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Anyone else here sitting the Management Level Case Study in May?
From the initial analysis I’ve seen, Piping seems to be quite a straight forward pre seen, well established company in a well established industry. I can only think the questions on the variants are going to be quite tough
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For those students whose first taste of a case study will be in May 2023, what can you expect and how should you prepare?
The pre-seen materials release date is an obvious starting point for preparations, but from personal experience I found that using the weeks BEFORE the pre-seen materials are released as the perfect time to develop a exam strategy and look at the bigger picture on what CIMA expects of a student looking to pass the case study exams first time.
Here are three pieces advice I would give students sitting a May case study exam
Each CIMA case study exam requires a different approach and mindset, it’s important to understand what role you are playing and how to react to the questions.
Bear this in mind when your answering questions on exam day.
For example, in the SCS exam don’t get drawn into answering a question from the point of view of a Finance Clerk or Manager, you role is Finance Director so you will be required to answer in that mindset – developing strategy and thinking long-term!
Time management on exam day is crucial and having a plan when answering a question will give you a enough time to produce a full and well balanced answer.
You should have a plan on exam day on how you will answer your question.
Assuming you have 45 minutes for each question in the OCS and MCS (4 questions at 45 mins = 3 hours), I used the below as guideline for answer planning and time management.
It’s a natural tendency to rush straight in and start writing out your answering as you see the question, but this can lead to rambling, not answering the requirement and forgetting to add relevant points from the industry analysis or pre-seen materials.
The most common trap students fall into is not understanding the requirement of the question asked, but instead trotting out a pre-rehearsed answer based on the subject.
While it’s important to understand the theory you have studied in the CIMA objective tests, practicing rehearsed statements is not a good idea.
Don’t fall into this trap!
If you identify the requirements of the question and plan your answer around the requirements, you will avoid this trap and maximise your chances of passing the CIMA case study first time.
Astranti was the training provider I used to pass my CIMA case studies first time and they’ve recently put together an informative guide on how to crack the case studies !
It’s well worth a read before the pre-seen materials are released later this month.
In terms of the resources, the Astranti course for the May CIMA Case Studies is packed full of resources and tutor support and they have an early sale on their full courses.
cimastudent
[…] Preparing for a CIMA Case Study […]
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Open Access
Peer-reviewed
Research Article
Roles Formal analysis, Investigation, Writing – original draft, Writing – review & editing
* E-mail: [email protected]
Affiliation Independent Public Health Consultant, Dakar, Senegal
Roles Project administration, Supervision, Writing – review & editing
Affiliation Regional Office to the Eastern-Mediterranean Region, World Health Organization, Cairo, Egypt
Roles Methodology, Validation, Writing – review & editing
Affiliation Independent Clinical Epidemiologist, Cape Town, South Africa
Roles Writing – review & editing
Affiliation World Health Organization, Johannesburg, South Africa
Roles Project administration, Writing – review & editing
Affiliation Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland
Roles Funding acquisition, Project administration, Writing – review & editing
Roles Conceptualization, Supervision, Validation, Writing – review & editing
Caregiver-assisted testing using HIV self-test (CG-HIVST) kits has been proposed to enhance paediatric HIV case finding and contribute toward ending paediatric HIV/AIDS by 2030. We conducted a systematic review to assess the risks and benefits of CG-HIVST. We searched nine electronic databases and consulted experts to identify relevant articles through 5 February, 2022. Studies comparing CG-HIVST to other testing services among children over 18-months, or to no intervention, were included. Outcomes included uptake, acceptability, diagnostic accuracy, feasibility, HIV positivity, linkage to care, social harm, values and preferences, costs, and cost-effectiveness. Risk of bias was assessed using relevant Cochrane tools and certainty of evidence was evaluated with GRADE. Among 2203 screened articles, nine observational studies from sub-Saharan Africa were included. All studies used and assessed caregiver-assisted testing using oral fluid-based HIVST. In one non-randomized intervention study of 6062 children, overall CG-HIVST uptake was lower than other standard testing services (3.30% vs. 56.71%). In the same study, HIV positivity following CG-HIVST appeared lower or comparable to standard testing (RR = 0.44; 95% CI: 0.06, 3.20). Two single-arm studies reported high linkage to confirmatory testing (97.48%) and treatment initiation (97.7%) among children reported positive with CG-HIVST. Pooled positive predictive value was 36.72% across three non-randomized intervention studies. Reported social harms were rare, and acceptability appeared high among caregivers taking up the intervention, but feasibility was unclear as some reported anxiety in relation to reactive results. Evidence was appraised very low certainty. Average CG-HIVST costs varied widely and were consistently higher than standard testing services. CG-HIVST may be acceptable, but feasibility remains uncertain with potential higher costs. Current evidence favours standard testing for uptake and positivity. Low positive predictive values raise concerns about false positives and potential harm. Programmes should prioritize evidence-based approaches for paediatric case-finding, while research to fully evaluate this approach continues.
