1.  Peer Reviewed Title: Universal voluntary HIV testing and immediate antiretroviral therapy [letter] Author: Assefa Y; Lera M Source: Lancet. 2009 Mar 28;373(9669):1080; author reply 1080-1. Abstract: Reuben Granich and colleagues use mathematical models to show that annual screening of most adults for HIV, with immediate commencement of antiretroviral therapy for all infected, would strikingly reduce HIV incidence. The findings are very interesting. We would like to share our lessons from Ethiopia. Ethiopia had a millennium AIDS campaign with the objective of increasing the number of people tested for HIV through universal voluntary counselling and testing and providing antiretroviral treatment for eligible patients. We were able to increase the number of people tested in 1 year from 560 000 in 2005/06 to 4.6 million in 2007/08. The number of patients started on antiretroviral therapy per month increased from 3500 to more than 5700. Even though we accomplished a lot in terms of HIV testing and antiretroviral therapy provision, we had challenges during the rapid scale-up of these services. We learnt that mass testing is very resource-intensive and needs a strong health system, including adequate human resources and a continuous supply of commodities. As a result, our current guiding principle is "high yield" and "high impact" through targeted testing of most-at-risk populations: patients with tuberculosis or sexually transmitted diseases, and pregnant women. Universal voluntary HIV testing and antiretroviral therapy provision might be effective in reducing HIV transmission, but with the current health system constraints in many sub-Saharan African countries such as Ethiopia, it is really not feasible to practise it. We recommend "high yield" and "high impact" HIV testing with early initiation of antiretroviral therapy, and improved adherence and retention of patients in care and treatment. (full-text) Language: English Keywords: DEVELOPING COUNTRIES | THEORETICAL STUDIES | RESEARCH PROPOSAL | THEORETICAL MODELS | COST BENEFIT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | BEST PRACTICES | HIV PREVENTION | PUBLIC HEALTH | TIME FACTORS | COST EFFECTIVENESS | ETHICS | NOTIFICATION | Studies | Research Methodology | Quantitative Evaluation | Evaluation | HIV Infections | Viral Diseases | Diseases | HIV | Programs | Organization and Administration | Health | Population Dynamics | Demographic Factors | Population | Evaluation Indexes | Sociocultural Factors | Political Factors Document Number: 330977 |
| 2. Peer Reviewed Title: Expanding antiretroviral options in resource-limited settings--a cost-effectiveness analysis. Author: Bendavid E; Wood R; Katzenstein DA; Bayoumi AM; Owens DK Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):106-13. Abstract: BACKGROUND: Current World Health Organization (WHO) guidelines for treatment of HIV in resource-limited settings call for 2 antiretroviral regimens. The effectiveness and cost-effectiveness of increasing the number of antiretroviral regimens is unknown. METHODS: Using a simulation model, we compared the survival and costs of current WHO regimens with two 3-regimen strategies: an initial regimen of 3 nucleoside reverse transcriptase inhibitors followed by the WHO regimens and the WHO regimens followed by a regimen with a second-generation boosted protease inhibitor (2bPI). We evaluated monitoring with CD4 counts only and with both CD4 counts and viral load. We used cost and effectiveness data from Cape Town and tested all assumptions in sensitivity analyses. RESULTS: Over the lifetime of the cohort, 25.6% of individuals failed both WHO regimens by virologic criteria. However, when patients were monitored using CD4 counts alone, only 6.5% were prescribed additional highly active antiretroviral therapy due to missed and delayed detection of failure. The life expectancy gain for individuals who took a 2bPI was 6.7-8.9 months, depending on the monitoring strategy. When CD4 alone was available, adding a regimen with a 2bPI was associated with an incremental cost-effectiveness ratio of $2581 per year of life gained, and when viral load was available, the ratio was $6519 per year of life gained. Strategies with triple-nucleoside reverse transcriptase inhibitor regimens in initial therapy were dominated. Results were sensitive to the price of 2bPIs. CONCLUSIONS: About 1 in 4 individuals who start highly active antiretroviral therapy in sub-Saharan Africa will fail currently recommended regimens. At current prices, adding a regimen with a 2bPI is cost effective for South Africa and other middle-income countries by WHO standards. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | THEORETICAL MODELS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | COST EFFECTIVENESS | MONITORING | WHO | IMMUNOLOGICAL EFFECTS | LIFE EXPECTANCY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | HIV Infections | Viral Diseases | Diseases | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Evaluation Indexes | Quantitative Evaluation | Evaluation | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Immunity | Immune System | Physiology | Biology | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population Document Number: 342908 |
| 3. Peer Reviewed Title: Political feasibility of scaling-up five evidence-informed HIV interventions in Pakistan: a policy analysis. Author: Buse K; Lalji N; Mayhew SH; Imran M; Hawkes SJ Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 2):ii37-ii42. Abstract: Background: Drawing on policy theories, an assessment was made of the perceived political feasibility of scaling-up five evidence-based interventions to curb Pakistan's HIV epidemic: needle and syringe exchange programmes; targeted behaviour change communication; sexual health care for male and transgender sex workers; sexual and reproductive health care for female sex workers; and promoting and protecting the rights of those at greatest risk. Method: A questionnaire was emailed to 40 stakeholders and completed by 22. They expressed their level of agreement with 15 statements for each intervention (related to variables associated with policy success). Semi-structured interviews were conducted with 12 respondents. Results: The interventions represent considerable change from the status quo, but are perceived to respond to widely acknowledged problems. These perceptions, held by the HIV policy elite, need to be set in the context of the prevailing view that the AIDS response is not warranted given the small and concentrated nature of the epidemic and that the interventions do not resonate closely with values held by society. The interventions were perceived to be evidence-based, supported by at least one donor and subject to little resistance from frontline staff as they will be implemented by contracted non-government organisations. The results were mixed in terms of other factors determining political feasibility, including the extent to which interventions are easy to explain, exhibit simple technical features, require few additional funds, are supported and not opposed by powerful stakeholders. Conclusion: The interventions stand a good chance of being implemented although they depend on donor support. The prospects for scaling them would be improved by ongoing policy analysis and strengthening of domestic constituencies among the target groups. Language: English Keywords: PAKISTAN | RESEARCH REPORT | THEORETICAL MODELS | KAP SURVEYS | POLICYMAKERS | IV DRUG USERS | SEX WORKERS | HIV PREVENTION | BEHAVIOR CHANGE COMMUNICATION | POLICY DEVELOPMENT | HEALTH POLICY | INTERVENTIONS | CAPACITY BUILDING | SEXUALLY TRANSMITTED DISEASE PREVENTION | SYRINGE | NEEDLE SHARING | SOCIAL POLICY | Developing Countries | Asia, Southern | Asia | Research Methodology | Surveys | Sampling Studies | Studies | Administrative Personnel | Organization and Administration | Drug Use and Abuse | Behavior | Sex Behavior | HIV Infections | Viral Diseases | Diseases | Communication Programs | Communication | Behavior Change | Planning | Policy | Political Factors | Sociocultural Factors | Programs | Program Sustainability | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Equipment and Supplies | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Risk Behavior Document Number: 340114 |
