Do digital innovations for HIV and sexually transmitted infections work? Results from a systematic review (1996-2017).

OBJECTIVE: Digital innovations with internet/mobile phones offer a potential cost-saving solution for overburdened health systems with high service delivery costs to improve efficiency of HIV/STI (sexually transmitted infections) control initiatives. However, their overall evidence has not yet been appraised. We evaluated the feasibility and impact of all digital innovations for all HIV/STIs. DESIGN: Systematic review. SETTING/PARTICIPANTS: All settings/all participants. INTERVENTION: We classified digital innovations into (1) mobile health-based (mHealth: SMS (short message service)/phone calls), (2) internet-based mobile and/or electronic health (mHealth/eHealth: social media, avatar-guided computer programs, websites, mobile applications, streamed soap opera videos) and (3) combined innovations (included both SMS/phone calls and internet-based mHealth/eHealth). PRIMARY AND SECONDARY OUTCOME MEASURES: Feasibility, acceptability, impact. METHODS: We searched databases MEDLINE via PubMed, Embase, Cochrane CENTRAL and Web of Science, abstracted data, explored heterogeneity, performed a random effects subgroup analysis. RESULTS: We reviewed 99 studies, 63 (64%) were from America/Europe, 36 (36%) from Africa/Asia; 79% (79/99) were clinical trials; 84% (83/99) evaluated impact. Of innovations, mHealth based: 70% (69/99); internet based: 21% (21/99); combined: 9% (9/99).All digital innovations were highly accepted (26/31; 84%), and feasible (20/31; 65%). Regarding impacted measures, mHealth-based innovations (SMS) significantly improved antiretroviral therapy (ART) adherence (pooled OR=2.15(95%CI: 1.18 to 3.91)) and clinic attendance rates (pooled OR=1.76(95%CI: 1.28, 2.42)); internet-based innovations improved clinic attendance (6/6), ART adherence (4/4), self-care (1/1), while reducing risk (5/5); combined innovations increased clinic attendance, ART adherence, partner notifications and self-care. Confounding (68%) and selection bias (66%) were observed in observational studies and attrition bias in 31% of clinical trials. CONCLUSION: Digital innovations were acceptable, feasible and generated impact. A trend towards the use of internet-based and combined (internet and mobile) innovations was noted. Large scale-up studies of high quality, with new integrated impact metrics, and cost-effectiveness are needed. Findings will appeal to all stakeholders in the HIV/STI global initiatives space

STRATEGIES FOR ADDRESSING VACCINE HESITANCY – A SYSTEMATIC REVIEW

The purpose of the systematic review of strategies for addressing vaccine hesitancy is to identify strategies that have been implemented and evaluated across diverse global contexts in an effort to respond to, and manage, issues of vaccine hesitancy. This is to fulfil the requirements of the SAGE working group (WG) dealing with vaccine hesitancy in respect to: a) identifying existing and new activities and strategies relating to vaccines or from other areas that could successfully address vaccine hesitancy; b) identifying strategies that do not work well, and; c) prioritising activities and strategies based on an assessment of their potential impact. These requirements were translated into the following specific objectives: 1. Identify published strategies related to vaccine hesitancy and hesitancy of other health technologies (reproductive health technologies (RHT) were chosen as the additional focus) and provide a descriptive analysis of the findings; 2. Map all evaluated strategies to the SAGE WG “Model of determinants of Vaccine Hesitancy” (Appendix 1) and identify key characteristics; 3. Evaluate relevant evaluated strategies relating to vaccine hesitancy using GRADE (Grades of Recommendation, Assessment, Development and Evaluation); relevance was informed by the PICO questions defined a priori by the WG, and; 4. Synthesise findings in a manner which aids the design of future interventions and further research

Systematic literature review to examine the evidence for the effectiveness of interventions that use theories and models of behaviour change: towards the prevention and control of communicable diseases

A systematic literature review assessed the effectiveness of interventions using theories and models of behaviour change to prevent or control communicable diseases relevant to Europe. The review was commissioned by the European Centre for Disease Prevention and Control (ECDC) and conducted by the Institute for Social Marketing of the University of Stirling and the Open University

