Black People Narrate Inequalities in Healthcare Systems that Hinder COVID-19 Vaccination: Evidence from the USA and the UK.

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented global health emergency. As a novel condition, there is no known definitive treatment for the condition, except for the use of vaccines as a control measure. In the literature, the issue of inequalities in healthcare systems has been documented as a hindrance to COVID-19 vaccination; however, the specific inequalities in healthcare systems that hinder COVID-19 vaccination are poorly understood. Guided by the fundamental cause theory (FCT), this study aims to address this gap among Black people, a minority group vulnerable to inequalities in healthcare systems. Thirty-five Black people (age range = 21-58 years) residing in either the United States of America (USA) or the United Kingdom (UK) participated in this study. Qualitative data were collected and analyzed using thematic analysis. Most USA participants and a few UK participants narrated that no inequalities in healthcare systems hinder them from receiving COVID-19 vaccines. Contrarily, most UK participants and a few USA participants narrated inequalities in healthcare systems that hinder them from receiving COVID-19 vaccines. These are mistrust of the healthcare system, health policies regarding COVID-19 vaccination, historical factors (such as historical abuse of Black bodies by health professionals), residential location, and dissatisfaction with health services. In terms of what governments must do to correct these inequalities, participants recommended the need for acknowledgment and community engagement. This is the first international collaboration to examine this problem. Important implications for theory, healthcare systems, and COVID-19 vaccination program planning are highlighted. Finally, there are members of other minority groups and vulnerable communities who are not Black people. Such groups could face unique inequalities that hinder COVID-19 vaccination. Therefore, future studies should include such groups.

Building a national framework for multicentre research and clinical trials: experience from the Nigeria Implementation Science Alliance.

There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement sessions, and established a governance structure. Additionally, we selected and trained a core research team, developed criteria for site selection, assessed site readiness for research and obtained ethical approval from a single national institutional review board. We used the Exploration, Preparation, Implementation, Sustainment framework to guide our reporting of the process in the development of this network. The NISA-MIRCs will provide a nationally representative infrastructure to initiate new studies, support collaborative research, inform policy decisions and thereby fill a significant research infrastructure gap in Africa's most populous country.

Risk and protective factors for adolescent substance use: a comparative study of secondary school students in rural and urban areas of Osun State, Nigeria.

BACKGROUND: Substance use is a leading adolescent health problem globally, but little is known regarding associated factors for adolescent substance use in Nigeria. This study compared the prevalence of substance use among in-school adolescents in urban and rural areas of Osun State, Nigeria, and identified risk and protective factors. METHODS: This cross-sectional study involved 600 randomly selected adolescents (aged 10-19 years) from rural and urban areas of Osun State, Nigeria. Data were collected using the facilitated self-completed questionnaire method. Binary logistic regression was used to examine the association of individual, peer, and parental factors with adolescent substance use. Adjusted odds ratio (OR) and 95% confidence interval (CI) were obtained. RESULTS: About two-thirds of respondents had used substances in both rural (65.7%) and urban areas (66.0%) (p=0.93). Logistic analysis showed private school attendance as a risk factor for substance use (OR=2.32, 95% CI=1.20-4.46) and adolescent disapproval of adult substance use as a protective factor (OR=0.47, 95% CI=0.27-0.82) in rural areas. For urban areas, having friends who use substances (OR=4.04, 95% CI=1.39-11.6) and a mother having had tertiary education (OR=3.34, 95% CI=1.06-10.4) were risk factors while parental disapproval of substance use (OR=0.50, 95% CI=0.28-0.90) was a protective factor. CONCLUSION: Lifetime prevalence of substances is high among in-school adolescents in Osun State. The risk and protective factors for adolescent substance use somewhat differ for rural and urban areas, and these have implications for designing effective intervention strategies.