| 4. Peer Reviewed Title: Universal voluntary HIV testing and immediate antiretroviral therapy [letter] Author: Epstein H Source: Lancet. 2009 Mar 28;373(9669):1078-9; author reply 1080-1. Abstract: Reuben Granich and colleagues explore a policy of universal voluntary HIV testing with immediate anti retroviral therapy as a strategy for elimination of HIV transmission. I wonder how relevant their findings are, given that the models used do not account for concurrency-i.e., overlapping, longterm partnerships-which are likely to account for a substantial amount of HIV transmission in South Africa. Granich and colleagues do state that their model "allows for a high level of concurrency and for a much higher infectiousness during the acute phase than during the chronic phase." However, the reference they use to support this statement does not model concurrency, but uses a basic risk-category, deterministic model combined with a factor for changes in viral load. This is not the same thing as modelling concurrency, which is a network effect enhanced by, but independent of, viral load fluctuations. For deterministic models to approximate the observed prevalence of HIV, they must make unreasonable assumptions about African sexual behaviour. The authors of the cited paper, and presumably Granich and colleagues, assume that 1% of people have on average 77 partners per year. Behavioural surveys from Africa have never found such high levels of "promiscuity". The authors' assumption is derived not from behavioural data, but from the demands of the model itself. The model would not predict actual prevalence otherwise. Network models do not require unrealistic assumptions, and are much better able to derive prevalence estimates on the basis of actual behavioural data. Thus, it would seem worth modelling the effect of testing and antiretroviral therapy with a network model that includes concurrent partnerships. At the very least, factoring in concurrency would increase the relative amount of transmission attributable to the "acute" phase-i.e., when infection is not even detectable on an HIV test- beyond that calculated by Abu-Raddad and Longini (and presumably Granich and colleagues). That would reduce the effect of testing and early treatment significantly, I suspect. (full-text) Language: English Keywords: SOUTH AFRICA | CRITIQUE | RECOMMENDATIONS | THEORETICAL MODELS | TARGET POPULATION | VOLUNTARY COUNSELING AND TESTING | HIV TESTING | HIV PREVENTION | CAPACITY BUILDING | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Program Design | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Program Sustainability Document Number: 330978 |
| 5. Peer Reviewed Title: Adapting a multifaceted U.S. HIV prevention education program for girls in Ghana. Author: Fiscian VS; Obeng EK; Goldstein K; Shea JA; Turner BJ Source: AIDS Education and Prevention. 2009;21(1):67-79. Abstract: A U.S. HIV prevention program was adapted to address knowledge gaps and cultural pressures that increase the risk of infection in adolescent Ghanaian girls. The theory-based nine-module HIV prevention program combines didactics and games, an interactive computer program about sugar daddies, and tie-and-dye training to demonstrate an economic alternative to transactional sex. The abstinence-based study was conducted in a church-affiliated junior secondary school in Nsawam, Ghana. Of 61 subjects aged 10-14 in the prevention program, over two thirds were very worried about becoming HIV infected. A pre-post evaluation of the intervention showed significant gains in three domains: HIV knowledge (p = .001) and self efficacy to discuss HIV and sex with men (p < .001) and with boys (p < .001). Responses to items about social norms of HIV risk behavior were also somewhat improved (p = .09). Subjects rated most program features highly. Although short-term knowledge and self-efficacy to address HIV improved significantly, longer term research is needed to address cultural and economic factors placing young women at risk of HIV infection. (author's) Language: English Keywords: GHANA | UNITED STATES OF AMERICA | EVALUATION REPORT | THEORETICAL MODELS | KAP SURVEYS | ADOLESCENTS, FEMALE | WOMEN IN DEVELOPMENT | SEX WORKERS | HIV PREVENTION | SEX EDUCATION | KNOWLEDGE | COMPUTER PROGRAMS AND PROGRAMMING | SELF ESTEEM | RISK BEHAVIOR | PARTNER COMMUNICATION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Developed Countries | North America | Americas | Evaluation | Research Methodology | Surveys | Sampling Studies | Studies | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Education | Sociocultural Factors | Information Processing | Information | Psychological Factors | Interpersonal Relations Document Number: 325287 |
| 6. Peer Reviewed Title: Adapting a multifaceted U.S. HIV prevention education program for girls in Ghana. Author: Fiscian VS; Obeng EK; Goldstein K; Shea JA; Turner BJ Source: AIDS Education and Prevention. 2009 Feb;21(1):67-79. Abstract: We adapted a U.S. HIV prevention program to address knowledge gaps and cultural pressures that increase the risk of infection in adolescent Ghanaian girls. The theory-based nine-module HIV prevention program combines didactics and games, an interactive computer program about sugar daddies, and tie-and-dye training to demonstrate an economic alternative to transactional sex. The abstinence-based study was conducted in a church-affiliated junior secondary school in Nsawam, Ghana. Of 61 subjects aged 10-14 in the prevention program, over two thirds were very worried about becoming HIV infected. A pre-post evaluation of the intervention showed significant gains in three domains: HIV knowledge (p = .001) and self efficacy to discuss HIV and sex with men (p < .001) and with boys (p < .001). Responses to items about social norms of HIV risk behavior were also somewhat improved (p = .09). Subjects rated most program features highly. Although short-term knowledge and self-efficacy to address HIV improved significantly, longer term research is needed to address cultural and economic factors placing young women at risk of HIV infection. Language: English Keywords: UNITED STATES OF AMERICA | GHANA | EVALUATION REPORT | THEORETICAL MODELS | ADOLESCENTS, FEMALE | SUGAR DADDIES | SEX WORKERS | FAITH-BASED ORGANIZATION | HEALTH EDUCATION | SEX EDUCATION | HIV PREVENTION | CULTURE | COMPUTER PROGRAMS AND PROGRAMMING | ABSTINENCE | BEHAVIOR CHANGE COMMUNICATION | Developed Countries | North America | Americas | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Evaluation | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Sex Behavior | Behavior | Organizations | Political Factors | Sociocultural Factors | Education | HIV Infections | Viral Diseases | Diseases | Information Processing | Information | Family Planning, Behavioral Methods | Family Planning | Communication Programs | Communication | Behavior Change Document Number: 331081 |
