Bleeding during and after childbirth (postpartum haemorrhage, PPH) is the leading cause of severe maternal morbidity in the UK. Between 2017 and 2018, a PPH care bundle termed the Obstetric Bleeding Strategy (OBS) was implemented as a quality improvement project across all Welsh maternity units and improvements in maternal outcomes were observed. The OBS PPH care bundle incorporates assessment of bleeding risk, real-time cumulative quantification of blood loss, escalation of multiprofessional care including more senior staff at defined volumes of blood loss and point-of-care testing of coagulation at 1 L blood loss (or earlier if clinical concern) with targeted blood product transfusion in cases of haemostatic impairment. The Obstetric Bleeding Study UK (OBS UK) will evaluate this intervention in a larger number of maternity units across the UK.

OBS UK is a stepped wedge cluster randomised trial designed to test the effectiveness of the OBS intervention compared with usual care on clinical and psychological PPH outcomes after childbirth, evaluate its cost-effectiveness and perform a process evaluation. The study will be capturing data from over 270 000 women and birthing people giving birth in the care of 36 participating maternity units during the 30-month study period. All maternity units will undertake a control period (lasting 3–18 months) during which usual PPH care will be provided, followed by a 9-month implementation period during which the OBS PPH care bundle will be introduced using quality improvement methods and then an OBS UK intervention period (lasting 3–18 months) during which OBS PPH care will be delivered.

The primary outcome is the number of women receiving allogeneic red blood cell transfusion for PPH per 1000 maternities. Secondary outcomes are informed by the core PPH outcome set, psychological and cost-effectiveness measures for women and their partners and a mixed methods process evaluation exploring how the intervention was deployed and possible improvements to inform wider implementation.

OBS UK will establish whether (and how) the OBS UK PPH care bundle improves outcomes and experiences of women and their partners. Published results will provide evidence to inform PPH maternity care across the UK and internationally. Dissemination of the findings will be made available to members of the public and participants.

ISRCTN17679951.

To estimate the causal effect of increased schooling arising from national policy reforms on HIV/AIDS infection and testing, along with associated indicators of risk across a wide range of settings in sub-Saharan Africa.

Multicountry quasi-experimental analysis using two-stage least squares (instrumental variable) analysis with national schooling reforms as the instrument for years of schooling.

A pooled sample from 23 sub-Saharan African countries with historical peak HIV-prevalence rates ranging from under 1% to over 20%, surveyed from 2003 to 2019.

A sample of 191 128 cases with linked HIV test results was obtained from nationally representative Demographic and Health Surveys and AIDS Indicator Surveys (and a related survey in Botswana), restricted to adults aged 18–49 years in birth cohorts spanning 1955–1998.

Primary outcomes were HIV test positivity and ever having been tested for HIV. Secondary outcomes were comprehensive HIV knowledge, age at first intercourse, condom use at last intercourse, number of sexual partners in the preceding 12 months and lifetime number of sexual partners.

Exposure to an education reform increased mean schooling by 0.45 years (95% CI 0.28 to 0.63). Pooled instrumental variable analysis found no significant effect of an additional year of schooling on HIV test positivity (–0.5 percentage points, coefficient –0.005, 95% CI –0.018 to 0.008). One additional year of schooling was associated with a 4.6 percentage point increase in ever having been tested for HIV, significant at the 10% level (coefficient 0.046, 95% CI –0.001 to 0.094). Effects on secondary behavioural outcomes were limited to specific subgroups: women showed a small delay in age at first intercourse while men and urban residents showed increased condom use. No significant effect on comprehensive HIV knowledge was identified in the pooled sample.

Across a wide range of African settings, policies expanding access to schooling appear to increase HIV testing but do not directly reduce HIV infection. Policymakers should look beyond education alone as an HIV prevention strategy, with realistic expectations of schooling expansion as a strategy on its own.

People with intellectual disability face significant barriers to accessing genetic healthcare, including during appointments. Many adults with intellectual disability are denied opportunities to discuss genetic testing that could improve their health and well-being. This study follows best practice in inclusive research, with co-researchers with intellectual disability co-leading alongside educational, disability and clinical experts to co-design and implement a respectful, accessible and inclusive national model of genetic healthcare.

This three-phase qualitative study positions people with intellectual disability as active researchers and partners throughout. Phase 1 will identify barriers and enablers to genetic healthcare for people with intellectual disability by engaging with approximately 100 participants—people with intellectual disability (with and without genetic testing experience), families/support people and genetic healthcare professionals—through interviews, focus groups, arts-based methods and yarning circles. Phase 2 will co-design and evaluate Guiding Principles, providing solutions to identified barriers and leveraging identified facilitators. Phase 3 will develop practical resources using workshops across Australia, guided by three Community Engagement Groups, including people with intellectual disability, families/support people and healthcare providers. This phase will also investigate strategies to optimise the national roll-out and implementation of resources among health professionals, people with intellectual disability and their families/carers. Aboriginal and Torres Strait Islander research methods are integrated throughout, led by Indigenous researchers.

Ethics approval has been granted by UNSW Sydney Human Research Ethics Committee (HC230353) and the Australian Institute of Aboriginal and Torres Strait Islander Studies (REC-0284). Participants will provide written consent using Easy Read or plain English materials. Findings will be disseminated through journal articles, conferences, websites and accessible formats, including Easy Read summaries and videos.

See the Graphical Abstract for a visual summary in online supplemental file 1