Citation: McGee K, Jamil MS, Siegfried N, Radebe BM, Barr-DiChiara M, Baggaley R, et al. (2024) Caregiver-assisted testing with HIV self-test kits for children 18 months and older: A GRADE systematic review. PLOS Glob Public Health 4(8): e0003588. https://doi.org/10.1371/journal.pgph.0003588
Editor: Sharmistha Mishra, University of Toronto, CANADA
Received: February 29, 2024; Accepted: July 15, 2024; Published: August 14, 2024
Copyright: © 2024 McGee et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All data presented in this systematic review were obtained from published reports and additional information shared by contacted authors and are available within the manuscript and in supplementary information.
Funding: This systematic review was supported by the Bill and Melinda Gates Foundation (BMGF) through the World Health Organization (WHO) grant INV-024432 and Unitaid through the Unitaid-WHOHIV and Co-Infections/Co-Morbidities Enabler Grant (HIV&COIMS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Reaching children with HIV to enable them to test and link to onward HIV prevention and care services is key strategy to end AIDS by 2030 [ 1 ]. There has been a substantial progress in addressing HIV among children through scale-up of prevention of mother-to-child transmission (PMTCT) services, infant diagnosis and treatment. However, only 57% of all children living with HIV in 2022 were accessing ART, resulting in approximately 660,000 children (0–14 years) living with HIV remain untreated [ 1 ]. Global progress is also far from achieving fewer than 15,000 new pediatric infections annually [ 2 ].
WHO recommends a package of evidence-based approaches for prevention and diagnosis of HIV infections in children [ 3 ]. These include improving access to PMTCT services for pregnant women, routinely offering HIV testing to pregnant women and prioritizing infant diagnosis for children born to parents who have not received PMTCT interventions. Subsequently, routinely offering testing to reach HIV exposed infants is critical for diagnosis and treatment [ 3 ]. Effective entry points for reaching infants and children who have been missed by infant diagnosis and routine follow-up testing include health facilities, including immunization, malnutrition, tuberculosis, and inpatient wards [ 4 ]. Family and household testing (also called provider-assisted referral or index testing) is also recommended for biological children of people with HIV. Virological testing is essential for infant diagnosis, however diagnosis of children above the age of 18 months should adhere to the standard national testing algorithms, often with use of three serology-based diagnostic tests [ 3 ].
HIV self-testing (HIVST) is an approach whereby an individual collects their own blood or oral-fluid specimen, performs the test and interprets their results. Since 2016, WHO has recommended HIVST to address gaps in HIV diagnosis [ 5 ]. Globally HIVST has been scaled up considerably as an effective approach to reach those who do not otherwise access services for testing. WHO guidance currently does not recommend caregiver-assisted testing with HIVST kits (CG-HIVST), defined as an HIV testing approach whereby a parent or guardian performs HIV testing on a child, generally as part of family-based index testing, using a quality-assured self-test. In recent years, some programs have explored the utility of CG-HIVST as an additional approach to identify undiagnosed children [ 6 – 14 ]. In 2022, we conducted a systematic review to assess the potential risks and benefits of CG-HIVST to inform the development of WHO guidelines and recommendations. This paper presents the work and findings that were presented and used to inform WHO’s guideline development group in November 2022.
The review protocol was registered online in the International prospective register of systematic reviews (PROSPERO Registration number: CRD42022302617). No deviations from the registered protocol were made.
We searched nine electronic databases including Ovid Medline, Embase, CINAHL Plus, EconLit, Global Health, PsycInfo, Cochrane Library, Web of Science, and Scopus through 5 February 2022. We verified secondary references on previously published review articles relevant to HIVST and contacted experts in the field to identify additional articles and abstracts. As previously stated, this paper presents the results as they were presented to WHO’s guideline development group in November 2022. While the search results have not been updated since 2022, a recent search of the literature has revealed no new publications regarding CG-HIVST, as of December 2023. This additional search included a review of the databases mentioned earlier to verify that no new publications relevant to our study were available during this period.