| 7. Peer Reviewed Title: A 15-Minute Interactive, Computerized Condom Use Intervention With Biological Endpoints. Author: Grimley DM; Hook EW 3rd Source: Sexually Transmitted Diseases. 2009 Feb;36(2):73-78. Abstract: BACKGROUND:: Brief face-to-face-behavioral interventions have been shown to be efficacious, but are costly to sustain and to widely disseminate. This study evaluated the efficacy of a 15-minute theory-based behavioral intervention designed to increase condom use and reduce new cases of Neisseria gonorrhoeae and Chlamydia trachomatis. METHODS:: Participants were randomly assigned via the computer to the intervention or the comparison group stratified by gender and their baseline stage of change (motivational readiness) for using condoms consistently (100%) with their main partners. Behavioral data and biologic specimens for testing of Neisseria gonorrhoeae and Chlamydia trachomatis were obtained at baseline and at 6 months post intervention. The intervention was delivered via an audio, multimedia, computerized application that provided individualized interventions to patients based on their responses to assessment items; comparison patients interacted with a 15-minute, computerized, multiple health risk assessment with no intervention. RESULTS:: The majority of the sample (N = 430) was black (88%); 54.5% women; with a mean age = 24.5. Assuming all participants who did not return to the clinic at 6 months were not using condoms consistently, 32% of the treatment group versus 23% in the comparison group reported consistent condom use (P = 0.03). The combined Neisseria gonorrhoeae and Chlamydia trachomatis incidence declined to 6% in the intervention group versus 13% in the comparison group (P = 0.04). Results from a regression analysis revealed that the only statically significant predictor of sexually transmitted diseases infection at the follow-up was group assignment (OR = 1.91, 95% confidence index = 1.09-3.34; P = 0.043). CONCLUSIONS:: These findings suggest that brief, interactive, computer-delivered interventions provided at the evaluation visit increase condom use and reduce sexually transmitted diseases without putting additional burden on clinicians or staff. Language: English Keywords: ALABAMA | RESEARCH REPORT | KAP SURVEYS | CASE CONTROL STUDIES | STATISTICAL REGRESSION | THEORETICAL MODELS | BLACKS | COMPUTER PROGRAMS AND PROGRAMMING | GONORRHEA | CHLAMYDIA | CONDOM USE | AUDIOVISUAL AIDS | TIME FACTORS | RISK ASSESSMENT | CONTRACEPTIVE PREVALENCE | Developed Countries | United States of America | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Ethnic Groups | Cultural Background | Population Characteristics | Demographic Factors | Population | Information Processing | Information | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Risk Reduction Behavior | Behavior | Educational Methods | Educational Activities | Education | Population Dynamics | Evaluation | Contraceptive Usage | Contraception | Family Planning Document Number: 329674 |
| 8. Title: Determinants of actual condom use among adolescents in Thailand. Author: Khumsaen N; Gary FA Source: Journal of the Association of Nurses In AIDS Care. 2009 May-Jun;20(3):218-29. Abstract: This study examined the relationships among attitudes toward condom use, personal characteristics, condom use self-efficacy, and actual condom use among Thai adolescents. Predictors of condom use were also investigated. The sample consisted of 270 Thai vocational students aged 18 to 21 years. Multiple regressions were used to estimate the correlates between the independent study variables and condom use among Thai adolescents. The results showed that self-reported history of alcohol or drug use, attitudes toward condom use, and condom use self-efficacy were related to actual condom use. Language: English Keywords: THAILAND | RESEARCH REPORT | KAP SURVEYS | MULTIVARIATE ANALYSIS | THEORETICAL MODELS | YOUTH | STUDENTS | NURSES AND NURSING | CONDOM USE | SAFER SEX | ATTITUDES | PREMARITAL SEX BEHAVIOR | ALCOHOL USE AND ABUSE | DRUG USE AND ABUSE | SEX DISCRIMINATION | Developing Countries | Asia, Southeastern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Age Factors | Population Characteristics | Demographic Factors | Population | Education | Health Personnel | Delivery of Health Care | Health | Risk Reduction Behavior | Behavior | Sex Behavior | Psychological Factors | Social Discrimination | Social Problems | Sociocultural Factors Document Number: 341111 |
| 9. Peer Reviewed Title: Fitting the HIV epidemic in Zambia: a two-sex micro-simulation model. Author: Leclerc PM; Matthews AP; Garenne ML Source: PloS One. 2009;4(5):e5439. Abstract: BACKGROUND: In describing and understanding how the HIV epidemic spreads in African countries, previous studies have not taken into account the detailed periods at risk. This study is based on a micro-simulation model (individual-based) of the spread of the HIV epidemic in the population of Zambia, where women tend to marry early and where divorces are not frequent. The main target of the model was to fit the HIV seroprevalence profiles by age and sex observed at the Demographic and Health Survey conducted in 2001. METHODS AND FINDINGS: A two-sex micro-simulation model of HIV transmission was developed. Particular attention was paid to precise age-specific estimates of exposure to risk through the modelling of the formation and dissolution of relationships: marriage (stable union), casual partnership, and commercial sex. HIV transmission was exclusively heterosexual for adults or vertical (mother-to-child) for children. Three stages of HIV infection were taken into account. All parameters were derived from empirical population-based data. Results show that basic parameters could not explain the dynamics of the HIV epidemic in Zambia. In order to fit the age and sex patterns, several assumptions were made: differential susceptibility of young women to HIV infection, differential susceptibility or larger number of encounters for male clients of commercial sex workers, and higher transmission rate. The model allowed to quantify the role of each type of relationship in HIV transmission, the proportion of infections occurring at each stage of disease progression, and the net reproduction rate of the epidemic (R(0) = 1.95). CONCLUSIONS: The simulation model reproduced the dynamics of the HIV epidemic in Zambia, and fitted the age and sex pattern of HIV seroprevalence in 2001. The same model could be used to measure the effect of changing behaviour in the future. Language: English Keywords: ZAMBIA | RESEARCH REPORT | THEORETICAL MODELS | DEMOGRAPHIC AND HEALTH SURVEYS | HETEROSEXUALS | SEX WORKERS | HIV INFECTIONS | EPIDEMICS | AGE FACTORS | SEX FACTORS | EPIDEMIOLOGY | MARRIAGE | SEX BEHAVIOR | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Behavior | Viral Diseases | Diseases | Population Characteristics | Public Health | Health | Nuptiality Document Number: 341943 |
| 10. 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 |