2016 United Kingdom national guideline on the sexual health care of men who have sex with men.

This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022

Immunisation in refugee and migrant communities in Australia: barriers, facilitators and future directions

Immunisation programs available in low and middle-income countries include fewer vaccines in comparison to Australia’s National Immunisation Program. As a result, refugees and some migrants may have a heightened risk of being inadequately immunised upon arrival to Australia. Whilst there are studies exploring the barriers to healthcare access in refugee and migrant communities in Australia, not much is known regarding the social and behavioural drivers impacting vaccine coverage and the factors leading to under-immunisation in these communities. This thesis, therefore, aims to explore the barriers, facilitators, and future directions in the provision of immunisation services to refugee and migrant communities. A mixed methods approach was used which included five studies presented across five chapters. In the first study, in-depth, semi-structured interviews were conducted with newly arrived East-African refugees and migrants in Australia to explore the barriers to immunisation and the facilitators that could be implemented to improve overall vaccine uptake. The key barriers identified included language, low motivation/risk perception and limited education about vaccines. Next, the health literacy demand and cultural appropriateness of current immunisation resources aimed at refugee and migrant communities were evaluated. To assess the health literacy demand of the resources, the Patient Education Materials Assessment Tool (PEMAT) was utilised. Cultural appropriateness was assessed using additional criteria developed by the Centre for Culture, Ethnicity and Health (CEH), Victoria, Australia. This work identified that there were few resources aimed specifically at these communities and in the instance that it was, the resources were inappropriately pitched. To help support our understanding of the factors leading to disparities in vaccine uptake, a linked dataset was used to examine on-time vaccine coverage and vaccine disease burden in children born to migrant mothers. Factors associated with lower on-time coverage included low birthweight, previous pregnancies, prematurity, maternal smoking, and higher maternal age. The final piece of work involved using the World Health Organisation Tailoring Immunisation Programme (WHO TIP) approach to outline a series of strategies and interventions to help improve vaccine uptake in these populations. The findings of this thesis have important implications for vaccination policy and practice. There is a need for improved integration between key stakeholders in the immunisation sector to help improve vaccine uptake for these refugee and migrant communities. Engaging with members from migrant communities is recommended to better understand their health literacy needs so that appropriately tailored resources are co-developed. Increased guidance and dedicated training for GPs in the delivery of immunisation for refugees particularly catch-up, is also recommended

Sex, young people and chlamydia: reducing the impact

Genital chlamydia infection is a highly prevalent condition and disproportionately affects young people. Chlamydia screening is the major strategy for chlamydia control in developed countries. This research includes two separate, linked studies, aiming to reduce the impact of chlamydia in Australian young people by increasing chlamydia testing. The first study is a randomised controlled trial (RCT) and the second a qualitative study using in-depth interviews and discourse analysis. The RCT evaluated an email based intervention and found that those who engaged in email interaction were more likely to report chlamydia test uptake at six month follow up compared with those in the control group. Young people who completed the RCT were invited to participate in face-to-face in-depth interviews, which explored the young person’s experiences of the RCT and enquired about the meanings of STIs they held. Discourse analysis of interview transcripts suggested that young people strongly uphold a medical discourse about STIs and see themselves and others as being responsible if they are safe (ie use condoms or get tested). As digital technologies continue to rapidly evolve, understanding the ways in which young people engage with them in relation to sexual health care will be important

Sex, young people and chlamydia: reducing the impact

Genital chlamydia infection is a highly prevalent condition and disproportionately affects young people. Chlamydia screening is the major strategy for chlamydia control in developed countries. This research includes two separate, linked studies, aiming to reduce the impact of chlamydia in Australian young people by increasing chlamydia testing. The first study is a randomised controlled trial (RCT) and the second a qualitative study using in-depth interviews and discourse analysis. The RCT evaluated an email based intervention and found that those who engaged in email interaction were more likely to report chlamydia test uptake at six month follow up compared with those in the control group. Young people who completed the RCT were invited to participate in face-to-face in-depth interviews, which explored the young person’s experiences of the RCT and enquired about the meanings of STIs they held. Discourse analysis of interview transcripts suggested that young people strongly uphold a medical discourse about STIs and see themselves and others as being responsible if they are safe (ie use condoms or get tested). As digital technologies continue to rapidly evolve, understanding the ways in which young people engage with them in relation to sexual health care will be important

