First social impact bond for the SAMRC: A novel financing strategy to address the health and social challenges facing adolescent girls and young women in South Africa.

A social impact bond (SIB) is an innovative financing mechanism to attract investors to social programmes traditionally funded by governments. In this article, in celebration of the 50th anniversary of the South African Medical Research Council (SAMRC), the authors describe the SAMRC's first foray into this new world of financing through a SIB to improve the health and quality of life of adolescent girls and young women (AGYW). The AGYW SIB is in its preparatory phase and is scheduled for implementation in 2020. The authors describe the mechanism, including financial flows and the process of customising the SIB to meet the needs of AGYW, focusing on HIV prevention and treatment and the prevention and management of unintended pregnancies in schoolgoing AGYW. The authors outline an approach to designing the package of interventions, the metrics associated with such a programme and the business model. It is hypothesised that the proposed approach will lead to an improvement in programmatic outcomes, monitoring and evaluation tools and cost-effectiveness, and will develop key learning data for the future use of SIBs in health service delivery.

HLA and tropical sprue.

In 27 Puerto Rican patients with tropical sprue proven by intestinal biopsy and clinical response to folic acid, HLA type was determined with a microcytotoxicity assay. 25 of these patients had at least one antigen of the Aw-19 series (p = 10(-10)). The strongest association was with Aw-31, for which the relative risk was 10.6 (p = 1.2 X 10(-6)). The absence of a B-locus or haplotype effect suggests a marker association only, rather than an immune association.

Pretransplant predictors in renal transplantation.

We have prospectively studied the predictive value of three tests commonly used in transplant units (mixed lymphocyte culture, phytohemagglutinin-induced transformation, and skin testing with recall antigens), and their correlation with rejection and kidney loss. Thirty-five transplant recipients provided complete data for analysis. The results of mixed lymphocyte culture reactivity, phytohemagglutinin-induced transformation, and skin reactivity to recall antigens were similar and did not predict or discriminate between the patients that had few or many rejections, nor between those that kept or lost their allografts. Nonetheless, patients with a very high mixed lymphocyte culture stimulation index (above 3) had higher morbidity and mortality than those with a nonreactive mixed lymphocyte culture. Pretransplant mixed lymphocyte culture may give more important information than nonspecific immunologic tests regarding allograft outcome.