| 11. Peer Reviewed Title: Theory-based strategies for improving contraceptive use: a systematic review. Author: Lopez LM; Tolley EE; Grimes DA; Chen-Mok M Source: Contraception. 2009 Jun;79(6):411-7. Abstract: BACKGROUND: Theories and models help explain how behavior change occurs. We systematically reviewed randomized controlled trials that examined theory-based interventions for improving contraceptive use. STUDY DESIGN: We searched electronic databases for eligible trials. Primary outcomes included pregnancy and contraceptive use. We calculated the odds ratio for dichotomous outcomes and the mean difference for continuous data. RESULTS: Of 14 included trials, 10 showed positive results for a theory-based group: 2 of 10 studies with pregnancy or birth data, 4 of 9 addressing contraceptive use (for contraception) and 5 of 9 with condom use (to prevent HIV/sexually transmitted infections). An experimental group had favorable results for six of seven trials based on Social Cognitive Theory, two based on other social cognition models and two using motivational interviewing. Most interventions focused on adolescents and involved multiple sessions. CONCLUSIONS: Effects were not consistent across outcomes and comparisons. The field could benefit from thorough use of single theories and better reporting on intervention implementation. Language: English Keywords: UNITED STATES OF AMERICA | LITERATURE REVIEW | THEORETICAL STUDIES | CASE CONTROL STUDIES | KAP SURVEYS | THEORETICAL MODELS | WOMEN | ADOLESCENTS | CONTRACEPTIVE USAGE | CONDOM USE | CONTRACEPTIVE EFFECTIVENESS | SEXUALLY TRANSMITTED DISEASE PREVENTION | MOTIVATION | TIME FACTORS | PROGRAM DESIGN | Developed Countries | North America | Americas | Studies | Research Methodology | Surveys | Sampling Studies | Demographic Factors | Population | Youth | Age Factors | Population Characteristics | Contraception | Family Planning | Risk Reduction Behavior | Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Psychological Factors | Population Dynamics | Programs | Organization and Administration Document Number: 341105 |
| 12. Peer Reviewed Title: Predictors of early first sexual intercourse among adolescents in Cape Town, South Africa. Author: Mathews C; Aaro LE; Flisher AJ; Mukoma W; Wubs AG; Schaalma H Source: Health Education Research. 2009 Feb;24(1):10 p. Abstract: The authors used a social cognition theoretical framework to investigate the predictors of young adolescents' transition to first intercourse. The analyses were based on a longitudinal study of students in schools allocated to the control arm of a cluster-randomized controlled trial to investigate the effect of a school-based HIV prevention program. The study involved 2,360 Grade 8 students in Cape Town. Of the 1,440 students who were virgins at baseline, 1,144 remained virgins 15 months later, and 296 (20.6%) reported having had their first sexual intercourse. Transition to first sexual intercourse was more likely among males, among older students, and among students with a lower socio-economic status. Transition to first sexual intercourse was significantly associated with intentions to have sexual intercourse, poor self-efficacy to negotiate delayed sex, and intimate partner violence. The model predicted 35% of the variance in intentions and 16% of the variance in transition. These findings indicate some of the factors that influence young people to have first sex and that need to be addressed when designing effective interventions. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | LONGITUDINAL STUDIES | ADOLESCENTS | URBAN POPULATION | FIRST INTERCOURSE | AGE FACTORS | RISK FACTORS | PSYCHOSOCIAL FACTORS | SEX FACTORS | SOCIOECONOMIC STATUS | PARTNER COMMUNICATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Youth | Population Characteristics | Demographic Factors | Population | Sex Behavior | Behavior | Biology | Socioeconomic Factors | Economic Factors | Interpersonal Relations Document Number: 329524 |
| 13. Peer Reviewed Title: Demographic and personality factors as predictors of HIV/STD partner-specific risk perceptions: implications for interventions. Author: Mehrotra P; Noar SM; Zimmerman RS; Palmgreen P Source: AIDS Education and Prevention. 2009 Feb;21(1):39-54. Abstract: Although risk perception as a motivator of precautionary behavior is a key component of several health behavior theories, this motivational hypothesis has found mixed support in the HIV/AIDS area. This may be, in part, because risk perceptions are more complex than they are treated in many studies of the motivational hypothesis. The current study examines demographic, personality, and sexual risk factors as predictors of partner-specific (main vs. casual) HIV/STD risk perceptions in a sample of 1,489 young adults. As expected, perceptions of HIV/STD risk were higher in the context of "casual" as compared with "main" partnerships. Although univariate analyses demonstrated that gender, race/ethnicity, sensation seeking, impulsivity, number of partners, and condom use all influenced HIV/STD risk perceptions, only gender, condom use, and race/ethnicity remained significant in multivariate analyses. Implications of these results for the design of efficacious HIV prevention interventions are discussed. Language: English Keywords: KENTUCKY | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | SEXUAL PARTNERS | YOUTH | DEMOGRAPHIC FACTORS | PERSONALITY | HIV PREVENTION | PERCEPTION | RISK ASSESSMENT | SEXUALLY TRANSMITTED DISEASE PREVENTION | SEX BEHAVIOR | MOTIVATION | RISK BEHAVIOR | Developed Countries | United States of America | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Behavior | Age Factors | Population Characteristics | Population | Psychological Factors | HIV Infections | Viral Diseases | Diseases | Evaluation | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections Document Number: 331082 |
| 14. Title: Correlates of the intention to remain sexually inactive among male adolescents in an Islamic country: case of the Republic of Iran. Author: Mohtasham G; Shamsaddin N; Bazargan M; Anosheravan K; Elaheh M; Fazlolah G Source: Journal of School Health. 2009 Mar;79(3):123-9. Abstract: BACKGROUND: There are very few studies that have examined sexual intentions and behaviors of adolescents in Islamic countries. This study employs the Health Belief Model to assess the correlates of the intention to remain sexually inactive among male adolescents in the Republic of Iran. METHODS: This cross-sectional study was performed with a sample of 314 adolescents recruited from 3 high schools from Tehran, Iran. RESULTS: Fifty-seven percent of this sample planned to remain abstinent until marriage. Another 23% rejected the notion of remaining abstinent and 20% were uncertain. Multinomial logistic regression revealed that students whose mothers were employed and who received a higher daily allowance were more likely to report that they would not remain abstinent. No significant independent relationship between human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome-related knowledge and an intention to remain abstinent was detected. However, consistent with previous studies conducted in Asia, Africa, and in Western countries, we documented that (1) perceived subjective norms, (2) self-efficacy, (3) and perceived susceptibility to contracting the HIV virus all are associated with the intention to remain sexually inactive among adolescents. CONCLUSIONS: It seems abstinence until marriage is more likely to be practiced in traditional families. However, Iranian society is changing rapidly and traditional family structures, values, and norms may not sufficiently protect adolescents from HIV infection. The data from this study support previous studies conducted in Western countries, which found that intervention programs that focus on knowledge alone are ineffective in their ability to alter adolescents' intentions to postpone sexual activity. Language: English Keywords: IRAN | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | CROSS SECTIONAL ANALYSIS | MULTIVARIATE ANALYSIS | ADOLESCENTS, MALE | STUDENTS | ABSTINENCE | ISLAM | SECONDARY SCHOOLS | PREVALENCE | INCOME | EMPLOYMENT | VALUE ORIENTATION | Middle East | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Data Analysis | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Education | Family Planning, Behavioral Methods | Family Planning | Religion | Sociocultural Factors | Schools | Measurement | Socioeconomic Factors | Economic Factors | Macroeconomic Factors | Psychological Factors | Behavior Document Number: 341162 |