The effectiveness of SMS Reminders and the impact of patient characteristics on missed appointments in a public dental outpatient clinic

This paper reports on the Failure To Attend (FTA) rate of appointments as well as patients following the implementation of SMS reminders in a public dental outpatient service. Given the ineffectiveness of the intervention and a highly representative patient’s profile, this paper identifies the demographic characteristics of patients who miss all of their appointments. Data on appointment attendance, patient demographics and dental service type was collected over a time period of 46 consecutive months. Using descriptive and inferential statistics (chi-square, two sample tests and Marascuilo procedure) we found the SMS intervention was ineffective in reducing the FTA rates. Further, patients associated with high rates of non-attendance exhibited one or more of the following characteristics: male; age 26 – 44; non-concession card holders; a person of Indigenous, local, Asian or African descent, and of refugee status, persons living in low socio-economic areas; and appointments in General Care and Student Clinics. Whilst the literature overwhelmingly attributes SMS reminders to improving the attendance rate of patients in outpatient clinics, our contradictory findings suggest a more targeted approach in settings whose patients exhibit strong characteristics associated with non-attendance

The readiness, need for, and effect of mhealth interventions to improve immunization timeliness and coverage in rural western Kenya

Background: As mobile phone ownership levels grow globally, opportunities to target hard-to-reach populations through mobile-health technologies become more realistic. In a rural Kenyan population, this dissertation seeks to assess the magnitude and risk factors of immunization timeliness and coverage, to determine the readiness of a community for mHealth interventions by assessing prevalence and risk factors for mobile phone ownership and SMS utilization, and to assess the effect of the Mobile Solutions for Immunization (M-SIMU) cluster randomized controlled trial. Methods: A cross-sectional survey of Kenyan caregivers was conducted to collect baseline immunization and mobile phone ownership estimates for M-SIMU. Predictors of mobile phone ownership were obtained through multivariable logistic regression. Risk factors for delayed immunizations and not receiving immunization were calculated using binomial regression with log link. The M-SIMU trial randomized villages to four arms: Control, short message system (SMS) reminders only, SMS reminders + 75 Kenyan Schillings (KSH) incentive or, SMS reminders + 200 KSH incentive. Inverse Kaplan-Meier curves and Cox regressions assessed the intervention’s effect on pentavalent3 and measles vaccination. Results: Older maternal age, higher maternal literacy and education, smaller households, and higher socioeconomic status were associated with phone ownership. Immunization coverage for the third dose of pentavalent vaccine (pentavalent3), measles, and fully immunized children (FIC) were 95%, 83%, and 80%, respectively. Delayed pentavalent1 was associated with not receiving pentavalent3 (RR: 5.61; 95%CI: 3.77-8.33), measles vaccine (RR: 1.51; 95%CI: 1.15-1.99), and FIC (RR: 1.87; 95%CI: 1.51-2.32). The prevalence of delayed pentavalent1, pentavalent3, and measles were 11%, 24%, and 29%, respectively. No common risk factors in the delay models were found. For M-SIMU, Kaplan-Meier curves found significant differences across arms in time to pentavalent3 (p<0.01) but not measles vaccination (p=0.10). SMS + 200 KSH infants were associated with pentavalent3 vaccination (HR: 3.33; 95%CI: 1.71-6.47) and approached significance for measles (HR: 2.05; 95%CI: 0.95-4.41; p=0.07), as compared to controls. The SMS only and SMS plus 75KSH were not significantly associated with either vaccine. Conclusions: In a population with moderate phone ownership, high immunization coverage, and moderate vaccine delays, SMS reminders plus 200KSH improved pentavalent3 vaccination