1.  Peer Reviewed Title: Can a clinical prediction tool guide HIV-testing decisions? Experience at a national hospital in Guatemala. Author: Anderson MR; Samayoa B; O'Sullivan LF; Fletcher J; Arathoon E Source: International Journal of STD and AIDS. 2009 Jan;20(1):30-4. Abstract: The USA and international recommendations no longer emphasize using risk factors to target groups for HIV-testing. Using a Guatemalan database of HIV tests, we developed a clinical prediction rule to guide decisions on HIV-testing. Prior to HIV-testing, data were collected on demographics, risk factors and prior testing. Based on a theoretical construct incorporating demographics, known HIV risk factors and symptoms, we developed a logistic regression model to predict HIV seropositivity. Between 2000 and 2005, 16,471 tests were performed, of which 19.8% were positive. The algorithm successfully predicted 1883 of 2489 HIV-positive tests (sensitivity 76%, likelihood ratio [LR]-positive 2.45) and 6282 of 9086 HIV-negative tests (specificity 69%, LR-negative 0.35). Although the model indices are robust, applying the model in a clinical setting would have little impact on improving selective testing practices. Our findings support current recommendations for universal HIV-testing, not selective testing based on risk factors. Before these recommendations can be adopted widely in Guatemala, treatment access needs to be assured and protections put in place for people diagnosed with HIV infection. Language: English Keywords: GUATEMALA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | MATHEMATICAL MODEL | STATISTICAL REGRESSION | HIV TESTING | HOSPITALS | DECISION MAKING | RISK ASSESSMENT | PROBABILITY | Central America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Theoretical Models | Data Analysis | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Behavior | Evaluation | Statistical Studies Document Number: 330715 |
2.  Title: Advocacy to improve global health: Strategies and stories from the field. Author: Cokelet E; Wilson R Source: Washington, D.C., Program for Appropriate Technology in Health [PATH], 2009 Mar. 11 p. Abstract: By influencing the priorities and actions of those in power, PATH works to create a policy environment that supports good health. This workbook provides examples of how PATH uses ten key steps for strategic advocacy to achieve lasting policy change. The collection of stories are intended to serve as a resource to help global health implementers and advocates more deliberately develop strategies to achieve policy goals. Language: English Keywords: DEVELOPING COUNTRIES | METHODOLOGICAL STUDIES | RECOMMENDATIONS | EVALUATION RESEARCH | CASE STUDIES | TARGET POPULATION | INFLUENTIALS | WOMEN IN DEVELOPMENT | ADVOCACY | NEEDS ASSESSMENT | HEALTH POLICY | SOCIAL POLICY | POLICY DEVELOPMENT | DECISION MAKING | SOCIAL CHANGE | Studies | Research Methodology | Evaluation Methodology | Evaluation | Program Design | Programs | Organization and Administration | Knowledge Sources | Communication | Economic Development | Economic Factors | Policy | Political Factors | Sociocultural Factors | Planning | Behavior Document Number: 331353 |
| 3. Peer Reviewed Title: Measuring trends in age at first sex and age at marriage in Manicaland, Zimbabwe. Author: Cremin I; Mushati P; Hallett T; Mupambireyi Z; Nyamukapa C; Garnett GP; Gregson S Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 1):i34-i40. Abstract: The authors analyzed longitudinal data from three rounds of a population-based cohort in eastern Zimbabwe. Reports of age at first sex and age at marriage from 6,837 individuals attending multiple rounds were classified according to consistency. Survival analysis was used to identify trends in the timing of first sex and marriage. In this population, women initiate sex and enter marriage at younger ages than men but spend much less time between first sex and marriage. Among those surveyed between 1998 and 2005, median ages at first sex and first marriage were 18.5 years and 21.4 years for men and 18.2 years and 18.5 years, respectively, for women aged 15-54 years. High levels of reports of both age at first sex and age at marriage among those attending multiple surveys were found to be unreliable. Excluding reports identified as unreliable from these analyses did not alter the observed trends in either age at first sex or age at marriage. Tracing birth cohorts as they aged revealed reporting biases, particularly among the youngest cohorts. Comparisons by birth cohorts, which span a period of >40 years, indicate that median age at first sex has remained constant over time for women but has declined gradually for men. Although many reports of age at first sex and age at marriage were found to be unreliable, inclusion of such reports did not result in artificial generation or suppression of trends. Language: English Keywords: ZIMBABWE | RESEARCH REPORT | METHODOLOGICAL STUDIES | KAP SURVEYS | COHORT ANALYSIS | LONGITUDINAL STUDIES | TARGET POPULATION | FIRST INTERCOURSE | AGE FACTORS | MARRIAGE AGE | BIAS | SEX FACTORS | RELIABILITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Surveys | Sampling Studies | Program Design | Programs | Organization and Administration | Sex Behavior | Behavior | Population Characteristics | Demographic Factors | Population | Marriage Patterns | Marriage | Nuptiality | Error Sources | Measurement Document Number: 340105 |
| 4. Peer Reviewed Title: Comparison of the new World Health Organization growth standards and the National Center for Health Statistics growth reference regarding mortality of malnourished children treated in a 2006 nutrition program in Niger. Author: Dale NM; Grais RF; Minetti A; Miettola J; Barengo NC Source: Archives of Pediatrics and Adolescent Medicine. 2009 Feb;163(2):126-30. Abstract: OBJECTIVE: To compare the National Centre for Health Statistics (NCHS) international growth reference with the new World Health Organization (WHO) growth standards for identification of the malnourished (wasted) children most at risk of death. DESIGN: Retrospective data analysis. SETTING: A Medecins Sans Frontieres (Doctors Without Borders) nutrition program in Maradi, Niger, in 2006 that treated moderately and severely malnourished children. PARTICIPANTS: A total of 53 661 wasted children aged 6 months to 5 years (272 of whom died) in the program were included. INTERVENTIONS: EpiNut (Epi Info 6.0; Centers for Disease Control and Prevention, Atlanta, Georgia) software was used to calculate the percentage of the median for the NCHS reference group, and the WHO (igrowup macro; Geneva, Switzerland) software was used to calculate z scores for the WHO standards group of the 53 661 wasted children. OUTCOME MEASURES: The main outcome measures are the difference in classification of children as either moderate or severely malnourished according to the NCHS growth reference and the new WHO growth standards, specifically focusing on children who died during the program. RESULTS: Of the children classified as moderately wasted using the NCHS reference, 37% would have been classified as severely wasted according to the new WHO growth standards. These children were almost 3 times more likely to die than those classified as moderately wasted by both references, and deaths in this group constituted 47% of all deaths in the program. CONCLUSIONS: The new WHO growth standards identifies more children as severely wasted compared with the NCHS growth reference, including children at high mortality risk who would potentially otherwise be excluded from some therapeutic feeding programs. Language: English Keywords: NIGER | UNITED STATES OF AMERICA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | CLASSIFICATION | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | EVALUATION INDEXES | CHILDREN | GROWTH | MALNUTRITION | STANDARDS | HEALTH STATUS INDEXES | WHO | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Developed Countries | North America | Americas | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Child Development | Biology | Nutrition Disorders | Diseases | Health | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors Document Number: 330228 |