| 15. Title: Good women, martyrs, and survivors: a theoretical framework for South Asian women's responses to partner violence. Author: Pinnewala P Source: Violence Against Women. 2009 Jan;15(1):81-105. Abstract: This article analyzes select psychological and social models to provide a new theoretical framework for South Asian women subjected to partner violence. It focuses on women's help-seeking behaviors and efforts to end violence. Analysis of the stress-coping paradigm, the ecological model, and the transtheoretical approach indicates the possibility of integrating their core constructs of cognitive, contextual, and process elements to provide a culturally relevant model for South Asia. Each model is reviewed from a Sri Lankan clinical perspective to discuss its relevance to South Asian women's experience with, and responses to, violence. This initial theoretical framework will need to undergo further comprehensive theorizing and rigorous empirical testing in different South Asian countries to assess its validity. Language: English Keywords: ASIA, SOUTHERN | RESEARCH REPORT | THEORETICAL MODELS | CASE STUDIES | COUPLES | DOMESTIC VIOLENCE | COUNSELING | VALIDITY | PSYCHOLOGICAL FACTORS | PHYSICAL ABUSE | PROGRAM EVALUATION | Asia | Developing Countries | Research Methodology | Studies | Family Characteristics | Family and Household | Sociocultural Factors | Crime | Social Problems | Clinic Activities | Program Activities | Programs | Organization and Administration | Measurement | Behavior | Violence Document Number: 340219 |
| 16. Title: HIV transmission networks. Author: Rothenberg R Source: Current Opinion In HIV and AIDS. 2009 Jul;4(4):260-5. Abstract: PURPOSE OF REVIEW: Over the past several years, one segment of the complex field of HIV transmission dynamics - heterosexual networks - has dominated theoretical and empirical investigation. This review provides an overview of recent work on HIV risks and networks, with a focus on recent findings in heterosexual network dynamics. RECENT FINDINGS: Qualitative (ethnographic) assessments have demonstrated the heterogeneity and complexity of heterosexual connections, particularly in Africa, where tradition, official polygamy, and unofficial multiperson arrangements have lead to concurrency of sexual partnerships. A large, quantitative study on Likoma Island, Malawi, demonstrated the considerable, interlocking sexual connections that arise from a high-concurrency sexual setting, even with a low average number of partnerships (low degree) of long duration. Such settings, as suggested by ethnographic studies, may be common in Africa and, coupled with newer information about transmissibility during acute and early infection, may provide a plausible explanation for endemic transmission and possibly for rapid HIV propagation. SUMMARY: Recognition of high-concurrency, low-degree networks is an important development for understanding HIV transmission dynamics. Their relevance to heterosexual transmission, and possible extension to other epidemiologic settings, reinforces the heterogeneity and complexity of HIV transmission dynamics. Language: English Keywords: GLOBAL | LITERATURE REVIEW | THEORETICAL MODELS | HETEROSEXUALS | HIV TRANSMISSION | EPIDEMIOLOGY | PREVALENCE | RISK FACTORS | SEX BEHAVIOR | MULTIPLE PARTNERS | Research Methodology | Behavior | HIV Infections | Viral Diseases | Diseases | Public Health | Health | Measurement | Sexual Partners Document Number: 342341 |
| 17. Peer Reviewed Title: Perceived risks of HIV/AIDS and first sexual intercourse among youth in Cape Town, South Africa. Author: Tenkorang EY; Rajulton F; Maticka-Tyndale E Source: AIDS and Behavior. 2009 Apr;13(2):234-245. Abstract: The "Health Belief Model" (HBM) identifies perception of HIV/AIDS risks, recognition of its seriousness, and knowledge about prevention as predictors of safer sexual activity. Using data from the Cape Area Panel Survey and hazard models, the authors examined the impact of risk perception (considered the first step in HIV prevention), within the context of the HBM and socioeconomic, familial, and school factors, on the timing of first sexual intercourse among youth aged 14-22 in Cape Town, South Africa. Of the HBM components, female youth who perceive their risk as "very small" and males with higher knowledge, experience their sexual debut later than comparison groups. For both males' and females' socioeconomic and familial factors also influence timing of sexual debut, confirming the need to consider the social embeddedness of this sexual behavior as well as the rational components of decision making when designing prevention programs. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | URBAN POPULATION | YOUTH | PERCEPTION | RISK ASSESSMENT | HIV TRANSMISSION | FIRST INTERCOURSE | KNOWLEDGE | SOCIOECONOMIC FACTORS | FAMILY RELATIONSHIPS | SCHOOLS | SEX FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Age Factors | Psychological Factors | Behavior | Evaluation | HIV Infections | Viral Diseases | Diseases | Sex Behavior | Sociocultural Factors | Economic Factors | Family Characteristics | Family and Household | Education Document Number: 340123 |
| 18. Peer Reviewed Title: A Mixed Methods Evaluation of the Effect of the Protect and Respect Intervention on the Condom Use and Disclosure Practices of Women Living with HIV/AIDS. Author: Teti M; Bowleg L; Cole R; Lloyd L; Rubinstein S; Spencer S; Aaron E; Ricksecker A; Berhane Z; Gold M Source: AIDS and Behavior. 2009 Apr 9; Abstract: This mixed methods study evaluated the efficacy of an intervention to increase HIV status disclosure and condom use among 184 women living with HIV/AIDS (WLH/A). Participants were recruited from an HIV clinic and randomly assigned to: (1) a comparison group, who received brief messages from their health care providers (HCPs), or; (2) an intervention group, who received messages from HCPs, a group-level intervention, and peer-led support groups. Participants completed risk surveys at baseline, 6-, 12-, and 18-months. Quantitative analyses using hierarchical generalized linear models within a repeated measures framework indicated that intervention participants had significantly higher odds of reporting condom use with sexual partners in months 6 and 18. Grounded Theory-based qualitative analyses suggested that the opportunity to discuss the social context of their lives in addition to HIV/AIDS, including continued stigma and fear related to disclosure, are also essential components of a prevention strategy for WLH/A. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | THEORETICAL MODELS | CASE CONTROL STUDIES | PERSONS LIVING WITH HIV/AIDS | WOMEN | PEER EDUCATORS | WOMEN'S GROUPS | SEXUAL PARTNERS | CONDOM USE | PARTNER COMMUNICATION | HIV PREVENTION | STIGMA | FEAR | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Demographic Factors | Population | Education | Interest Groups | Political Factors | Sociocultural Factors | Sex Behavior | Behavior | Risk Reduction Behavior | Interpersonal Relations | Social Problems | Emotions | Psychological Factors Document Number: 331003 |
