred intervention through a discrete choice experiment.\n3. Co-produce a gender responsive intervention with stakeholders (mobile fishing communities, health care workers and policy makers).\n4. Pilot final intervention to assess acceptability, efficacy, gender responsiveness, feasibility, affordability and sustainability.\n \n ID: GB-GOV-10-GAF_01_305511\nTitle: NIHR GAF: Co-Design and Implementation of a Digital Self-Care Intervention to Improve Sexual and Reproductive Health among Youth in Zimbabwe\nDescription: The NIHR Global Advanced Fellowship (GAF) scheme is a mid-career postdoctoral award that funds researchers undertaking research that aims to specifically and primarily benefit people in low- and middle-income countries (LMICs). The programme is open to researchers based in a Higher Education Institution (HEI) or Research Institute in a LMIC, or based in a HEI in the UK. The GAF funds research projects, training and development, and institutional capacity strengthening in LMICs.\n\nAfrica is the only region in the world where the youth population is expected to rise. When compared to adults, youth in Africa have higher unmet sexual and reproductive health (SRH) needs, including high new Human Immunodeficiency Virus (HIV) infections and sexually transmitted infections (STI) prevalence. My previous study in Zimbabwe found that one in five youth aged between 18-24 years have at least one of three curable STIs. According to UNICEF, one-third of new HIV infections in Zimbabwe are among youth. There is a clear unmet need for SRH services for youth in Zimbabwe. Unfortunately, most services primarily focus on HIV and not the broader SRH of youth. Where SRH services are offered, there is low uptake by youth as they face many barriers, including a lack of youth-friendly health providers. My study aims to design with youth a scalable digital self-care intervention that offers SRH services appropriate and tailored for youth in Zimbabwe.\n\nTo do this, during 2025 to 2030, I will (1) co-design a digital self-care intervention for SRH services with youth attending tertiary education institutions in Zimbabwe, (2) determine the feasibility, acceptability, and uptake of the intervention and develop optimal user pathways for delivery of SRH services for youth attending tertiary education institutions in Zimbabwe and (3) conduct a process evaluation of the intervention in order to develop a toolkit that will be used to help policymakers and programmers scale up and maintain this intervention.\n\nThe self-care intervention will offer HIV self-testing, STI screening, condoms, menstrual health products, and contraception. These SRH products will be delivered through a simple and free platform that can be used with the most basic mobile phone. I will work with youth to design this intervention through workshops and a design competition. A youth advisory committee will support the project throughout. During the intervention youth will be able to order services on their mobile phone using short messages without incurring connection or service charges. Their order will then be processed by the study team and delivered to a “grab and go” smart locker, which the youth will be able to access using a code sent to their phone once their order is ready. Youth will be given information on how to receive further support from a nurse in the tertiary educational institution’s clinic should they need it, for example, youth who screen positive for HIV or STIs.\n\nFindings from this study will respond directly to calls from the WHO and the Ministry of Health and Child Care in Zimbabwe regarding approaches to improve service delivery for youth. These approaches are important because improving the SRH of youth now has many benefits, including better SRH for them in the future and better health for their future offspring. Findings of this study will be shared with academics, youth, and policymakers via different channels, including journals, meetings, radio, and podcasts.\n\nThis NIHR GAF will rapidly expand my skills as a global SRH research leader. It will also enable me to build upon my already established track record in epidemiology. I will be able to transfer my experiences from the delivery of HIV and SRH services for youth into the co-development of innovative digital self-care interventions. My proposed intervention will transform the delivery of SRH services for youth in Zimbabwe, resulting in a toolbox of interventions for youth SRH service delivery.. This project aims to co-design, implement, and evaluate a digital self-care sexual and reproductive health intervention for youth attending tertiary education institutions in Zimbabwe. The study has three specific objectives:\n1. Co-design a digital self-care intervention for integrated sexual and reproductive health services with youth attending tertiary education institutions in Zimbabwe.\n2. Determine the feasibility, acceptability, and uptake of the digital self-care intervention and develop optimal user pathways for delivery of integrated sexual and reproductive health services for youth attending tertiary education institutions in Zimbabwe\n3. Conduct a process evaluation of the digital self-care intervention and develop a toolkit to inform operationalisation, scale-up and sustainability of the intervention.