| 5. Title: Micronutrient deficiencies in maternity and child health: a review of environmental and social context and implications for Malawi. Author: Dickinson N; Macpherson G; Hursthouse AS; Atkinson J Source: Environmental Geochemistry and Health. 2009 Apr;31(2):253-72. Abstract: It is well documented that micronutrient malnutrition is of increasing concern in the developing world, resulting in poor health and high rates of mortality and morbidity. During pregnancy, deficiency of iron and zinc can produce cognitive and growth impairment of the foetus, which may continue into infancy. Iron and zinc are essential micronutrients for both plant growth and human nutrition. Despite significant work in the areas of soil fertility, crop biofortification and dietary interventions, the problems of micronutrient deficiencies persist in Africa. There is a need to examine why communities have not embraced intervention strategies which may offer health benefits. Bottom-up, interdisciplinary approaches are required to effectively study the relationships between local communities and their environment, and to assess the impact their behaviour has on the cycling of micronutrients within the soil-plant-human system. From a detailed consideration of diverse influencing factors, a methodological model is suggested for studying the barriers to improving micronutrient uptake within rural communities. It combines environmental understanding with health and social factors, emphasising the need for and potential benefits of understanding and coherence in true interdisciplinary working. Language: English Keywords: MALAWI | CRITIQUE | RESEARCH PROPOSAL | METHODOLOGICAL STUDIES | INTERDISCIPLINARY STUDIES | STUDY DESIGN | RURAL POPULATION | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | INFANT | VITAMINS AND MINERALS | MATERNAL NUTRITION | INFANT NUTRITION | MALNUTRITION | SOIL DEGRADATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Youth | Age Factors | Physiology | Biology | Nutrition | Health | Nutrition Disorders | Diseases | Environmental Degradation | Environment Document Number: 341174 |
| 6. Title: Women, contraception, and consent to research participation [editorial] Author: Ding EL; Nagda SR Source: Journal of Women's Health. 2009 Apr;18(4):439-41. Abstract: This editorial piece explores women's Willingness To Participate (WTP) in clinical research. The sufficient inclusion of women in clinical research remains a challenge due to research participation conflicting with women's contraceptive behaviors and is further complicated by the potential risk of harm to a fetus. Language: English Keywords: UNITED STATES OF AMERICA | METHODOLOGICAL STUDIES | CRITIQUE | RECOMMENDATIONS | STUDY DESIGN | PILOT PROJECTS | WOMEN | INFORMED CONSENT | SEX FACTORS | GENDER ISSUES | CONTRACEPTION RESEARCH | PARTICIPATION | CONTRACEPTIVE METHODS CHOSEN | PERCEPTION | COST EFFECTIVENESS | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Population Characteristics | Sociocultural Factors | Contraception | Family Planning | Social Behavior | Behavior | Contraceptive Usage | Psychological Factors | Evaluation Indexes | Quantitative Evaluation | Evaluation Document Number: 330976 |
| 7. Peer Reviewed Title: Estimation of the predictive role of plasma viral load on CD4 decline in HIV-1 subtype C-infected subjects in India. Author: Ding M; Tarwater P; Rodriguez M; Chatterjee R; Ratner D; Yamamura Y; Roy P; Mellors J; Neogi D; Chen Y; Gupta P Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):119-25. Abstract: BACKGROUND: Plasma viral load has been shown to be a meaningful prognostic marker for disease progression in untreated, HIV-1 subtype B-infected subjects in United States and Western Europe and therefore used as a prognostic marker for disease progression. Because of high expenses of commercially available viral load assays, the role of viral load in disease progression has not been evaluated in HIV-1 subtype C-infected patients in India. METHODS: We developed an inexpensive real-time reverse transcriptase-polymerase chain reaction assay to quantify viral load in plasma of HIV-1 subtype C-infected subjects from India and used it in a longitudinal analysis of viral load and CD4 cell number in HIV-infected subjects from Calcutta, India. RESULTS: The real-time reverse transcriptase-polymerase chain reaction assay can quantify plasma viral load with a linear range of detection from 10 to 10 HIV-1 RNA copies per input. Longitudinal analysis of viral load in a cohort of 39 subjects over an average period of approximately 3 years indicates that 1-log increase in HIV-1 RNA level was associated with a decline of 67 CD4 cell count. Furthermore, HIV-1 RNA level between 500 and 50,000 copies per milliliter would predict a 12.9% decrease in CD4 cell count per year, whereas HIV-1 RNA levels above 50,000 copies HIV-1 RNA per milliliter would predict a 25.3% decrease in CD4 cells per year. In addition, we estimated that the mean incubation period of disease development, as defined by the loss of CD4 below 200, is 8.2 years. CONCLUSION: Our report on the level of viral load on predicting CD4 decline in Indian subjects with HIV-1 provides an additional important tool to the physicians for treating and planning a therapeutic strategy to control HIV-1 infection in India. Language: English Keywords: INDIA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | GENETIC TECHNIQUES | ESTIMATION TECHNIQUES | EVALUATION INDEXES | PERSONS LIVING WITH HIV/AIDS | HEALTH STATUS INDEXES | HIV INFECTIONS | COST EFFECTIVENESS | LABORATORY EXAMINATIONS AND DIAGNOSES | IMMUNITY, CELLULAR | Developing Countries | Asia, Southern | Asia | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology Document Number: 330366 |
| 8. Peer Reviewed Title: A framework of sexual partnerships: Risks and implications for HIV prevention in Africa. Author: Green EC; Mah TL; Ruark A; Hearst N Source: Studies in Family Planning. 2009 Mar;40(1):63-70. Abstract: The global diversity of HIV epidemics can be explained in part by types and patterns of sexual partnerships. We offer a typology of sexual partnerships that corresponds to varying levels of HIVtransmission risk to help guide thinking about appropriate behavioral interventions, particularly in the epidemics of sub-Saharan Africa. Declines in HIV prevalence have been associated with reductions in numbers of sex partners, whereas many other prevention strategies have not been demonstrated to reduce HIV transmission at a population level. We suggest a reorientation of current prevention efforts, based on the epidemiology of sexually transmitted HIV epidemics and trends in sexual behavior change. Concurrent sexual partnerships are likely to play a large role in transmission dynamics in the generalized epidemics of East and Southern Africa, and should be addressed through improved behavior-change interventions. Language: English Keywords: AFRICA, SUB SAHARAN | METHODOLOGICAL STUDIES | CLASSIFICATION | EPIDEMIOLOGIC METHODS | SEXUAL PARTNERS | MULTIPLE PARTNERS | HIV PREVENTION | RISK ASSESSMENT | BEHAVIOR CHANGE COMMUNICATION | EPIDEMIOLOGY | SEX BEHAVIOR | SAFER SEX | HUMAN GEOGRAPHY | Africa | Developing Countries | Studies | Research Methodology | Behavior | HIV Infections | Viral Diseases | Diseases | Evaluation | Communication Programs | Communication | Behavior Change | Public Health | Health | Geography | Social Sciences | Science | Sociocultural Factors Document Number: 341082 |