The search strategy was adapted to each database using key terms “HIV”, “self-test” ( S1 Table )). No restrictions were placed on location of the intervention or language of article. Two reviewers screened articles and differences in judgement were resolved by other review team members. To be included in the review, a study had to directly compare CG-HIVST to any other HIV testing services for children, or to no intervention. Studies offering caregivers the choice between CG-HIVST and other pediatric testing modalities were included. Eligible studies were limited to children 18 months of age up to 18 years of age, as children younger than 18 months should be diagnosed based on virological testing as per WHO recommendations [ 3 ]. Studies also had to report on one or more of the following outcomes: 1) HIV testing uptake (defined as proportion of children tested for HIV in study period among those enrolled. This outcome measures the actual uptake of CG-HIVST among the enrolled population of children. Note that one caregiver may have multiple children tested); 2) Acceptability of CG-HIVST (proportion of caregivers who accepted and chose the CG-HIVST testing approach. This outcome reflects the willingness of caregivers to opt for the CG-HIVST method); 3) Diagnostic accuracy (measured by sensitivity, specificity, positive predictive values (PPV), and negative predictive values); 4) Feasibility (proportion of caregivers who correctly administered CG-HIVST) and usability (proportion of caregivers who reported CG-HIVST easy to administer); 5) HIV positivity (proportion of children tested and confirmed positive); 6) linkage to care (proportion of children tested reactive linked to confirmatory testing, clinical assessment, or treatment); 7) social harm/adverse events (occurrence and reporting of any harm or undesirable experience occasioned by the intervention to children and/or caregivers); 8) values and preferences (reported facilitators and barriers associated with the intervention); 9) costs and cost-effectiveness.
Data was extracted by one reviewer (KM) using a standardized data extraction form. Study authors were contacted when additional data or clarification was needed. Pair-wise meta-analysis was planned, however, due to methodological heterogeneity across studies, this was not possible and quantitative and qualitative data was summarized descriptively. When values and preferences or resource use were reported by included studies they were descriptively summarized and reported. Studies reporting on costs or cost-effectiveness were also adjusted to and reported in 2021 United States Dollars. Risk of bias (RoB) was assessed using the Risk of Bias in Non-randomized Studies–of Interventions (ROBINS-I) tool [ 15 ]. Studies reporting on usability and diagnostic accuracy were also assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool [ 16 ]. In accordance with WHO guideline development practice, we report the results using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) recommended language which integrates the clinical importance of the estimate of effect with the overall certainty of the estimate [ 17 ]. Following guidance from GRADE Handbook, overall certainty of evidence was rated by appraising risk of bias, level of imprecision, indirectness, inconsistency and other considerations [ 18 ]. Full RoB and GRADE Quality Assessment is available in ( S1 Text and S2 Table ).
The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Searches were conducted on October 1st, 2021, and repeated on February 5th, 2022. Update search conducted in December 2023 revealed no new publications. Four records were identified through field experts. After duplicates were removed, the combined searches yielded 2,203 citations, of which, nine observational studies were included in the review (see “ Fig 1 ”).
https://doi.org/10.1371/journal.pgph.0003588.g001
Across all studies there were 6,916 caregivers with HIV and 13,840 children of unknown HIV status. All studies used oral fluid-based HIVST and were among children of caregivers with HIV (aged 18 months to 18 years). All Studies were in sub-Saharan Africa (Zimbabwe, Kenya, Uganda, and Zambia); with all but one related to two intervention trials: Bridging the Gap in HIV testing and care for children (or B-GAP) [ 6 ], which was conducted in Zimbabwe, and the Faith-based Action for Scaling up Testing and Treatment for Epidemic Response (or FASTER), which was conducted in Uganda and Zambia (see Table 1 ) [ 10 , 11 ].
https://doi.org/10.1371/journal.pgph.0003588.t001
B-GAP, a non-randomized intervention study without a control group, allowed caregivers to choose among three index-testing approaches for their children: 1) standard facility-based testing, 2) home-based testing by a lay provider, and 3) CG-HIVST. Chikwari 2021 presented the main study findings, including uptake, positivity, linkage to care, acceptability and social harm. B-GAP also includes a cost analysis [ 7 ], a study on feasibility and diagnostic accuracy [ 8 ], and a qualitative study on values and preferences [ 9 ]. The second study, FASTER, includes two parent trials, Tumwesigye 2022 [ 10 , 11 ] and Stecker 2022 [ 10 ], both single-arm intervention studies, along with a cost analysis [ 12 ], and an additional analysis on the effects of screening for social harm [ 13 ]. Finally, Neary 2022 [ 14 ], conducted a qualitative study as part of the larger STEP-UP studies [ 19 ], and used focus group discussions to explore the values and preferences of caregivers and health care workers.
