scholarly journals Effectiveness of Health Interventions towards HIV/AIDS in Developing Countries: A Systematic Review

2021 ◽  
pp. 540-555
Author(s):  
Sarmad Jamal Siddiqui ◽  
Rosnah Sutan ◽  
Zaleeha Md Isa ◽  
Arshad Hussain Laghari ◽  
Vijia Kumar Gemnani
Keyword(s):  
Developing Countries ◽  
Intervention Programs ◽  
Systemic Review ◽  
Hiv Incidence ◽  
Randomized Controlled ◽  
Evidence Strength ◽  
Testing Uptake ◽  
Exposure Prophylaxis ◽  
Preventive Methods ◽  
Prevention Of Hiv

Background: Plentiful development has been achieved in interventions for the prevention of HIV. Although, progression of prevention programs based on evidence – informed methods that interpret the effectiveness of these approaches in population is still a challenge. In developing countries, not many interventions are implemented for reduction of HIV burden. The single most important identified problem is lack of demand, supply, and adherence approaches. In current systemic review, recent evidence for the prevention of HIV in a cascade manner is described to see status of current interventions and further needs for improvements. Methodology: Systemic reviews regarding effectiveness on interventions of HIV prevention were searched. Primary studies were identified from eligible review that evaluated one of following factors: prevalence of HIV, incidence of HIV, testing uptake of HIV and use of condom. Interventions were categorized that pursued demand for prevention of HIV, improvement in supply for preventive approaches, support related to preventive behaviors or prevent HIV directly. A rating was assigned for each intervention based on evidence strength or randomized controlled trials. Results: Out of 91 eligible reviews, 264 primary studies were included in this review. Primary studies related to direct mechanisms of prevention that showed strong data for circumcision and effectiveness of pre – exposure prophylaxis. Evidence implies that interventions related to increased supply of preventive methods including clean needles or condoms can be operative. Interventions related to demand – side and adherence approaches were less clear with some studies showing effectiveness. Quality evidence was assessed among various categories. Various interventions showed supportive outcomes and results. In our findings, it was observed that difference between behavioral and structural has not evidently distinguished the interventions. Conclusion: Growing data is present for the support of effectiveness of products, behaviors, and procedures for prevention of HIV. In developing countries, negligible data is present for implementation of such approaches on community level. Interventions will be required for transforming this evidence to produce impact on population. It will empower the demand for prevention of HIV, supply of preventive technologies and utilization of preventive approaches against HIV. The findings can be eye opener to see actual burden of HIV and their implanted interventions and can be useful to design further intervention programs in future.

scholarly journals A Pre-Exposure Prophylaxis Adherence Intervention (LifeSteps) for Young Men Who Have Sex With Men: Protocol for a Pilot Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Katie B Biello ◽  
Christina Psaros ◽  
Douglas S Krakower ◽  
Elliot Marrow ◽  
Steven A Safren ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Young Men ◽  
The United States ◽  
Hiv Incidence ◽  
Randomized Controlled ◽  
Adherence Intervention ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Pilot Randomized Controlled Trial

BACKGROUND New HIV infections occur at a disproportionately high rate among young men who have sex with men (YMSM). It is, therefore, essential that comprehensive HIV prevention strategies, specifically tailored to their needs and perceptions, are developed, tested, and disseminated. Antiretroviral pre-exposure prophylaxis (PrEP) is effective in decreasing HIV transmission among men who have sex with men; however, adherence is critical to its efficacy. In open-label studies among YMSM, adherence was suboptimal. Hence, behavioral approaches that address the unique challenges to YMSM PrEP adherence are needed. OBJECTIVE This study aims to describe the protocol for intervention refinement and a pilot randomized controlled trial (RCT) of a PrEP adherence intervention, LifeSteps for pre-exposure prophylaxis for young men who have sex with men (LSPY). METHODS This study includes the following 2 phases: formative qualitative interviews with approximately 20 YMSM and 10 key informants for intervention adaptation and refinement and a pilot RCT of up to 50 YMSM to assess the feasibility, acceptability, and preliminary efficacy of the LSPY, compared with the PrEP standard of care, to improve PrEP adherence. Participants will be recruited at 3 iTech subject recruitment venues in the United States. RESULTS Phase 1 is expected to begin in June 2018, and enrollment of phase 2 is anticipated to begin in early 2019. CONCLUSIONS Few rigorously developed and tested interventions have been designed to increase PrEP adherence among YMSM in community settings, despite this population’s high HIV incidence. The long-term goal of this intervention is to develop scalable protocols to optimize at-risk YMSM’s PrEP uptake and adherence to decrease the HIV incidence. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/10661

scholarly journals Frame me if you must: PrEP framing and the impact on adherence to HIV Pre-exposure Prophylaxis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S439-S439
Author(s):  
Eric Ellorin ◽  
Jill Blumenthal ◽  
Sonia Jain ◽  
Xiaoying Sun ◽  
Katya Corado ◽  
...  
Keyword(s):  
A Priori ◽  
Social Groups ◽  
Continuous Measure ◽  
Gay Community ◽  
Randomized Controlled ◽  
Exposure Prophylaxis ◽  
The Impact ◽  
Actual Prevalence ◽  
Tenofovir Diphosphate