| 9. Title: Monitoring HIV epidemics: declines in prevalence do not always mean good news [editorial] Author: Hallett T Source: AIDS. 2009 Jan 2;23(1):131-2. Abstract: The future of HIV epidemic monitoring is likely to rely on HIV prevalence for many years to come. After years of intensive research, direct measurements of incidence in local cohort studies are becoming less and less representative of whole countries, and assays that discriminate recent infections in cross-sectional serosurveys have been shown to be unreliable in African countries without calibration. Antiretroviral therapy will add a further layer of complexity, as longer survival times will tend to increase HIV prevalence; so that upturns in epidemics may not indicate increased risk behaviour, and stable prevalence rates could mask substantial reductions in incidence. It will, therefore, be essential to make maximum use of mathematical modelling in the interpretation of trends in HIV prevalence. To be conservative and defensible, these modelsmust reasonably account for all other potential sources of natural changes in epidemics, so that the contribution of actual reductions in risk-if any-can be resolved. And only from that starting point, can the important investigations into the proximal and distal causes and reasons for the behaviour changes begin. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | MATHEMATICAL MODEL | EVALUATION INDEXES | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | MONITORING | HIV INFECTIONS | EPIDEMIOLOGY | EPIDEMICS | RELIABILITY | VALIDITY | ERROR SOURCES | Africa | Developing Countries | Research Methodology | Theoretical Models | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Measurement | Public Health | Health Document Number: 330256 |
| 10. Peer Reviewed Title: The burden of HIV-associated cryptococcal disease [editorial] Author: Harrison TS Source: AIDS. 2009 Feb 20;23(4):531-2. Abstract: In this issue, Park et al. from the Centers for Disease Control, University of Alabama, and Johannesburg, South Africa, have made the first attempt to estimate the global burden of HIV-associated cryptococcal infection. As clearly stated by the authors, the estimates are exactly that -estimates, which rely on the quality of the data on which they are based. Nevertheless, the results are striking, especially for sub-Saharan Africa, where the estimated number of deaths associated with cryptococcal disease, at half a million per year, is comparable with the number attributed to tuberculosis, a much more frequent infection, but one for which we have much more effective and widely available therapy. So are these results credible? The data are sparse, with just three incidence studies driving the estimates for sub- Saharan Africa (ruling out the possibility of evaluating or taking account of possible intraregional differences in incidence); and the reported incidences are variable, resulting in wide ranges for the estimates of cases and associated deaths. However, biases are as possible on the downside as on the upside. As the authors acknowledge, the relatively low incidence estimate from a South African study with which some of the same authors were involved was likely affected by incomplete case ascertainment. (excerpt) Language: English Keywords: GLOBAL | CRITIQUE | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | ESTIMATION TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | COMPLICATIONS | PREVALENCE | CAUSES OF DEATH | DEATH RATE | ANTIRETROVIRAL THERAPY | CENTRAL NERVOUS SYSTEM EFFECTS | Studies | Research Methodology | Viral Diseases | Diseases | Measurement | Mortality | Population Dynamics | Demographic Factors | Population | HIV | Central Nervous System | Physiology | Biology Document Number: 341160 |
| 11. Peer Reviewed Title: Evaluating completeness of maternal mortality reporting in a rural health and social affairs unit in Vellore, India, 2004. Author: Kim SY; Rochat R; Rajaratnam A; Digirolamo A Source: Journal of Biosocial Science. 2009 Mar;41(2):195-205. Abstract: Health systems in developing countries infrequently implement and evaluate maternal death surveillance. This study identified under-reported and misclassified maternal deaths among women of reproductive age between 1999 and 2004 in a rural service unit in Vellore, India. In-depth interviews, semi-structured interviews and structured questionnaires were used to identify maternal deaths known to health care providers and community leaders who regularly come in contact with pregnant women. Eighteen under-reported and misclassified cases--or 50% of maternal deaths--were reported. These included 29% of abortion-related and 7% of domestic violence-related deaths. Based on this study's fieldwork, the existing death surveillance system detected 100% of the maternal deaths reported by hospital staff; however, it missed most maternal deaths reported by community workers. The latter are more likely than deaths reported by hospital workers to result from abortion and family violence. The existing surveillance system should be augmented with a community-based death surveillance system. This comprehensive approach identified twice as many maternal deaths than previously recorded and could be applied in other settings. Appropriate public health interventions should be initiated to prevent maternal deaths in this community. Language: English Keywords: INDIA | RESEARCH REPORT | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CLASSIFICATION | KAP SURVEYS | LONGITUDINAL STUDIES | RURAL POPULATION | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | DEATH RATE | MATERNAL MORTALITY | RURAL HEALTH SERVICES | CAUSES OF DEATH | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Surveys | Sampling Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Mortality | Population Dynamics | Health Services | Delivery of Health Care | Health Document Number: 331112 |
| 12. Peer Reviewed Title: Assessment of the Chinese version of HIV and homosexuality related stigma scales. Author: Liu H; Feng T; Rhodes AG; Liu H Source: Sexually Transmitted Infections. 2009 Feb;85(1):65-69. Abstract: Objectives: To design and assess HIV and homosexuality related stigma scales in a developing world context. Methods: A respondent-driven sampling survey was conducted among 351 men who have sex with men (MSM) in Shenzhen, China. Exploratory and confirmatory factor analyses were used to examine and determine the latent factors of stigma subscales. Results: Factor analyses identified three subscales associated with homosexuality and HIV stigma: public homosexual stigma (10 items), self homosexual stigma (8 items) and public HIV stigma (7 items). There were no items with cross-loadings onto multiple factors, supporting the distinctness of the constructs that these scales were meant to measure. The fit indices in confirmatory factor analysis provide evidence for the hypothesised three-factor structure of associations (the x2/degree ratio=1.84, CFI=0.91, RMSEA=0.05 and SRMR=0.05). Reliability of the three scales was excellent (Cronbach's alpha: 0.78-0.85) and stable across split samples and for the data as a whole. Conclusions: The selection of three latent factors was supported by both psychometric properties and theories of stigmatisation. The scales are brief and suitable for use in developing countries where less time-consuming measurement is preferable. Language: English Keywords: CHINA | RESEARCH REPORT | METHODOLOGICAL STUDIES | KAP SURVEYS | QUESTIONNAIRE DESIGN | EVALUATION INDEXES | FACTOR ANALYSIS | HOMOSEXUALS | MEN HAVING SEX WITH MEN | PERSONS LIVING WITH HIV/AIDS | STIGMA | HIV INFECTIONS | PUBLIC OPINION | Asia, Eastern | Asia | Developing Countries | Studies | Research Methodology | Surveys | Sampling Studies | Survey Methodology | Quantitative Evaluation | Evaluation | Data Analysis | Sex Behavior | Behavior | Viral Diseases | Diseases | Social Problems | Sociocultural Factors | Attitudes | Psychological Factors Document Number: 340113 |