A single non-randomized intervention study [ 6 ] directly compared and reported HIV testing uptake between CG-HIVST and provider-assisted index testing. In the study, caregivers were offered the choice among three testing options for children: CG-HIVST, home-based testing by lay provider and standard facility-based testing by health worker. Out of 6,062 eligible children enrolled in the study, 3.3% (n = 197/6062) were tested by CG-HIVST. In comparison, 31.61% (n = 1916/6062) tested in a facility by a health provider, and 25.11% (n = 1522/6062) tested at home by a lay health-worker. Certainty of this evidence for uptake was very low due to an extremely serious risk of bias.
In the same study, when excluding children whose caregivers refused any testing option (non-ITT approach), uptake was highest for children whose caregivers opted for home-based HIV testing at 69% (n = 1026/1487), followed by 65.67% of children whose caregivers selected CG-HIVST (n = 197/300), and by 52.13% of children selected into facility-based HIV testing (n = 1845/3539). While denominators reflect the number of children selected for testing option, there were instances of crossovers between study arms. Certainty of this evidence was very low due to an extremely serious risk of bias. Potential in-study heterogeneity related to child sex and age was explored using subgroup analysis, but no differences in uptake was found (additional analysis available in ( S3 Table ).
Acceptability of CG-HIVST was reported in two single-arm intervention trials [ 10 ]. Overall, both studies reported high acceptability among caregivers who opted into CG-HIVST (96.91%, 3924/4049) and among caregivers who performed the self-test on their children (94.02%, 3807/4049). Evidence was graded as uncertain because study enrolment procedures introduced risk of bias. Prior to study enrolment, study teams approached index caregivers and offered them a choice of HIV testing services for their children. Caregivers who opted for CG-HIVST were enrolled and remaining caregivers were re-directed to alternative testing modalities. N either study was able to provide information on the proportions of approached caregivers who accepted or declined CG-HIVST.
Diagnostic accuracy was reported in three studies [ 8 , 10 , 11 ] (see Table 2 ) , comparing caregivers’ interpreted results of CG-HIVST to the results of blood-based rapid HIV testing performed by researchers. In one study [ 8 ], specificity of CG-HIVST was high (98.6%; 95%CI: 97–99%) but sensitivity, while high, had a very large confidence interval (100%, 95%CI: 40–100%) due to a small sample size and very few children testing positive. Negative predictive value was 100%. Two other studies [ 10 , 11 ] reported performance and accuracy measures, including positive predictive values (PPV) and the number of discrepant results. However, true sensitivity and specificity of CG-HIVST could not be estimated as only children testing positive received confirmatory testing. Using total true positives and total false positive results, the pooled positive predictive value (PPV) of all three studies [ 8 , 10 , 11 ] was 36.72% (range: 32.7–61.1%); indicating there could be a substantial risk of false positive results. Due to the absence of reported true negatives in two studies [ 10 , 11 ], it was not possible to calculate a weighted PPV average across studies. All studies were treated equally to avoid potential bias.
https://doi.org/10.1371/journal.pgph.0003588.t002
Additional analysis from one study in Uganda [ 11 ] reported that implementing a refresher training course to staff did reduce the number of discrepant results over time. In this study, it was reported positive predictive values increased from 23.33% in weeks 1–8 to 47.37% in weeks 9–25.
Feasibility of CG-HIVST was reported in three trials [ 8 , 10 ]. In one study [ 8 ], the majority caregivers who received an in-person demonstration on how to test children with an HIVST kit were observed to correctly administer the test (92.4%, 145/157). However, in this same study, caregivers who did not receive a demonstration appeared to have more difficulty with only 78.0% (490/629) able to correctly administer the test. In two studies [ 10 ], most caregivers receiving demonstrations felt testing was easy to administer (96.95%, 2636/2719) but three-quarters 75.30% of caregivers who did not receive demonstration felt testing was easy to administer. The certainty of evidence was very low.