| 19. Peer Reviewed Title: Explaining adherence success in sub-Saharan Africa: an ethnographic study. Author: Ware NC; Idoko J; Kaaya S; Biraro IA; Wyatt MA; Agbaji O; Chalamilla G; Bangsberg DR Source: PLoS Medicine. 2009 Jan 27;6(1):e11. Abstract: BACKGROUND: Individuals living with HIV/AIDS in sub-Saharan Africa generally take more than 90% of prescribed doses of antiretroviral therapy (ART). This number exceeds the levels of adherence observed in North America and dispels early scale-up concerns that adherence would be inadequate in settings of extreme poverty. This paper offers an explanation and theoretical model of ART adherence success based on the results of an ethnographic study in three sub-Saharan African countries. METHODS AND FINDINGS: Determinants of ART adherence for HIV-infected persons in sub-Saharan Africa were examined with ethnographic research methods. Findings indicate that individuals taking ART routinely overcome economic obstacles to ART adherence through a number of deliberate strategies aimed at prioritizing adherence: borrowing and "begging" transport funds, making "impossible choices" to allocate resources in favor of treatment, and "doing without." Prioritization of adherence is accomplished through resources and help made available by treatment partners, other family members and friends, and health care providers. Helpers expect adherence and make their expectations known, creating a responsibility on the part of patients to adhere. Patients adhere to promote good will on the part of helpers, thereby ensuring help will be available when future needs arise. CONCLUSION: Adherence success in sub-Saharan Africa can be explained as a means of fulfilling social responsibilities and thus preserving social capital in essential relationships. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | THEORETICAL MODELS | INTERVIEWS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | HUMAN CAPITAL | TREATMENT | Africa | Developing Countries | Research Methodology | Data Collection | HIV Infections | Viral Diseases | Diseases | HIV | Behavior | Human Resources | Economic Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330191 |
20.  Title: The potential role of contraceptive implants in sub-Saharan Africa. Author: Family Health International [FHI] Source: [Research Triangle Park, North Carolina], FHI, [2008]. [2] p. (Research Brief on Hormonal Contraception) Abstract: A study by investigators at Family Health International and University College London suggests that a large number of unintended pregnancies in sub-Saharan Africa could be averted if even a fraction of women who use short-term hormonal contraceptives (pills and injectables) would switch to contraceptive implants. Language: English Keywords: AFRICA, SUB SAHARAN | SUMMARY REPORT | THEORETICAL MODELS | CONTRACEPTIVE IMPLANTS | PREGNANCY, UNPLANNED | CONTRACEPTIVE AGENTS, FEMALE | CONTRACEPTION TERMINATION | CONTRACEPTION FAILURE | CONTRACEPTIVE METHOD SWITCHING | Africa | Developing Countries | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Contraceptive Agents | Contraceptive Usage Document Number: 331723 |
| 21. Peer Reviewed Title: Genital herpes has played a more important role than any other sexually transmitted infection in driving HIV prevalence in Africa. Author: Abu-Raddad LJ; Magaret AS; Celum C; Wald A; Longini IM Jr Source: PLoS One. 2008 May;3(5):e2230. Abstract: Extensive evidence from observational studies suggests a role for genital herpes in the HIV epidemic. A number of herpes vaccines are under development and several trials of the efficacy of HSV-2 treatment with acyclovir in reducing HIV acquisition, transmission, and disease progression have just reported their results or will report their results in the next year. The potential impact of these interventions requires a quantitative assessment of the magnitude of the synergy between HIV and HSV-2 at the population level. A deterministic compartmental model of HIV and HSV-2 dynamics and interactions was constructed. The nature of the epidemiological synergy was explored qualitatively and quantitatively and compared to other sexually transmitted infections (STIs). The results suggest a more substantial role for HSV-2 in fueling HIV spread in sub-Saharan Africa than other STIs. We estimate that in settings of high HSV-2 prevalence, such as Kisumu, Kenya, more than a quarter of incident HIV infections may have been attributed directly to HSV-2. HSV-2 has also contributed considerably to the onward transmission of HIV by increasing the pool of HIV positive persons in the population and may explain one-third of the differential HIV prevalence among the cities of the Four City study. Conversely, we estimate that HIV had only a small net impact on HSV-2 prevalence. HSV-2 role as a biological cofactor in HIV acquisition and transmission may have contributed substantially to HIV particularly by facilitating HIV spread among the low-risk population with stable long-term sexual partnerships. This finding suggests that prevention of HSV-2 infection through a prophylactic vaccine may be an effective intervention both in nascent epidemics with high HIV incidence in the high risk groups, and in established epidemics where a large portion of HIV transmission occurs in stable partnerships. (author's) Language: English Keywords: AFRICA, SUB SAHARAN | KENYA | RESEARCH REPORT | THEORETICAL MODELS | HIV | PREVALENCE | HIV TRANSMISSION | HERPES GENITALIS | EPIDEMIOLOGY | Developing Countries | Africa | Africa, Eastern | Research Methodology | HIV Infections | Viral Diseases | Diseases | Measurement | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Public Health | Health Document Number: 326884 |
| 22. Peer Reviewed Title: Reproduction in upheaval: Ethnic-specific fertility responses to societal turbulence in Kazakhstan. Author: Agadjanian V; Dommaraju P; Glick JE Source: Population Studies. 2008 Jul;62(2):211-233. Abstract: This study contributes to the literature on demographic adjustments to societal crises by examining ethnic-specific probabilities of having first, second, and third marital births in late-twentieth-century Kazakhstan. Discrete-time logit models, employing data from the 1995 and 1999 Kazakhstan Demographic and Health Surveys, are fitted. The results show that the probability of a first birth responded to societal cataclysms of the post-Soviet transition, but this response was most manifest and enduring in the ethnic group that had been most demographically advanced and that also found itself most politically and economically vulnerable. While ethnic differences in the probabilities of second and third births were generally more pronounced than in the probability of first birth, the pace of their post-Soviet decline was relatively uniform across all ethnic groups. (author's) Language: English Keywords: KAZAKHSTAN | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | THEORETICAL MODELS | SOCIAL PROBLEMS | POLITICAL FACTORS | ECONOMIC FACTORS | FERTILITY DETERMINANTS | FERTILITY CHANGES | ETHNIC GROUPS | FIRST BIRTH | FIRST BIRTH INTERVALS | Asia, Central | Asia | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Research Methodology | Sociocultural Factors | Fertility | Cultural Background | Population Characteristics | Pregnancy History | Fertility Measurements | Birth Intervals Document Number: 327527 |