| 13. Title: Theory-based interventions for contraception. Author: Lopez LM; Tolley EE; Grimes DA; Chen-Mok M Source: Cochrane Database of Systematic Reviews. 2009;(1):CD007249. Abstract: BACKGROUND: The explicit use of theory in research helps expand the knowledge base. Theories and models have been used extensively in HIV-prevention research and in interventions for preventing sexually transmitted infections (STIs). The health behavior field uses many theories or models of change. However, educational interventions addressing contraception often have no stated theoretical base. OBJECTIVES: Review randomized controlled trials that tested a theoretical approach to inform contraceptive choice; encourage contraceptive use; or promote adherence to, or continuation of, a contraceptive regimen. SEARCH STRATEGY: We searched computerized databases for trials that tested a theory-based intervention for improving contraceptive use (MEDLINE, POPLINE, CENTRAL, PsycINFO, EMBASE, ClinicalTrials.gov, and ICTRP). We also wrote to researchers to find other trials. SELECTION CRITERIA: Trials tested a theory-based intervention for improving contraceptive use. We excluded trials focused on high-risk groups. Interventions addressed the use of one or more contraceptive methods. The reports provided evidence that the intervention was based on a specific theory or model. The primary outcomes were pregnancy, contraceptive choice, initiating or changing contraceptive use, contraceptive regimen adherence, and contraception continuation. DATA COLLECTION AND ANALYSIS: The primary author evaluated abstracts for eligibility. Two authors extracted data from included studies. We calculated the odds ratio for dichotomous outcomes and the mean difference for continuous data. No meta-analysis was conducted due to intervention differences. MAIN RESULTS: Of 26 trials, 12 interventions addressed contraception (other than condoms), while 14 focused on condom use for preventing HIV or STIs. In 2 of 10 trials with pregnancy or birth data, a theory-based group showed better results. Four of nine trials with contraceptive use (other than condoms) showed better outcomes in an experimental group. For condom use, a theory-based group had favorable results in 14 of 20 trials, but the number was halved in a subgroup analysis. Social Cognitive Theory was the main theoretical basis for 12 trials, and 10 showed positive results. Of the other 14 trials, favorable results were shown for other social cognition models (N=2), motivational interviewing (N=5), and the AIDS Risk Reduction Model (N=2). No major patterns were detected by type of theory, intervention, or target population. AUTHORS' CONCLUSIONS: Family planning researchers and practitioners could apply the relevant theories and effective interventions from HIV and STI prevention. More thorough use of single theories would help inform the field about what works. Better reporting is needed on research design and intervention implementation. Language: English Keywords: UNITED STATES OF AMERICA | METHODOLOGICAL STUDIES | THEORETICAL STUDIES | LITERATURE REVIEW | THEORETICAL MODELS | CLINICAL TRIALS | WOMEN | CONTRACEPTIVE METHODS CHOSEN | CONDOM USE | CONTRACEPTIVE USAGE | MOTIVATION | COUNSELING | HIV PREVENTION | Developed Countries | North America | Americas | Research Methodology | Clinical Research | Demographic Factors | Population | Contraception | Family Planning | Risk Reduction Behavior | Behavior | Psychological Factors | Clinic Activities | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases Document Number: 329594 |
| 15. Peer Reviewed Title: Critical next steps for female condom research - report from a workshop. Author: Mauck CK; Weaver MA; Schwartz JL; Walsh T; Joanis C Source: Contraception. 2009 May;79(5):339-44. Abstract: In addition to a standard slippage and breakage study, the United States Food and Drug Administration (USFDA) currently requires a contraceptive effectiveness trial to be carried out as part of the pathway to regulatory approval for new female condoms. In an attempt to explore acceptable alternatives to expensive and resource-consuming Phase 3 contraceptive effectiveness trials, the United States Agency for International Development (USAID) recently requested that CONRAD organize a 1-day meeting of investigators in the female condom and semen biomarker fields. The charge to the group was to devise a study design that would validate a biomarker against a biological end point, such as pregnancy or a sexually transmitted infection (STI), so that the validated marker could be used to augment a slippage and breakage study for approval of new female condoms, eliminating the need for the currently required contraceptive effectiveness trial. The meeting was entitled "Critical Next Steps for Female Condom Research - A Meeting/Workshop" and was convened by CONRAD in Arlington, VA, on July 8, 2008, with USAID support. Afterward, a working group of clinical researchers continued deliberations via teleconference and wrote the following report. After exploring the pros and cons of several biological markers, prostate-specific antigen (PSA) was identified as the most promising one to pursue for this application because of the extensive, previous work involving that marker. (excerpt) Language: English Keywords: UNITED STATES OF AMERICA | DEVELOPING COUNTRIES | RESEARCH PROPOSAL | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | EVALUATION RESEARCH | CLINICAL TRIALS | WOMEN | WOMEN IN DEVELOPMENT | FEMALE CONDOMS | WORKSHOPS | CONTRACEPTIVE EFFECTIVENESS | CANCER | ANTIGENS | CONTRACEPTIVE SAFETY | Developed Countries | North America | Americas | Studies | Research Methodology | Evaluation Methodology | Evaluation | Demographic Factors | Population | Economic Development | Economic Factors | Vaginal Barrier Methods | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Education | Neoplasms | Diseases | Immunologic Factors | Immunity | Immune System | Physiology | Biology | Safety | Public Health | Health Document Number: 330937 |
| 16. Peer Reviewed Title: Protecting the unprotected: mixed-method research on drug use, sex work and rights in Pakistan's fight against HIV/AIDS. Author: Mayhew S; Collumbien M; Qureshi A; Platt L; Rafiq N; Faisel A; Lalji N; Hawkes S Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 2):ii31-ii36. Abstract: Objectives: To investigate the nature and extent of human rights abuses against three vulnerable groups (injecting drug users (IDUs) and male and female sex workers), to understand the social and sexual linkages between them and to examine how protecting their rights could enhance the impact of HIV prevention policies. Methods: In-depth interviews were carried out with 38 high-risk respondents (IDUs and female, male and transgender sex workers) and a bio-behavioural survey was performed of 813 IDU/sex worker respondents in Rawalpindi. Results: People in all vulnerable groups interacted both sexually and socially. All groups experienced human rights abuses by state and non-state actors which increased their HIV risk. Non-state actors, including relations and sex worker clients, are responsible for verbal, physical and sexual violence. State actors (particularly police) perpetrate harassment, exploitation and abuse of all vulnerable groups with impunity. Health service providers fail to provide adequate services for vulnerable groups. Conclusions: High levels of discrimination and abuse