HIV positivity was reported by one study with a comparative design [ 6 ]. There was very low certainty that HIV positivity was reduced in the CG-HIVST group compared to other index-testing options, but this estimate ranged from a reduction in HIV positivity of 94% compared to the other index-testing approaches to a threefold increase in HIV positivity (RR = 0.44; 95% CI:0.06, 3.20). In two additional single-arm studies, the pooled HIV positivity was 0.57% (n = 43/7608) [ 10 ].
Linkage to further testing and care following CG-HIVST was reported in two single-arm trials [ 10 ]. In one study in Uganda, all children with a reactive result (n = 98) received further testing within 1-month of follow-up. However, in the other study in Zambia, 86% of children with a reactive result (n = 21) received further testing within 1-month of follow-up. Across both studies, among children receiving confirmatory testing and diagnosed with HIV, linkage to care was 97.5% (116/119).
Potential harm related to CG-HIVST was reported in three studies [ 6 , 10 , 13 ] In one study [ 10 ], there were reports of minor adverse events related to CG-HIVST, such as children experiencing gum pain (n = 6/9), bleeding gums (n = 3/9), or gum itching (n = 1/9).
There were no reports of physical harm or abuse to caregivers or children in any of the studies. In two single-arm studies [ 13 ], caregivers were pre-screened for factors associated with violence or harm, rendering the results uncertain.
Across four studies, caregiver-assisted testing with HIVST kits was well-liked by caregivers among those who opted into the approach[ 9 , 10 , 14 ], with many caregivers feeling it was private, convenient, and could protect from potential stigma and discrimination. Some caregivers expressed concerns about their ability to correctly administer HIVST and about the accuracy of the approach [ 9 , 10 , 14 ], as well as their ability to deliver post-test messages to children and to handle a reactive result [ 9 , 14 ]. For this reason, many caregivers desired the presence of a provider or counsellor when testing children [ 9 , 10 , 14 ]. Some caregivers also felt that greater education and sensitization about CG-HIVST was needed, along with efforts to optimize the intervention by providing better demonstrations on how to perform the test and to improve supply and access to HIVST kits [ 10 ].
Two studies reported on resource use [ 7 , 12 ] and are summarized in ( S4 Table ). Overall, the average cost per child tested ranged from $5.12 in Zambia to $154.23 in Zimbabwe, and the average cost per child diagnosed range from $869.00 in Uganda to $2,468.68 in Zimbabwe.
One study compared costs across different testing modalities for children and adolescents [ 7 ]. In this study, the average cost per child tested using standard testing approaches ranged from $14.58 to $17.67, whereas the incremental average cost of CG-HIVST to standard testing range from $43.48 to $154.23. When this was compared to other standard index-testing approaches, the incremental cost per child tested of CG-HIVST was three to eleven times greater than standard testing approaches for children and adolescents.
The key cost drivers across studies were HIVST commodities, as well as personnel used to deliver support and demonstrations. In one study, personnel costs ranged between 39.7% and 50.3% and supervision costs ranged between 25.7% and 29.1% of total costs [ 7 ]. Two other studies had lower personnel costs (15–16% of total), but reported higher cost HIVST kits which took up between 41% and 51% of the total costs [ 12 ].
Average costs per child tested and per child diagnosed were sensitive to testing uptake and positivity. Because HIV positivity was low across all studies, this contributed to high average unit costs per child diagnosed.
In the risk of bias assessment (summarised in Figure A, Tables A and B in S1 Text ), several critical and serious risks of bias were identified that affected the certainty of evidence. Overall, measures of testing uptake, positivity, acceptability, feasibility and social harm were contingent on caregivers’ self-reporting. Notably, all three studies exhibited a significant gender imbalance among caregiver participants, with a higher proportion of female caregivers opting for CG-HIVST (79% female in Chikwari 2021, 73% female in Tumwesigye 2022, 88% female in Stecker 2022). Multivariate analyses further confirmed women were more likely to uptake, potentially rendering testing uptake and ensuing outcomes appear greater among these study populations. The ROBINS-I tool also highlighted risks of bias in the selection of participants, such as in Tumwesigye 2022 and Stecker 2022 [ 10 ] where caregivers opting for other testing options were directed to other services and excluded from the study. Chikwari 2021 [ 6 ] was found to have critical bias due to deviations from caregivers’ originally selected testing modalities and an overall attrition rate of 21%.
This systematic review set out to assess the risks and benefits of CG-HIVST and explore whether CG-HIVST may be an additional, safe and effective approach to increase diagnosis of children living with HIV. While revealing challenges in uptake, diagnostic accuracy, and feasibility, the review also demonstrated high acceptability and a low risk of harm. However, the review found that available evidence remains at very low certainty, limiting the ability to make robust conclusions.