\n \n ID: GB-GOV-10-GAF_01_305519\nTitle: NIHR GAF: Co-developing interventions to reduce HIV-related mortality after hospitalisation \nDescription: The NIHR Global Advanced Fellowship (GAF) scheme is a mid-career postdoctoral award that funds researchers undertaking research that aims to specifically and primarily benefit people in low- and middle-income countries (LMICs). The programme is open to researchers based in a Higher Education Institution (HEI) or Research Institute in a LMIC, or based in a HEI in the UK. The GAF funds research projects, training and development, and institutional capacity strengthening in LMICs.\n\nDespite improvements in Human Immunodeficiency Virus (HIV) diagnosis and treatment, more than 600,000 people living with HIV (PLWH) die globally each year, mostly due to advanced HIV disease. In this condition, their immune systems are weak and vulnerable to life-threatening illnesses. Many of those who die are hospitalised before their death. While some die during hospitalisation, many more die after being discharged. In South Africa, around 50,000 PLWH die annually, and about 45% of these deaths happen among people who have returned home from the hospital, mostly about 6 months after being hospitalised. This high post-hospitalisation mortality for PLWH is largely preventable, but research has found that after discharge from hospital, PLWH don't get the care they need. \n\nNot much research is being done to address this problem in sub-Saharan Africa, where most of the HIV burden lies. Also, the solutions that have been tried by other researchers to address this issue have not been successful. We believe this is partly because the solutions have been developed without involving the care recipients discharged from hospitals, carers, and healthcare providers. Yet, these people are better placed to know what is likely needed to address some of these challenges. We have also seen from the published research that little work is being done to understand how solutions to reducing these post-hospitalisation deaths can involve the carers providing key support to care recipients discharged from the hospital. \n\nThe planned research is very important for PLWH, carers, and healthcare providers, as each group has a significant role in influencing the well-being of care recipients after they leave the hospital. By involving these groups as active participants in identifying and developing solutions, we believe we can reduce the number of deaths after hospital discharge. Therefore, we aim to work with these groups to develop and test interventions to lower the risk of post-hospitalisation mortality, focusing on the first six months after hospital discharge.\n\nWe plan to conduct a study in two phases between 2025 and 2029. In the first phase, we want to understand why PLWH have poor outcomes after leaving the hospital. We will recruit 328 care recipients living with HIV across four different hospitals in South Africa. The hospitals will be of different sizes, including a mix of those in rural and urban areas. We will follow these care recipients for 6 months after they leave the hospital and gather information at different times about how they are accessing healthcare services and their well-being. We will also enrol those caring for these care recipients to understand their needs and challenges as they provide support. With this information, we will work together with the patients, caregivers, and healthcare providers to develop potential solutions. We will then create sample interventions called prototypes to address the challenges we identify at each of the four study sites. In the second phase, we will test these prototypes to see if they can be used in real-world programs and if they are helpful to patients, caregivers, and healthcare providers. \n\nThe findings may drive advocacy efforts in the short term and inform improvements in service delivery in South Africa and similar settings in the long term.\n. This project has three key objectives:\nObjective 1: To identify the individual and contextual factors influencing care engagement and mortality in the first six months after hospital discharge among people living with Human Immunodeficiency Virus (HIV). There is a paucity of evidence on this topic to support a scoping review to inform intervention development. We will collect primary data through a mixed-methods, multi-centre prospective study of care recipients and carers in South Africa to provide nuanced evidence to inform the development of effective interventions.\nObjective 2: To co-develop interventions with care recipients, carers, and healthcare stakeholders aimed at enhancing care engagement and reducing mortality in the first six months after hospital discharge among people living with HIV. Co-developing the intervention with those who use, deliver services, and make decisions about public sector services is crucial for ensuring that solutions are tailored to real-world needs and challenges, thereby increasing the chances of achieving the desired outcomes. We will use a participatory human centered design approach to identify, refine, and prioritise components for co-developed intervention prototypes across four study sites in South Africa. This objective aligns with my training and development plan as an area where I intend to enhance my technical skills.