of human dignity of all groups studied were revealed. This violates their physical and mental integrity and also leads to an increased risk of HIV. The sexual and social interactions between groups mean that human rights abuses experienced by one high-risk group can increase the risk of HIV both for them and other groups. The protection of human rights needs to become an integral part of a multisector response to the risk of HIV/AIDS by state and non-state agencies. The Government of Pakistan should work at both legal and programme levels to protect the rights of, and minimise discrimination against, groups vulnerable to HIV in order to reduce the potential for the spread of HIV before the epidemic takes hold. Language: English Keywords: PAKISTAN | METHODOLOGICAL STUDIES | KAP SURVEYS | SEX WORKERS | SOCIAL NETWORKS | IV DRUG USERS | POLICE | SEX BEHAVIOR | STIGMA | DRUG USE AND ABUSE | HUMAN RIGHTS | SOCIAL DISCRIMINATION | HIV PREVENTION | RISK BEHAVIOR | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Surveys | Sampling Studies | Behavior | Friends and Relatives | Family and Household | Sociocultural Factors | Corrections Officers | Government | Political Factors | Social Problems | HIV Infections | Viral Diseases | Diseases Document Number: 340115 |
| 17. Peer Reviewed Title: Heterogeneity in host HIV susceptibility as a potential contributor to recent HIV prevalence declines in Africa. Author: Nagelkerke N; de Vlas SJ; Jha P; Luo M; Plummer FA; Kaul R Source: AIDS. 2009 Jan 2;23(1):125-30. Abstract: BACKGROUND: HIV prevalence has recently declined in several African countries, and prior to this the risk of HIV acquisition per unprotected sex contact also declined in Kenyan sex workers. We hypothesized that heterogeneity in HIV host susceptibility might underpin both of these observations. METHODS: A compartmental mathematical model was used to explore the potential impact of heterogeneity in susceptibility to HIV infection on epidemic behavior, in the absence of other causative mechanisms. RESULTS: Studies indicated that a substantial heterogeneity in susceptibility to HIV infection may lead to an epidemic that peaks and then declines due to a depletion of the most susceptible individuals, even without changes in sexual behavior. This effect was most notable in high-risk groups such as female sex workers and was consistent with empirical data. DISCUSSION: Declines in HIV prevalence may have other causes in addition to behavior change, including heterogeneity in host HIV susceptibility. There is a need to further study this heterogeneity and its correlates, particularly as it confounds the ability to attribute HIV epidemic shifts to specific interventions, including behavior change. Language: English Keywords: KENYA | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | MATHEMATICAL MODEL | SEX WORKERS | PREVALENCE | HIV TRANSMISSION | SEX BEHAVIOR | RISK REDUCTION BEHAVIOR | RISK ASSESSMENT | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Theoretical Models | Behavior | Measurement | HIV Infections | Viral Diseases | Diseases | Evaluation Document Number: 330257 |
| 18. Title: Levonorgestrel-releasing intra-uterine systems (LNG-IUS) and breast cancer [letter] Author: Neven P; Amant F; Poppe W; Van den Broecke R Source: Fertility and Sterility. 2009 Apr;91(4):e5; author reply e6. Abstract: The observational study by Trinh et al. concludes that there is a higher recurrence rate when breast cancers are detected during the use of the levonorgestrel-releasing intrauterine system (LNG-IUS) and when it is not removed after diagnosis. Although the authors mainly generate several hypotheses around their observations, we would like to warn about inappropriate interpretation of their data and premature conclusions, as such a message was released in a couple of Belgian newspapers recently. First, there is a problem with the control group in the authors' study. This control group is matched for "all" LNG-IUS users, including a group with a low risk for relapse, those where the clinician decided to insert an LNG-IUS probably long after breast cancer diagnosis, and a group with a higher risk of relapse, i.e., those diagnosed with breast cancer during the use of the LNG-IUS. Understandably, the high risk of relapse group (more chemotherapy, more ER-negative, more grade 3), also being the LNG-IUS users at breast cancer diagnosis, presented with a poorer outcome than the control subjects. To prove their point, the authors should have matched cases with the LNG-IUS at breast cancer diagnosis for control subjects without LNG-IUS at diagnosis and followed up taking into account demographics such as family history as well as prognostic and predictive factors and adjuvant therapy. Furthermore, the authors hypothesize that breast cancers in LNG users are detected in a much more advanced stage based on differences, e.g., in nodal involvement between the group with the LNG-IUS at diagnosis and those where the LNG-IUS was inserted after diagnosis. They now define a second control group (subgroup B), which is inappropriate. The question of whether breast cancers in LNG users are in a much more advanced stage at diagnosis is therefore not proven by this observation, because the control group is likely biased by selection for the use of an LNG-IUS after breast cancer diagnosis to a lower breast cancer relapse risk population. We believe that a case-control study is more appropriate to prove this point. We also do not know whether breast cancer prognosis is different when the LNG-IUS is removed at diagnosis, an important group which is missing in this study. It is also unclear how long the LNG-IUS was inserted before or after the diagnosis of breast cancers, respectively, in subgroup A and subgroup B. We understand that patients in subgroup A could have had the LNG-IUS for >14 years, whereas those in subgroup B might have had the LNG-IUS inserted several years after their breast cancer diagnosis. This may, again, imply bias through a healthy user effect that may affect relapse of breast cancer. It may also explain local versus distant metastasis between subgroups and control subjects. Finally, both Kaplan-Meier curves suppose a much longer mean followup than the stated 2.8 and 2.9 years for LNG-IUS users and control subjects, respectively. Based on these observations, the hypotheses on neither safety nor prognosis of the LNG-IUS in operable breast cancer have been generated. It remains an open question whether low levels of circulating levonorgestrel affect the natural history of breast cancer at diagnosis and follow-up, or whether it interferes with adjuvant antiestrogen therapy. We continue to agree that there is need for further research and welcome their prospective registration of LNG-IUS. This is an important issue, not only because the LNG-IUS is a very popular method of contraception, and 2% of women in Belgium develop breast cancer during their fertile years, but also because the LNG-IUS is now being used in long-term estrogen and tamoxifen users to protect the uterus from bleeding and proliferative endometrial changes. (full-text) Language: English Keywords: BELGIUM | RESEARCH REPORT | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | WOMEN | CONTROL GROUPS | MATCHED GROUPS | PREVALENCE | IUD SIDE EFFECTS | IUD, HORMONE RELEASING | LEVONORGESTREL | BIAS | DEMOGRAPHIC FACTORS | TIME FACTORS | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Population | Measurement | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Error Sources | Population Dynamics Document Number: 331240 |