The available evidence, albeit limited to a single comparative study [ 6 ] suggests that uptake of CG-HIVST among caregivers was comparatively low, with only 3.3% of eligible children tested using this approach. Other standard index-testing approaches showed higher uptake rates, including facility-based testing by health providers and home-based testing by lay health workers. While the single-arm studies from Uganda and Zambia [ 10 ] signaled CG-HIVST may be highly acceptable, they did not report on how many caregivers approached to join the studies declined CG-HIVST, suggesting possible preference for alternate options. While HIV positivity appeared to be low across studies (less than 1%), particularly in the studies’ high HIV burden settings and among children of parents living with HIV, the effects of CG-HIVST on positivity remain uncertain.
No cases of physical harm or abuse to children or caregivers were reported in all three intervention studies [ 6 , 10 ] however evidence was limited as two of the three studies [ 10 ] excluded participants at-risk of social harm prior to study enrolment [ 13 ]. Furthermore, low positive predictive values raise concerns that potential false-positive results may increase the risk of harm, users’ costs when seeking confirmatory testing, and erode the confidence of users in CG-HIVST. These same concerns are echoed in qualitative interviews, where caregivers reported concerns on accuracy, how to handle reactive results, and expressed desire for post-test provider or counsellor support. It is important to note that studies directly comparing the diagnostic accuracy of blood-based and oral-fluid HIV self-testing (OF-HIVST) among adult populations have found OF-HIVST to have very high sensitivity and specificity (Figueroa et al 2018), with recent studies reporting PPVs of 95.24% [ 20 ] and 98.13% [ 21 ]. The tests used in these studies were also prequalified and reported 99.4% sensitivity and 99.0% specificity [ 22 ]. This suggests that the lower accuracy observed in this review may be due to challenges in implementing the approach among children and/or caregivers, especially in settings with very low HIV prevalence. While these studies focused on a population of biological children of people with HIV, HIV positivity across the three studies stood at less than 1%, directly affecting the PPV and thus further indicating the need for HIV testing strategies to be appropriately designed and targeted for paediatric populations.
Feasibility appeared to be high when caregivers received demonstrations on how to correctly administer HIV self-testing to their children, but this adds to costs (including test costs) and staff time. While such approaches have been valuable in the roll-out of existing HIVST approaches among adult populations and should not be discounted, the cost of this approach as part of CG-HIVST may be a limiting factor. In Zimbabwe, CG-HIVST incurred incremental costs three to eleven times higher than standard testing, driven largely by the low uptake and low positivity of the approach. Implementing CG-HIVST at scale may pose challenges, especially in resource-constrained settings. While CG-HIVST may increase access to some, the intervention’s high costs and low yields may lead to de-prioritization or fewer resources for other more effective testing modalities. Until further evidence demonstrate CG-HIVST to be safe and effective, programs may need to prioritize recommended pediatric testing approaches, leveraging existing and effective strategies for reaching children such as PMTCT, malnutrition, TB, and immunization services, which, to date have not been fully maximized [ 23 ]. Given the substantial gaps among children, the suboptimal implementation of these evidence-based testing approaches to reach children and adolescents needs to be addressed urgently through updated national strategies in sub-Saharan Africa where, in the most recent population-level study, close to 40% of children had undiagnosed HIV [ 24 ].
This review was significantly limited by the number of studies that directly compared CG-HIVST to other standard pediatric index-testing services. Meta-analysis was not feasible, and the overall certainty of evidence was very low due to very high risks of bias as well as the indirectness of the evidence, caused by study enrolment criteria and procedures. Future systematic reviews and meta-analyses will need studies with comparative study designs to better understand the relative risks, benefits, and preferences between CG-HIVST and other pediatric testing modalities. While randomized controlled trials are considered the gold standard, cohort, pre- and post- and other observational study designs using rigorous methods to minimize bias due to selection of participants and attrition would be valuable. The areas of greatest uncertainty that require further attention include the accuracy, resource use, and the actual impact of CG-HIVST on uptake of HIV testing, case-finding and treatment in the undiagnosed paediatric population compared to existing strategies. Future studies may also want to explore considerations between different age groups including potential issues on coercion, age of consent, provision of first line support services to children and families where abuse or harm are identified, and implementation of the approach for adolescents and older children. For adolescents, provider or peer-delivered approaches [ 25 – 27 ] may be preferable, in settings where age of consent polices allow HIVST distribution to adolescents. It would also be valuable for studies to better characterize and understand differences particularly among populations that decline the intervention. This requires study designs that compare outcomes and insights from different population groups, including those who find the testing approach acceptable and those who decline it. Resource use is increasingly important with policy shifts towards sustainability and decreased funding from donors. The cost per diagnosis was high in the studies included in this review and it is important to identify opportunities to optimize limited resources for paediatric case-finding.