Abstract Background “PrEP whore” has been used both as a pejorative by PrEP opponents in the gay community and, reactively, by PrEP advocates as a method to reclaim the label from stigmatization and “slut-shaming.” The actual prevalence and impact of such PrEP-directed stigma on adherence have been insufficiently studied. Methods CCTG 595 was a randomized controlled PrEP demonstration project in 398 HIV-uninfected MSM and transwomen. Intracellular tenofovir-diphosphate (TFV-DP) levels at weeks 12 and 48 were used as a continuous measure of adherence. At study visits, participants were asked to describe how they perceived others’ reactions to them being on PrEP. These perceptions were categorized a priori as either “positively framed,” “negatively framed,” or both. We used Wilcoxon rank-sum to determine the association between positive and negative framing and TFV-DP levels at weeks 12 and 48. Results By week 4, 29% of participants reported perceiving positive reactions from members of their social groups, 5% negative, and 6% both. Reporting decreased over 48 weeks, but positive reactions were consistently reported more than negative. At week 12, no differences in mean TFV-DP levels were observed in participants with positively-framed reactions compared with those reporting no outcome or only negatively-framed (1338 [IQR, 1036-1609] vs. 1281 [946-1489] fmol/punch, P = 0.17). Additionally, no differences were observed in those with negative reactions vs. those without (1209 [977–1427] vs. 1303 [964–1545], P = 0.58). At week 48, mean TFV-DP levels trended toward being higher among those that report any reaction, regardless if positive (1335 [909–1665] vs. 1179 [841–1455], P = 0.09) or negative (1377 [1054–1603] vs. 1192 [838–1486], P = 0.10) than those reporting no reaction. At week 48, 46% of participants reported experiencing some form of PrEP-directed judgment, 23% reported being called “PrEP whore,” and 21% avoiding disclosing PrEP use. Conclusion Over 48 weeks, nearly half of participants reported some form of judgment or stigmatization as a consequence of PrEP use. However, individuals more frequently perceived positively framed reactions to being on PrEP than negative. Importantly, long-term PrEP adherence does not appear to suffer as a result of negative PrEP framing. Disclosures All authors: No reported disclosures.

Comparison of Two Rehabilitation Protocols on Patient- and Disease-Oriented Outcomes in Individuals With Chronic Ankle Instability

2017 ◽  
Vol 22 (3) ◽  
pp. 57-65 ◽  
Author(s):  
Kyle Kosik ◽  
Masafumi Treada ◽  
Ryan McCann ◽  
Samantha Boland ◽  
Phillip A. Gribble
Keyword(s):  
Ankle Instability ◽  
Dynamic Balance ◽  
Controlled Trial ◽  
Intervention Programs ◽  
Foot And Ankle ◽  
Balance Test ◽  
Randomized Controlled ◽  
Rehabilitation Protocols ◽  
Main Effect ◽  
Ability Measure

Proximal neuromuscular alterations are hypothesized to contribute to the patient- and disease-oriented deficits observed in CAI individuals. The objective was to compare the efficacy of two 4-week intervention programs with or without proximal joint exercises. Twenty-three individuals with CAI completed this single-blinded randomized controlled trial. Outcome measures included the Star Excursion Balance Test (SEBT) and the Foot and Ankle Ability Measure (FAAM). A time main effect was observed for the FAAM-ADL (p = .013), FAAM-Sport (p = .012), and posteromedial (p = .04) and posterolateral (p = .003) SEBT reach directions. No group main effect or time by group interaction was found. Four weeks of supervised rehabilitation improved self-reported function and dynamic balance in people with CAI.

scholarly journals The Antihypertensive Effects and Safety of LCZ696 in Patients with Hypertension: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 10 (13) ◽  
pp. 2824
Author(s):  
Su-Kiat Chua ◽  
Wei-Ting Lai ◽  
Lung-Ching Chen ◽  
Huei-Fong Hung
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Randomized Controlled Trials ◽  
Diastolic Blood Pressure ◽  
Publication Bias ◽  
Meta Analysis ◽  
Systemic Review ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Mean

Background: The management of hypertension remains suboptimal throughout the world. Methods: We performed a random-effects model meta-analysis of randomized controlled trials to determine the effectiveness and safety of sacubitril/valsartan (LCZ696) for the treatment of high arterial pressure. Relevant published articles from PubMed, Cochrane base, and Medline were examined, and the last search date was December 2020. Only published randomized controlled trials and double-blind studies were selected for further analysis. The mean reductions in systolic blood pressure (msSBP) and diastolic blood pressure (msDBP) in the sitting position, as well as the mean reductions in ambulatory systolic blood pressure (maSBP) and ambulatory diastolic blood pressure (maDBP), were assumed as efficacy endpoints. Adverse events (AEs) were considered as safety outcomes. Results: Ten studies with a total of 5931patients were included for analysis. Compared with placebo, LCZ696 had a significant reduction in msSBP (weight mean difference (WMD) = −6.52 mmHg, 95% confidence interval (CI): −8.57 to −4.47; p < 0.001), msDBP (WMD = −3.32 mmHg, 95% CI: −4.57 to −2.07; p < 0.001), maSBP (WMD = −7.08 mmHg, 95% CI: −10.48 to −3.68; p < 0.001), maDBP (WMD = −3.28 mmHg, 95% CI: −4.55 to −2.02, p < 0.001). In subgroup analysis, only 200 mg and 400 mg LCZ696 showed a significant BP reduction. There was no difference in the AE rate between the LCZ696 and placebo groups (WMD = 1.02, 95% CI: 0.83 to 1.27, p = 0.54). Egger’s test revealed a potential publication bias for msSBP (p = 0.025), but no publication bias for other outcomes. Conclusion: LCZ696 may reduce blood pressure more efficaciously than traditional therapy in hypertensive patients without increasing adverse effects.

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