Can payment by results ensure equitable access to contraceptive services? a qualitative case study.

BACKGROUND: The Leave No One Behind (LNOB) agenda compels sexual and reproductive health and rights (SRHR) implementers to focus on the multiple and intersecting forms of discrimination and inequalities. One strategy to address these is Payment by Results (PbR). Using the Women's Integrated Sexual Health (WISH) programme as a case study, this paper examines if and how PbR can ensure equitable reach and impact. METHODS: Given the complexity of PbR mechanisms, a theory-based approach was used in the design and analysis of this evaluation, drawing on four case studies. These were conducted by reviewing global and national programme data and by interviewing 50 WISH partner staff at national level and WISH programme staff at global and regional levels. RESULTS: The case studies found that inclusion of equity-based indicators in the PbR mechanism had demonstrable effects on people's incentives, on how systems work, and on modes of working. The WISH programme was successful in achieving its desired programme indicators. The use of Key Performance Indicators (KPIs) clearly incentivised several strategies for service providers to innovate and reach adolescents and people living in poverty. However, there were trade-offs between performance indicators that increased coverage and others that increased equitable access, as well as several systemic challenges that limited the possible incentive effects. CONCLUSIONS: The use of PbR KPIs incentivised several strategies to reach adolescents and people living in poverty. However, the use of global indicators was too simplistic, resulting in several methodological issues.

COVID-19 outbreak among temporary foreign workers in British Columbia, March to May 2020.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, temporary foreign workers (TFWs) provided a critical role to maintaining the food supply in Canada, yet workers faced a number of challenges that made them particularly vulnerable to COVID-19. The objective of this study was to describe the epidemiological investigation and public health response to a COVID-19 outbreak among TFWs in an agricultural setting in British Columbia from March to May 2020. METHODS: An outbreak was declared on March 28, 2020 following detection of two cases of COVID-19 among a group of 63 TFWs employed by a nursery and garden centre. Outbreak control measures included immediate isolation of cases, case finding via outreach screening and testing, cohorting of asymptomatic workers and enhanced cleaning and disinfection. The outbreak was declared over on May 10, 2020. RESULTS: A total of 26 COVID-19 cases were identified among the group of TFWs; no cases were identified among local workers. Cases were primarily male (77%) with a median age of 41 years. Symptom onsets ranged from March 8 to April 9, 2020. One case required overnight hospitalization for pneumonia. CONCLUSION: This was the first COVID-19 community outbreak identified in British Columbia and the first COVID-19 outbreak identified among TFWs in Canada. This outbreak began prior to implementation of provincial and federal quarantine orders for international travellers. A provincial policy was later developed that requires TFWs to quarantine in government-funded accommodation prior to deployment to agricultural settings.

Characterization of novel lignocellulose-degrading enzymes from the porcupine microbiome using synthetic metagenomics.

Plant cell walls are composed of cellulose, hemicellulose, and lignin, collectively known as lignocellulose. Microorganisms degrade lignocellulose to liberate sugars to meet metabolic demands. Using a metagenomic sequencing approach, we previously demonstrated that the microbiome of the North American porcupine (Erethizon dorsatum) is replete with genes that could encode lignocellulose-degrading enzymes. Here, we report the identification, synthesis and partial characterization of four novel genes from the porcupine microbiome encoding putative lignocellulose-degrading enzymes: ß-glucosidase, α-L-arabinofuranosidase, ß-xylosidase, and endo-1,4-ß-xylanase. These genes were identified via conserved catalytic domains associated with cellulose- and hemicellulose-degradation. Phylogenetic trees were created for each of these putative enzymes to depict genetic relatedness to known enzymes. Candidate genes were synthesized and cloned into plasmid expression vectors for inducible protein expression and secretion. The putative ß-glucosidase fusion protein was efficiently secreted but did not permit Escherichia coli (E. coli) to use cellobiose as a sole carbon source, nor did the affinity purified enzyme cleave p-Nitrophenyl ß-D-glucopyranoside (p-NPG) substrate in vitro over a range of physiological pH levels (pH 5-7). The putative hemicellulose-degrading ß-xylosidase and α-L-arabinofuranosidase enzymes also lacked in vitro enzyme activity, but the affinity purified endo-1,4-ß-xylanase protein cleaved a 6-chloro-4-methylumbelliferyl xylobioside substrate in acidic and neutral conditions, with maximal activity at pH 7. At this optimal pH, KM, Vmax, and kcat were determined to be 32.005 ± 4.72 µM, 1.16x10-5 ± 3.55x10-7 M/s, and 94.72 s-1, respectively. Thus, our pipeline enabled successful identification and characterization of a novel hemicellulose-degrading enzyme from the porcupine microbiome. Progress towards the goal of introducing a complete lignocellulose-degradation pathway into E. coli will be accelerated by combining synthetic metagenomic approaches with functional metagenomic library screening, which can identify novel enzymes unrelated to those found in available databases.