Based on the findings of this review, the guidelines development group convened by WHO assessed the evidence not sufficient and conclusive at this time to make a recommendation for or against CG-HIVST. Since the systematic review was conducted and presented, no additional studies on CG-HIVST have been published, as far as authors are aware. Lack of evidence emphasizes the need for ongoing research. While the safety and effectiveness of CG-HIVST remains very uncertain and needs to be further investigated, greater efforts are needed to better reach children and adolescents living with HIV and to link them to care. Investment and scale-up of effective pediatric and family-centered testing approaches remain crucial and must be delivered beyond traditional service delivery points. It is important that the global HIV response prioritizes existing pediatric case-finding interventions until further evidence is available.
S1 table. full search term for ovid medline..
This appendix contains the detailed search strategy used for identifying relevant studies in the Ovid Medline database. It includes specific search terms and the combinations used.
https://doi.org/10.1371/journal.pgph.0003588.s001
This appendix contains the GRADE evidence profiles for each outcome assessed in the systematic review, detailing the certainty of evidence and summary of findings.
https://doi.org/10.1371/journal.pgph.0003588.s002
This appendix contains the subgroup analyses for each outcome assessed by gender and children age groups.
https://doi.org/10.1371/journal.pgph.0003588.s003
This appendix contains the summary of the reported unit costs for caregiver-assisted HIV self-testing, expressed in 2021 USD. Comparative unit costs for alternative index-testing modalities were included when reported.
https://doi.org/10.1371/journal.pgph.0003588.s004
This appendix contains the risk of bias assessment for each included study using the ROBINS-1 and QUADAS-2 assessment tools. It includes summary results as well as a detailed justification of the assessment for each study and each domain.
https://doi.org/10.1371/journal.pgph.0003588.s005
https://doi.org/10.1371/journal.pgph.0003588.s006
Full post exam materials ocs nov 21- feb 22.
This document contains the full post exam supporting materials for the November 2021 and February 2022 operational case study exam containing:
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MCS November 2022 - February 2023 Post Exam Material. This document contains the full post exam supporting materials for the November 2022 and February 2023 Management Case Study exam containing: The CGMA Study Hub keeps you on track to achieve your personal study goals.
This document contains the full post exam supporting materials for the November 2022 and February 2023 Strategic Case Study exam containing: pre-seen material; exam variants; suggested solutions; examiners report (available from 28 April) marking guidance (available from 28 April)
November 2021 - February 2022 Management Case Study Examination . 1 ©CIMA 2021. No reproduction without prior consent. Management Case Study Examination . November 2021 - February 2022 . Pre-seen material . COVID-19 Statement This pre-seen and the case study in general (while aiming to reflect real life), are set in a
Exam resources from the last CIMA case study - November 2023 & February 2024. In this section you can access the pre-seen documents and interim examiner's reports for the previous case study sitting, as well as links to our pre-seen analysis video archive playlist on YouTube. The full examiner's reports are usually published around the ...
CIMA 2022. No reproduction without prior consent. Introduction Happy Playz is a quoted toy retailer that has a chain of retail shops. Happy Playz also sells a substantial quantity of its toys online. Happy Playz operates in Westaria, a developed country that has a strong economy and whose citizens have a high standard of living.
As part of the Management case study exam, you'll have 30 to 60 minutes to write a financial report or response to a colleague, manager, or senior executive via email. In the exam you can expect 4 tasks to answer. A good, clear, writing style is very important. Use short, digestible, paragraphs to make it easy for the marker to read, and give ...
Candidates are recommended to schedule/book and sit their CGMA Case Study (CS) exam in the November 2024 exam window so that they, if they were unsuccessful, may retake the exams in the February 2025 exam window. A Certificate of Completion will be awarded to all FLP Class of '24 (Season II) candidates after the programme.
The CIMA Professional Management Level Case Study Text will provide you with the understanding of the Integrated Case Study requirements. You'll also have the tools to analyse the pre-seen material for your exam. Kaplan Publishing is the only official publisher of CIMA approved material, meaning that all of our books and materials have been ...