| 23. Peer Reviewed Title: Migration, fertility, and aging in stable populations. Author: Alho JM Source: Demography. 2008 Aug;45(3):641-650. Abstract: Fertility is below replacement level in all European countries, and population growth is expected to decline in the coming decades. Increasing life expectancy will accentuate concomitant aging of the population. Migration has been seen as a possible means to decelerate aging. In this article, I introduce a stable, open-population model in which cohort net migration is proportional to births. In this case, the migration-fertility trade-off can be studied with particular ease. I show that although migration can increase the growth rate, which tends to make the age distribution younger, it also has an opposite effect because of its typical age pattern. I capture the effect of the age pattern of net migration in a migration-survivor function. The effect of net migration on growth is quantified with data from 17 European countries. I show that some countries already have a level of migration that will lead to stationarity. For other countries with asymptotically declining population, migration still provides opportunities for slowing down aging of the population as a whole. (author's) Language: English Keywords: EUROPE | RESEARCH REPORT | THEORETICAL MODELS | MIGRATION | FERTILITY CHANGES | POPULATION DYNAMICS | AGE FACTORS | DEPENDENCY BURDEN | Developed Countries | Research Methodology | Demographic Factors | Population | Fertility | Population Characteristics | Microeconomic Factors | Economic Factors Document Number: 327986 |
| 24. Peer Reviewed Title: Estimating the resources needed and savings anticipated from roll-out of adult male circumcision in sub-Saharan Africa. Author: Auvert B; Marseille E; Korenromp EL; Lloyd-Smith J; Sitta R Source: PLoS One. 2008 Aug 6;3(8):e2679. Abstract: Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20 years in sub-Saharan Africa and cost less than treating those who would have been infected. This paper estimates the financial and human resources required to roll out MAMC and the net savings due to reduced infections. We developed a model which included costing, demography and HIV epidemiology. We used it to investigate 14 countries in sub-Saharan Africa where the prevalence of male circumcision was lower than 80% and HIV prevalence among adults was higher than 5%, in addition to Uganda and the Nyanza province in Kenya. We assumed that the roll-out would take 5 years and lead to an MC prevalence among adult males of 85%. We also assumed that surgery would be done as it was in the trials. We calculated public program cost, number of full-time circumcisers and net costs or savings when adjusting for averted HIV treatments. Costs were in USD, discounted to 2007. 95% percentile intervals (95% PI) were estimated by Monte Carlo simulations. In the first 5 years the number of circumcisers needed was 2 282 (95% PI: 2 018 to 2 959), or 0.24 (95% PI: 0.21 to 0.31) per 10 000 adults. In years 6-10, the number of circumcisers needed fell to 513 (95% PI: 452 to 664). The estimated 5-year cost of rolling out MAMC in the public sector was $919 million (95%PI: 726 to 1 245). The cumulative net cost over the first 10 years was $672 million (95% PI: 437 to 1 021) and over 20 years there were net savings of $2.3 billion (95% PI: 1.4 to 3.4). A rapid roll-out of MAMC in sub-Saharan Africa requires substantial funding and a high number of circumcisers for the first five years. These investments are justified by MAMC's substantial health benefits and the savings accrued by averting future HIV infections. Lower ongoing costs and continued care savings suggest long-term sustainability. (author's) Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | THEORETICAL MODELS | MALE CIRCUMCISION | HIV PREVENTION | INTERVENTIONS | COST BENEFIT ANALYSIS | COST EFFECTIVENESS | ESTIMATION TECHNIQUES | PRIVATE SECTOR | PUBLIC SECTOR | PROGRAM SUSTAINABILITY | Africa | Developing Countries | Research Methodology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Quantitative Evaluation | Evaluation | Evaluation Indexes | Macroeconomic Factors | Economic Factors Document Number: 328126 |
| 25. Title: Birth-spacing, fertility and neonatal mortality in India: Dynamics, frailty, and fecundity. Author: Bhalotra S; van Soest A Source: Journal of Econometrics. 2008 Apr;143(2):274-290. Abstract: Using microdata on 30,000 childbirths in India and dynamic panel data models, we analyse causal effects of birth spacing on subsequent neonatal mortality and of mortality on subsequent birth intervals, controlling for unobserved heterogeneity. Right censoring is accounted for by jointly estimating a fertility equation, identified by using data on sterilization. We find evidence of frailty, fecundity, and causal effects in both directions. Birth intervals explain only a limited share of the correlation between neonatal mortality of successive children in a family. We predict that for every neonatal death, 0.37 additional children are born, of whom 0.30 survive. (author's) Language: English Keywords: INDIA | RESEARCH REPORT | THEORETICAL MODELS | CORRELATION STUDIES | BIRTH SPACING | FERTILITY DETERMINANTS | NEONATAL MORTALITY | ESTIMATION TECHNIQUES | Developing Countries | Asia, Southern | Asia | Research Methodology | Statistical Studies | Studies | Family Planning | Fertility | Population Dynamics | Demographic Factors | Population | Infant Mortality | Mortality Document Number: 327065 |
| 26. Title: Youth risk-taking behavior in Brazil: Drug use and teenage pregnancy. Author: Cardoso AR; Verner D Source: Washington, D.C., World Bank, Sustainable Development Division, 2008 Mar. 14 p. (World Bank Policy Research Working Paper No. 4548) Abstract: Using an extensive survey that addresses risk factors faced by the population in the shantytowns (favelas) of Fortaleza, Brazil, the aim of this paper is to study risk-taking behavior by youth, focusing on drug use and teenage pregnancy. The paper analyzes the impact of factors such as exposure to mass media, the existence of support networks, self-esteem, and the occurrence of violence at home and in the neighborhood, on the probability of risk-taking behavior. A bivariate probit model is estimated. The findings indicate that reliance on support networks and exposure to mass media are associated with a lower probability of either type of risk behavior. Living in a violent home increases drug consumption. Race does not have a significant impact on either type of behavior. (author's) Language: English Keywords: BRAZIL | RESEARCH REPORT | SURVEYS | THEORETICAL MODELS | YOUTH | URBAN AREAS | RISK BEHAVIOR | DRUG USE AND ABUSE | SEX BEHAVIOR | ADOLESCENT PREGNANCY | MASS MEDIA | FAMILY AND HOUSEHOLD | SELF ESTEEM | South America, Eastern | South America | Latin America | Americas | Developing Countries | Sampling Studies | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Geographic Factors | Behavior | Reproductive Behavior | Fertility | Population Dynamics | Communication | Sociocultural Factors | Psychological Factors Document Number: 325788 |