\nObjective 3: To assess the preliminary feasibility and acceptability of co-developed prototype interventions. We will conduct a single-arm feasibility and acceptability study to determine if the interventions can be successfully implemented in real-world settings and are well-received by care recipients, carers, and healthcare providers. The study's results will be used to refine and enhance the intervention theory, components, and delivery for a future definitive implementation-effectiveness trial.\n \n ID: GB-GOV-10-GAF_01_305556\nTitle: NIHR GAF: Pathways to equitable stroke care in Sierra Leone and South Africa\nDescription: The NIHR Global Advanced Fellowship (GAF) scheme is a mid-career postdoctoral award that funds researchers undertaking research that aims to specifically and primarily benefit people in low- and middle-income countries (LMICs). The programme is open to researchers based in a Higher Education Institution (HEI) or Research Institute in a LMIC, or based in a HEI in the UK. The GAF funds research projects, training and development, and institutional capacity strengthening in LMICs.\n\nStroke is the second leading cause of death in Sub Saharan Africa (SSA) and the burden of stroke does not fall equally across different socioeconomic and ethnic groups. The current evidence in SSA is limited by being hospital based, therefore it only includes patients who have the means to access care at hospitals. This means that stroke may go unrecognised and uncounted amongst underserved and poorer populations, producing biased estimates of the impact of stroke. Measurement is key to improvement and accountability, however current stroke research does not always measure what is most important to patients, including patient experience of care.\n\nBetween 2026 and 2029 in Sierra Leone and South Africa we will conduct community based surveillance for stroke to identify patients with stroke in the community, using innovative community health worker led models. By training community health workers and primary health care staff on stroke recognition and awareness, we will add stroke surveillance to already funded disease surveillance systems in both settings. This innovative low cost stroke surveillance system will provide valuable learning for other countries in SSA to measure the burden of stroke in their communities. We will map how patients access care for acute stroke and how they previously sought care for risk factors for stroke to improve targeting of stroke prevention services. We will compare this community sample to hospital based data to assess inequalities in access to stroke care. We will measure the impact of stroke for patients in terms of mortality, health-related quality of life and disability.\n\nStroke services are in development in SSA, access to stroke prevention services and stroke unit based care is limited and unevenly distributed. Care pathways for acute stroke care and post hospital care are not well defined, most patients do not seek care early enough or in the most appropriate place. Organized stroke care has shown to be effective in randomised controlled trials, in reducing death and dependence after stroke. However, most stroke patients in Sierra Leone and South Africa are not admitted to a specialist stroke unit. There are differing levels and components of organized stroke care, which require different staffing mixes and ratios. Due to workforce and economic constraints, the highest level of organized stroke care currently or in the medium term cannot be delivered to all who need it. Therefore, there is a need to evaluate the effective of different levels of organized stroke care in this setting to help plan the development and scale up of stroke services. We will assess the relative effectiveness of different levels of organized stroke care in South Africa and Sierra Leone. \n\nWe aim to engage and involve patients and caregivers in the research, through working with a stroke survivor organisation in each country. Patients will be engaged in selecting and adapting patient experience questionnaires to assess experience of stroke care. We will hold Policy Labs with patients, healthcare workers and policy makers, where findings will be presented to inform patients and policy makers on decision making. We expect findings from the project will be used to guide decision making on the development of more equitable stroke services in both countries. \n. This project has three key objectives:\n1. Create population-based stroke registers within two existing and funded surveillance systems in South Africa and Sierra Leone to investigate inequalities in stroke occurrence, care and outcomes (Workpackage 1).\n2. Use causal inference methods to understand the effects of different levels of OSC in this setting (Workpackage 2).\n3. Use these findings to identify priority areas for quality improvement, and work with local policymakers to drive improvements and equity (Workpackage 3).\n", "_version_":1862856021028896768 }] } }