| 19. Peer Reviewed Title: Comparison of T-SPOT.TB assay and tuberculin skin test for the evaluation of young children at high risk for tuberculosis in a community setting. Author: Nicol MP; Davies MA; Wood K; Hatherill M; Workman L; Hawkridge A Source: Pediatrics. 2009 Jan;123(1):38-43. Abstract: OBJECTIVE: We wished to compare the sensitivity of an enzyme-linked immunospot assay (T-SPOT.TB; Oxford Immunotec, Oxford, United Kingdom) and the tuberculin skin test for the detection of tuberculosis infection in very young children being evaluated for active tuberculosis in a rural community setting. METHODS: Children with a history of exposure to tuberculosis and children presenting to a local clinic or hospital with symptoms suggesting tuberculosis were admitted to a dedicated case verification ward. T-SPOT.TB testing was performed, and children were evaluated with a clinical examination, a tuberculin skin test, chest radiographs, and cultures of induced sputum and gastric lavage specimens. The diagnosis was determined by using a clinical algorithm. RESULTS: A total of 243 children (median age: 18 months) were recruited, of whom 214 (88%) had interpretable T-SPOT.TB results. Children > or =12 months of age were more likely than younger children to have positive T-SPOT.TB results, whereas tuberculin skin test results were unaffected by age. The sensitivity of the T-SPOT.TB was no better than that of the tuberculin skin test for culture-confirmed tuberculosis (50% and 80%, respectively) and was poorer for the combined group of culture-confirmed and clinically probable tuberculosis (40% and 52%, respectively). For the 50 children clinically categorized as not having tuberculosis, the specificity of both the T-SPOT.TB and the tuberculin skin test was 84%. CONCLUSIONS: For young children presenting in a community setting after exposure to tuberculosis or with symptoms suggesting tuberculosis, T-SPOT.TB cannot be used to exclude active disease. The sensitivity of this assay may be impaired for very young children. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | COMPARATIVE STUDIES | CHILDREN | COMMUNITY | TUBERCULOSIS | TESTING | COMMUNITY HEALTH SERVICES | LABORATORY EXAMINATIONS AND DIAGNOSES | DERMATOLOGICAL EFFECTS | PHYSICAL EXAMINATIONS AND DIAGNOSES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Infections | Diseases | Measurement | Primary Health Care | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses | Medical Procedures | Medicine | Physiology | Biology Document Number: 328039 |
| 20. Peer Reviewed Title: Implications of the HIV testing protocol for refusal bias in seroprevalence surveys. Author: Reniers G; Araya T; Berhane Y; Davey G; Sanders EJ Source: BMC Public Health. 2009 May 28;9(1):163. Abstract: ABSTRACT: BACKGROUND: HIV serosurveys have become important sources of HIV prevalence estimates, but these estimates may be biased because of refusals and other forms of non-response. We investigate the effect of the post-test counseling study protocol on bias due to the refusal to be tested. METHODS: Data come from a nine-month prospective study of hospital admissions in Addis Ababa during which patients were approached for an HIV test. Patients had the choice between three consent levels: testing and post-test counseling (including the return of HIV test results), testing without post-test counseling, and total refusal. For all patients, information was collected on basic sociodemographic background characteristics as well as admission diagnosis. The three consent levels are used to mimic refusal bias in serosurveys with different post-test counseling study protocols. We first investigate the covariates of consent for testing. Second, we quantify refusal bias in HIV prevalence estimates using Heckman regression models that account for sample selection. RESULTS: Refusal to be tested positively correlates with admission diagnosis (and thus HIV status), but the magnitude of refusal bias in HIV prevalence surveys depends on the study protocol. Bias is larger when post-test counseling and the return of HIV test results is a prerequisite of study participation (compared to a protocol where test results are not returned to study participants, or, where there is an explicit provision for respondents to forego post-test counseling). We also find that consent for testing increased following the introduction of antiretroviral therapy in Ethiopia. Other covariates of refusal are age (non-linear effect), gender (higher refusal rates in men), marital status (lowest refusal rates in singles), educational status (refusal rate increases with educational attainment), and counselor. CONCLUSIONS: The protocol for post-test counseling and the return of HIV test results to study participants is an important consideration in HIV prevalence surveys that wish to minimize refusal bias. The availability of ART is likely to reduce refusal rates. Language: English Keywords: ETHIOPIA | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | ESTIMATION TECHNIQUES | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | HIV INFECTIONS | HIV TESTING | BIAS | COUNSELING | VOLUNTARY COUNSELING AND TESTING | INFORMED CONSENT | ANTIRETROVIRAL THERAPY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Viral Diseases | Diseases | Measurement | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Error Sources | Clinic Activities | Program Activities | Programs | Organization and Administration | HIV Document Number: 341483 |
| 21. Peer Reviewed Title: Spousal violence and spontaneous fetal loss [letter] Author: Shelton JD; Adetunji J Source: Lancet. 2009 May 2;373(9674):1520; author reply 1520-1. Abstract: Amina Alio and colleagues (Jan 24, p 318) make an admirable effort to unravel a myriad of confounders to explain their finding of a statistical relation between spousal violence and spontaneous fetal loss. Spousal violence is clearly deplorable. But, as Alio and colleagues note, it included a wide range of behaviours, including "saying something to humiliate" and pushing and twisting the arm, as well as more violent acts. A biological explanation for such spousal violence "ever" to account for a 50% increase in fetal loss "ever" does not seem obvious. Another explanation is major misclassification with induced abortion. Although the 2004 Demographic and Health Survey instrument for Cameroon attempted to distinguish between the two, responses on numbers of induced abortions, spontaneous abortions, and still births were contained within the same question. It would be easy for respondents to report induced abortions as spontaneous. Induced abortion is notoriously underreported, especially in countries such as Cameroon where it is illegal. On the other hand, both induced abortion and spousal violence might be common markers of other factors such as relationship stress or other dysfunction and thus lead to a spurious finding. There is a response from Amina Alio included. Language: English Keywords: CAMEROON | CRITIQUE | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLASSIFICATION | DEMOGRAPHIC AND HEALTH SURVEYS | SPOUSE | WOMEN IN DEVELOPMENT | PREGNANT WOMEN | DOMESTIC VIOLENCE | ABORTION, SPONTANEOUS | ABORTION | FETAL DEATH | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Economic Development | Economic Factors | Population Characteristics | Crime | Social Problems | Pregnancy Complications | Diseases | Fertility Control, Postconception | Family Planning | Mortality Document Number: 341098 |