Full Post Exam Materials MCS and Gateway Nov 21- Feb 22. This document contains the full post exam supporting materials for the November 2021 and February 2022 management / gateway case study exam containing: The CGMA Study Hub keeps you on track to achieve your personal study goals.
To gain access to exclusive content, your first step is to join the AICPA & CIMA. Manage preferences This site is brought to you by the Association of International Certified Professional Accountants, the global voice of the accounting and finance profession, founded by the American Institute of CPAs and The Chartered Institute of Management ...
Nov 21 - Feb 22 SCS Post Exam Materials. This document contains the full post exam supporting materials for the November 2021 and February 2022 strategic case study exam containing: The CGMA Study Hub keeps you on track to achieve your personal study goals.
Students sitting the first Operational Case Study exam for 2023 achieved a 68% pass rate. That is higher than any pass rate in 2022, and two percentage points higher than last November. The Management Case Study February pass rate was also up on November 2022 - from 71% to 72%. The worry is the Strategic Case Study pass rate, which has dipped ...
November 2021 & February 2022 Strategic Case Study Examination 2 ©CIMA 2021. No reproduction without prior consent. Introduction Pixlwizz is a quoted company that creates and sells video games. Pixlwizz generates revenue streams from its games in several different ways. You are a senior manager in Pixlwizz's finance function.
Jun 20, 2023 · 1 min read. FREE ACCOUNT. ACCESS. Advanced Diploma Highest AchieversAdvanced Diploma Highest Achievers. Check out the latest CIMA diploma in management accounting highest achievers! May 2024. Management case study. February 2024. Management case study.
Dedicated to helping you pass your case study exam. Ever since our first CIMA case study course over 14 years ago, Astranti has gained a reputation for offering the most comprehensive case study courses in the market. Our courses are dedicated to providing you with the best advice and support to help you pass your exams on the first attempt.
CIMA NOVEMBER 2023 AND FEBRUARY 2024 - MANAGEMENT CASE STUDY vi. KAPLAN PUBLISHING 1 Chapter 1 INTRODUCTION 1 INTRODUCTION TO CASE STUDY EXAMS The Case Study Exam is an attempt to simulate workplace problem solving, and allows examiners to move one step closer to the assessment of competence than is possible with objective test questions.
Check out the latest CIMA diploma in management accounting highest achievers! May 2024 Strategic case study February 2024 ... February 2022 Strategic case study. November 2021 Strategic case study. August 2021 Strategic case study. May 2021 ... founded by the American Institute of CPAs and The Chartered Institute of Management Accountants.
MCS May 2022. Anyone else here sitting the Management Level Case Study in May? From the initial analysis I've seen, Piping seems to be quite a straight forward pre seen, well established company in a well established industry. I can only think the questions on the variants are going to be quite tough. Archived post.
May 2023 CIMA Case Study Resources. Astranti was the training provider I used to pass my CIMA case studies first time and they've recently put together an informative guide on how to crack the case studies! It's well worth a read before the pre-seen materials are released later this month. In terms of the resources, the Astranti course for ...
Full Post Exam Materials May /August 2021 MCS and Gateway. This document contains the full post exam supporting materials for the May and August 2021 management case study and CIMA gateway exam containing: The CGMA Study Hub keeps you on track to achieve your personal study goals.
Caregiver-assisted testing using HIV self-test (CG-HIVST) kits has been proposed to enhance paediatric HIV case finding and contribute toward ending paediatric HIV/AIDS by 2030. We conducted a systematic review to assess the risks and benefits of CG-HIVST. We searched nine electronic databases and consulted experts to identify relevant articles through 5 February, 2022. Studies comparing CG ...
To start the return process, please contact us first. View all products eligible for refunds. Pass rates Certificate in Business Accounting and CIMA's CGMA® Professional Qualification Objective Test and Case Study Exam pass rates.
Free exam and question tutorial management case study. Exam Resource. Case Study Performance Descriptors. Exam Resource. Calculator guidance. Exam Resource. Resitters Guide - OT and CS exams. Exam Resource. Learning Resources Catalogue . Exam Resource. What do my exam results mean. Further reading.
Full Post Exam Materials OCS Nov 21- Feb 22. This document contains the full post exam supporting materials for the November 2021 and February 2022 operational case study exam containing: The CGMA Study Hub keeps you on track to achieve your personal study goals.