| 27. Peer Reviewed Title: Modifying Photovoice for community-based participatory Indigenous research. Author: Castleden H; Garvin T Source: Social Science and Medicine. 2008 Mar;66(6):1393-1405. Abstract: Scientific research occurs within a set of socio-political conditions, and in Canada research involving Indigenous communities has a historical association with colonialism. Consequently, Indigenous peoples have been justifiably sceptical and reluctant to become the subjects of academic research. Community-Based Participatory Research (CBPR) is an attempt to develop culturally relevant research models that address issues of injustice, inequality, and exploitation. The work reported here evaluates the use of Photovoice, a CBPR method that uses participant-employed photography and dialogue to create social change, which was employed in a research partnership with a First Nation in Western Canada. Content analysis of semi-structured interviews (n = 45) evaluated participants' perspectives of the Photovoice process as part of a larger study on health and environment issues. The analysis revealed that Photovoice effectively balanced power, created a sense of ownership, fostered trust, built capacity, and responded to cultural preferences. The authors discuss the necessity of modifying Photovoice, by building in an iterative process, as being key to the methodological success of the project. (author's) Language: English Keywords: CANADA | METHODOLOGICAL STUDIES | THEORETICAL MODELS | RESEARCH METHODOLOGY | ACTION RESEARCH | INDIGENOUS POPULATION | COMMUNITY | POLITICAL FACTORS | COLONIALISM | CULTURAL BACKGROUND | INEQUALITIES | VISUAL AIDS | OWNERSHIP | North America, Northern | Americas | Developed Countries | Population Characteristics | Demographic Factors | Population | Residence Characteristics | Population Distribution | Geographic Factors | Sociocultural Factors | Political Systems | Socioeconomic Factors | Economic Factors | Educational Methods | Educational Activities | Education Document Number: 324679 |
| 28. Peer Reviewed Title: Revisiting the impact of a reproductive health intervention on children's height-for-age with evidence from rural Bangladesh. Author: Chaudhuri A Source: Economic Development and Cultural Change. 2008 Apr;56(3):619-656. Abstract: In this article, I analyze the effect of the FPHSP program on the health status of the currently living child population under the age of 10 years, using each child as the unit of analysis. Health status of children is measured using height-for-age. Height-for-age is an age and gender standardized measure that is conventionally used as an indicator of long-term health or nutritional status in children. The children are further divided into two age groups, ages 0-5 and 6-10, to examine the nature of the program effect. This study finds that children living in the treatment area are significantly healthier than children living in the control area. Further, the program significantly affects the younger children who are directly targeted by the program. No significant program impact is evident for children who have aged out of the program. The details of the program are described in Section II. (excerpt) Language: English Keywords: BANGLADESH | RESEARCH REPORT | PROGRAM EVALUATION | THEORETICAL MODELS | CHILDREN | RURAL POPULATION | REPRODUCTIVE HEALTH | INTERVENTIONS | BODY HEIGHT | CHILD HEALTH | SEX FACTORS | HEALTH STATUS INDEXES | PROGRAM EFFECTIVENESS | IMPACT | MOTHERS | EDUCATIONAL STATUS | Developing Countries | Asia, Southern | Asia | Programs | Organization and Administration | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Physiology | Biology | Communication | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Socioeconomic Status | Socioeconomic Factors | Economic Factors Document Number: 325836 |
| 29. Peer Reviewed Title: Constant global population with demographic heterogeneity. Author: Cohen JE Source: Demographic Research. 2008 May 27;18(14):409-436. Abstract: To understand better a possible future constant global population that is demographically heterogeneous, this paper analyzes several models. Classical theory of stationary populations generally fails to apply. However, if constant global population size P(global) is the sum of all country population sizes, and if constant global annual number of births B(global) is the sum of the annual number of births of all countries, and if constant global life expectancy at birth e(global) is the population-weighted mean of the life expectancy at birth of all countries, then B(global) e(global) always exceeds P(global) unless all countries have the same life expectancy at birth, in which case B(global) e(global) = P(global). (author's) Language: English Keywords: GLOBAL | RESEARCH REPORT | THEORETICAL MODELS | POPULATION STABILIZATION | POPULATION SIZE | POPULATION CHARACTERISTICS | INTERNATIONAL MIGRATION | LIFE EXPECTANCY | Research Methodology | Population Dynamics | Demographic Factors | Population | Migration | Length of Life | Mortality Document Number: 326903 |
| 30. Peer Reviewed Title: Using sibling differences to estimate effects of parenting on adolescent sexual risk behaviors. Author: Coley RL; Medeiros BL; Schindler HS Source: Journal of Adolescent Health. 2008 Aug;43(2):133-140. Abstract: The purpose of this study was to estimate effects of positive and involved parenting during mid-adolescence on sexual risk behaviors (frequency of intercourse, unprotected intercourse, and number of sexual partners) during late adolescence. Substantial literature suggests that supportive family contexts and parenting behaviors may discourage adolescents from engaging in early and risky sexual activities; yet methodological limitations hamper the conclusions regarding causality and directionality that can be drawn from much existing research. To address such limitations, the current study used a variety of increasingly conservative statistical modeling techniques to help control for unobserved heterogeneity and potential bias and hence to progress toward identifying causal relationships. Drawing from a nationally representative longitudinal survey of adolescents (NLSY97; N = 4980), this study used ordinary least squares (OLS) regression models, lagged regression models, and family fixed-effects models to assess whether parental knowledge, parent negativity, and family activities during mid-adolescence predicted differences in late adolescent sexual risk behaviors. Even after controlling for unobserved heterogeneity across individuals and across families, parenting processes significantly predicted later adolescent sexual risk behaviors. Specifically, more regular family activities and less negative and hostile parenting during mid-adolescence predicted lower sexual risk behaviors during late adolescence. Results concerning the buffering effects of parenting on adolescent risk behaviors help to inform prevention and intervention efforts. Through the use of more rigorous statistical methodology and large representative samples of youth, this research provides an exemplar of how survey research can seek to move closer to understanding causal processes in the exceedingly complex systems of human development. (author's) Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | SURVEYS | LONGITUDINAL STUDIES | THEORETICAL MODELS | ADOLESCENTS | SEX BEHAVIOR | RISK BEHAVIOR | PARENTS | PARENTAL INVOLVEMENT | Developed Countries | North America | Americas | Sampling Studies | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Behavior | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Child Rearing Document Number: 327770 |
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