| 22. Peer Reviewed Title: Understanding contraceptive failure. Author: Trussell J Source: Best Practice and Research: Clinical Obstetrics and Gynaecology. 2009 Apr;23(2):199-209. Abstract: Contraceptive failure is a major source of unintended pregnancy. This chapter will review sources of data and measurement of contraceptive failure, summarize results from the literature on the risks of contraceptive failure during typical and perfect use for available methods of contraception, provide a tool for communicating risks of contraceptive failure to clients, examine determinants of contraceptive failure, and identify methodological pitfalls in the published literature. Language: English Keywords: LITERATURE REVIEW | METHODOLOGICAL STUDIES | EVALUATION | FAMILY PLANNING ACCEPTORS | CONTRACEPTION FAILURE | INFORMATION SOURCES | CONTRACEPTIVE METHODS | RISK ASSESSMENT | COMMUNICATION STRATEGY | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTION CONTINUATION | TIME FACTORS | RISK FACTORS | Studies | Research Methodology | Family Planning Programs | Family Planning | Contraceptive Usage | Contraception | Information | Communication | Population Dynamics | Demographic Factors | Population | Health Document Number: 341505 |
| 23. Title: Reproductive factors and risk of pancreatic cancer in women: a review of the literature. Author: Wahi MM; Shah N; Schrock CE; Rosemurgy AS 2nd; Goldin SB Source: Annals of Epidemiology. 2009 Feb;19(2):103-11. Abstract: PURPOSE: Pancreatic cancer (PCA) is the fourth leading cause of cancer death in the United States. The male-to-female incidence and mortality ratio of PCA is 1.1-2.0. One possible explanation for this difference is that female hormone exposure is protective for the development of PCA. Several hypotheses were investigated in this systematic review: (1) increased exposure to estrogen through early menarche and later menopause is associated with a decreased risk of PCA; (2) increased exposure to pregnancy is associated with decreased risk of PCA; and (3) increased exposure to oral contraceptives and/or hormone replacement therapy is associated with decreased risk of PCA. METHODS: Of 371 articles identified, 10 case-control and 5 cohort studies met the criteria for our review. Odds ratios for case-control studies and hazard ratios for cohort studies and their accompanying 95% confidence intervals for analyses relevant to our hypotheses were considered in the review. RESULTS: For all 3 hypotheses, studies displayed inconsistent results, and this may have been due to the diversity of study populations, exposure quantification, analysis approach, confounding and other limitations, and biases across studies. CONCLUSIONS: As there was no strong support for any of the 3 hypotheses, it appears that reproductive factors are not associated with the development of PCA in women. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CASE CONTROL STUDIES | COHORT ANALYSIS | WOMEN | CANCER | RISK FACTORS | SEX FACTORS | MENARCHE | AGE FACTORS | ESTROGENS | MENOPAUSE | Developed Countries | North America | Americas | Studies | Research Methodology | Demographic Factors | Population | Neoplasms | Diseases | Health | Population Characteristics | Menstruation | Reproduction | Hormones | Endocrine System | Physiology | Biology Document Number: 331229 |
| 24. Peer Reviewed Title: A new way of perceiving the pandemic: the findings from a participatory research process on young Africans' stories about HIV/AIDS. Author: Winskell K; Enger D Source: Culture, Health and Sexuality. 2009 May;11(4):453-467. Abstract: This paper presents the findings, shares the methodology and outlines the benefits of a multi-country participatory research process on a unique data source: stories about HIV and AIDS written by young Africans. Between 1997 and 2005, more than 105,000 young people from 37 countries participated in competitions inviting them to think up storylines for short fiction films to educate their communities about HIV and AIDS as part of the 'Scenarios from Africa' communication process. The winning stories were selected by juries made up of: PLWH and other local specialists in prevention, treatment and care; former contest winners and other young people; and communication specialists, including the top African directors, who went on to transform the ideas into short films. In 2005, over 200 jurors selected 30 winners from the 22,894 stories submitted that year by 63,327 contest participants. After reading around 200 stories each and participating in the selection process, jurors compiled their observations and recommendations. The jurors' findings reveal notable persistent shortcomings in existing communication efforts and identify key emerging needs. In some areas, they show remarkable consistency across the continent. Jurors view this as a powerful needs assessment, networking and capacity building process that motivates action. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | METHODOLOGICAL STUDIES | CROSS-CULTURAL COMPARISONS | ACTION RESEARCH | ADOLESCENTS | PERSONS LIVING WITH HIV/AIDS | PERCEPTION | HIV INFECTIONS | EPIDEMICS | FILM AND VIDEO | DRAMA AND THEATER | HEALTH EDUCATION | COMMUNITY HEALTH SERVICES | CONTESTS | Africa | Developing Countries | Studies | Research Methodology | Comparative Studies | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Psychological Factors | Behavior | Mass Media | Communication | Culture | Sociocultural Factors | Education | Primary Health Care | Health Services | Delivery of Health Care | Health | Incentives | Policy | Political Factors Document Number: 341091 |
| 25. Peer Reviewed Title: Comparative assessment of the quality of age-at-event reporting in three HIV cohort studies in sub-Saharan Africa. Author: Wringe A; Cremin I; Todd J; McGrath N; Kasamba I; Herbst K; Mushore P; Zaba B; Slaymaker E Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 1):i56-i63. Abstract: The authors assessed inconsistencies in reported age at first sex (AFS) and age at first marriage (AFM) in three African cohorts and considered the implications for interpreting trends in sexual and marital debut. They analyzed data from population-based cohort studies in Zimbabwe, Uganda, and South Africa with 3, 10, and 4 behavioral survey rounds, respectively. Three rounds over a similar time frame were selected from each site for comparative purposes. The consistency of AFS and AFM reports was assessed for each site by comparing responses made by participants in multiple surveys. Respondents were defined as unreliable if less than half of all their age-at-event reports were the same. Kaplan-Meier functions were used to describe the cumulative proportion (1) having had sex and (2) married by age, stratified by sex, birth cohort and site, to compare the influence of reporting inconsistencies on these estimates. Among participants attending all three comparable rounds, the percentage with unreliable AFS reports ranged from 30% among South African women to 56% among Zimbabwean men, with similar patterns observed for AFM. Inclusion of unreliable reports had little effect on estimates of median age-at-event in all sites. The authors concluded that although reporting quality is unlikely to affect comparisons of AFS and AFM between settings, care should be taken not to overinterpret small changes in reported age-at-event over time within each site. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | METHODOLOGICAL STUDIES | COMPARATIVE STUDIES | COHORT ANALYSIS | CROSS-CULTURAL COMPARISONS | KAP SURVEYS | TARGET POPULATION | AGE FACTORS | DATA QUALITY | RELIABILITY | FIRST INTERCOURSE | MARRIAGE AGE | SEX FACTORS | Africa | Developing Countries | Studies | Research Methodology | Surveys | Sampling Studies | Program Design | Programs | Organization and Administration | Population Characteristics | Demographic Factors | Population | Data Analysis | Measurement | Sex Behavior | Behavior | Marriage Patterns | Marriage | Nuptiality Document Number: 340108 |
| 26. Peer Reviewed Title: Influence of timing of sexual debut and first marriage on sexual behaviour in later life: findings from four survey rounds in the Kisesa cohort in northern Tanzania. Author: Zaba B; Isingo R; Wringe A; Marston M; Slaymaker E; Urassa M Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 1):i20-i26. Abstract: The authors evaluated reports on age at first sex (AFS) and age at first marriage (AFM) from a Kisesa cohort study, 1994-2004, for consistency and for trends in median age-at-event and time spent single but sexually active in different birth cohorts. The association of these variables with marital stability and numbers of partners at later ages was explored using statistical regression techniques. Age at first sex and AFM were inconsistently reported by 32% and 33% of respondents, respectively, but there was no general tendency to report lower or higher ages at a later report date. In 10-year birth cohorts born between 1950-1959 and 1980-1989, male median AFS declined from 18.1 to 17.0 years and female median AFM rose from 16.2 to 16.6 years. Young people of both sexes currently spend longer time sexually active but unmarried than previously. Early marriage is statistically associated with remarriage and polygamy; longer time between sexual debut and marriage is associated with higher numbers of partners at later stages of life. Inconsistent reporting of age-at-event introduces noise but does not bias estimates of population-level indicators. Lengthening time spent single and sexually active suggests that men and women entering first marriage will have been exposed to increased numbers of non-marital partners. Successful youth interventions may also influence adult behavior. Language: English Keywords: TANZANIA | RESEARCH REPORT | METHODOLOGICAL STUDIES | STATISTICAL REGRESSION | KAP SURVEYS | COHORT ANALYSIS | YOUTH | MULTIPLE PARTNERS | SEX BEHAVIOR | FIRST INTERCOURSE | MARRIAGE | AGE FACTORS | DATA QUALITY | MARRIAGE AGE | TIME FACTORS | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Data Analysis | Surveys | Sampling Studies | Population Characteristics | Demographic Factors | Population | Sexual Partners | Behavior | Nuptiality | Marriage Patterns | Population Dynamics Document Number: 340103 |
| 27. Title: Analysis of the operational policy barriers to financing and procuring contraceptives in Malawi. Author: Constella Futures. Health Policy Initiative; John Snow [JSI]. DELIVER Source: Washington, D.C., Health Policy Initiative, Constella Futures, 2008 Jun. :viii, 23 p.. viii, 23 p. (USAID Contract No. GPO-I-01-05-00040-00USAID Contract No. GPO-I-01-06-00007-00) Abstract: Contraceptive security exists when every person can choose, obtain, and use high-quality contraceptives whenever they need them. Two of the most important factors in achieving contraceptive security are adequate financing and efficient contraceptive procurement mechanisms. The USAID | Health Policy Initiative and USAID | DELIVER Project are working together to develop a methodology for identifying operational policy barriers in the financing and procurement of family planning (FP) products. The goal is to help national governments, donors, and other key stakeholders improve the policy environment for contraceptive security. This report presents the findings from a pilot study the two projects conducted in Malawi to test this methodology. Language: English Keywords: MALAWI | METHODOLOGICAL STUDIES | OPERATIONS RESEARCH | PILOT PROJECTS | DEMOGRAPHIC AND HEALTH SURVEYS | PRIVATE SECTOR | USAID | GOVERNMENT FINANCING | FINANCIAL ACTIVITIES | CONTRACEPTIVE AVAILABILITY | EQUIPMENT AND SUPPLIES | LOGISTICS | CONTRACEPTIVE PREVALENCE | DECENTRALIZATION | CAPACITY BUILDING | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Program Evaluation | Programs | Organization and Administration | Research Methodology | Studies | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Macroeconomic Factors | Economic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Contraception | Family Planning | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Management | Contraceptive Usage | Program Sustainability Document Number: 308944 |
| 28. Peer Reviewed Title: Markers for predicting mortality in untreated HIV-infected children in resource-limited settings: A meta-analysis. Author: Cross Continents Collaboration for Kids (3Cs4kids) Analysis and Writing Committee Source: AIDS. 2008 Jan 2;22(1):97-105. Abstract: The objectives were to evaluate the prognostic value of selected laboratory and growth markers on the short-term risk of mortality in untreated HIV-infected children in resource-limited settings. A meta-analysis of individual longitudinal data on children aged 12 months onwards from 10 studies (nine African, one Brazilian in the 3Cs4kids collaboration). Methods: The risk of death within 12 months based on age and the most recent measurements of laboratory and growth markers was estimated using Poisson regression models, adjusted for cotrimoxazole prophylaxis use and study effects. A total of 2510 children contributed 357 deaths during 3769 child-years-at-risk, with 81% follow-up occurring after start of cotrimoxazole. At first measurement, median age was 4.0 years (interquartile range, 2.2-7.0 years), median CD4% was 15% and weight-for-age z-score -1.9. CD4% and CD4 cell count were the strongest predictors of mortality, followed by weight-for-age and haemoglobin. After adjusting for these markers,the effects of total lymphocyte count and BMI-for-age were relatively small. Young children who were both severely malnourished and anaemic had high mortality regardless of CD4 values, particularly those aged 1-2 years. By contrast, high CD4% or CD4 cell count values predicted low mortality level amongst either children older than 5 years or those younger with neither severe malnutrition nor anaemia. CD4 measurements are the most important indicator of mortality and wider access to affordable tests is needed in resource-limited settings. Evaluation of antiretroviral initiation in children also needs to consider weight-for-age and haemoglobin. Prevention and treatment of malnutrition and anaemia is integral to HIV paediatric care and could improve survival. (author's) Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | METHODOLOGICAL STUDIES | ESTIMATION TECHNIQUES | LONGITUDINAL STUDIES | STATISTICAL REGRESSION | EVALUATION INDEXES | INFANT | PERSONS LIVING WITH HIV/AIDS | INFANT MORTALITY | GROWTH | RISK ASSESSMENT | LABORATORY EXAMINATIONS AND DIAGNOSES | HEMOGLOBIN LEVEL | HIV INFECTIONS | Research Methodology | Studies | Data Analysis | Quantitative Evaluation | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Mortality | Population Dynamics | Child Development | Biology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hemic System | Physiology Document Number: 322744 |
| 29. Title: Rapid assessment tool for sexual and reproductive health and HIV linkages: a generic guide. Author: International Planned Parenthood Federation [IPPF]; United Nations Fund for Population Activities [UNFPA]; World Health Organization [WHO]; UNAIDS; Global Network of People Living with HIV / AIDS [GNP+] Source: London, England, IPPF, 2008 Oct. 88 p. Abstract: This adaptable tool can be used to assess linkages betweeen HIV and sexual and reproductive health at the policy, systems and service-delivery levels. It is intended also to identify gaps and ultimately to contribute to the development of country-specific action plans to forge and strengthen these linkages. Language: English Keywords: DEVELOPING COUNTRIES | METHODOLOGICAL STUDIES | MANUAL | CLASSIFICATION | HEALTH PERSONNEL | POLICYMAKERS | ADMINISTRATIVE PERSONNEL | REPRODUCTIVE HEALTH | SEXUALLY TRANSMITTED DISEASES | HIV INFECTIONS | INTERVIEWS | QUESTIONNAIRES | HIV PREVENTION | RISK ASSESSMENT | TIME FACTORS | Research Methodology | Delivery of Health Care | Health | Organization and Administration | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Data Collection | Evaluation | |