HIV treatment as prevention : models, data, and questions-towards evidence-based decision-making

Antiretroviral therapy (ART) for those infected with HIV can prevent onward transmission of infection, but biological efficacy alone is not enough to guide policy decisions about the role of ART in reducing HIV incidence. Epidemiology, economics, demography, statistics, biology, and mathematical modelling will be central in framing key decisions in the optimal use of ART. PLoS Medicine, with the HIV Modelling Consortium, has commissioned a set of articles that examine different aspects of HIV treatment as prevention with a forward-looking research agenda. Interlocking themes across these articles are discussed in this introduction. We hope that this article, and others in the collection, will provide a foundation upon which greater collaborations between disciplines will be formed, and will afford deeper insights into the key factors involved, to help strengthen the support for evidence-based decision-making in HIV prevention

User involvement and desired service developments in drug treatment: Service user and provider views

Aims - To investigate the existing level of user involvement at selected agencies, to examine views about user involvement from both service-user and provider perspectives and to compare desired service developments. Design/Measurements - As part of a larger project, a series of semi-structured interviews was carried out between 2001 and 2003. Setting - Community-based drug services in Northern England. Participants - Service users (46) and service providers (51). Findings - Overall, the level of service-user involvement was low, with 16% of services having no user involvement at all. Nevertheless, service users expressed a desire for a high level of user involvement, compared with the low aspirations expressed by service providers. Service users' first priority for desired service developments was reduced waiting times, whereas service providers wished for increased provision of complementary therapies. Conclusions - The study highlighted important discrepancies regarding both desired level of user involvement and priorities for service developments between service users und providers. Given the current policies in this field and evidence that user involvement and closer partnerships between users and providers enhances treatment effectiveness, this lack of concurrence might be of major concern and working towards better understanding and balancing users' and providers' needs is highly recommended

Efficacy and safety of LDL‐lowering therapy among men and women: meta‐analysis of individual data from 174,000 participants in 27 randomised trials

Background There has been debate about whether statin therapy is as effective in women as men, especially for primary prevention. Methods Meta‐analyses were performed on data from 22 trials of statin therapy vs. control (n=134 537) and five trials of more intensive vs. less intensive statin therapy (n=39 612). Effects on major vascular events, major coronary events, stroke, coronary revascularisation and mortality were weighted per 1∙0 mmol/L reduction in LDL cholesterol and effects in men and women compared using a Cox model that adjusted for non‐gender differences. For subgroup analyses, 99% confidence intervals were used to make allowance for the multiplicity of comparisons. Findings Overall, 46675 (27%) of 174,149 randomised participants were women. Allocation to a statin had similar absolute effects on 1‐year lipid concentrations in both men and women (LDL cholesterol reduced by ~1∙1mmol/L in statin vs. control trials and ~0∙5mmol/L in more vs. less trials). The proportional reductions per 1∙0 mmol/L reduction in LDL cholesterol in major vascular events were similar in women (RR 0∙84, 99% CI 0∙78‐0∙91) and men (RR 0∙78, 99% CI 0∙75‐0∙81), both overall (adjusted p value for heterogeneity by gender=0∙33) and among those at <10% predicted 5‐year risk (adjusted heterogeneity p=0∙11). Likewise, the proportional reductions in major coronary events, coronary revascularisation and stroke did not differ by gender. Since there were similar proportional reductions in vascular mortality in women (RR 0∙92, 99% CI 0∙82‐1∙03) and men (RR 0∙87, 99% CI 0∙82‐0∙92) (adjusted heterogeneity p=0∙84), but no apparent effect on non‐vascular deaths in either sex, all‐cause mortality was reduced in both women (RR 0∙91, 99% CI 0∙84‐0∙99) and men (RR 0∙90, 99% CI 0∙86‐0∙95). Interpretation Other things being equal, statin therapy is of comparable effectiveness for the prevention of major vascular events in women as in men, even among those at low risk of vascular disease

Fargo Water Treatment Plant Records, 1911-1993

Records detailing the daily operation of one of the nation's earliest water treatment plants

Efficacy and safety of LDL‐lowering therapy among men and women: meta‐analysis of individual data from 174,000 participants in 27 randomised trials

Background There has been debate about whether statin therapy is as effective in women as men, especially for primary prevention. Methods Meta‐analyses were performed on data from 22 trials of statin therapy vs. control (n=134 537) and five trials of more intensive vs. less intensive statin therapy (n=39 612). Effects on major vascular events, major coronary events, stroke, coronary revascularisation and mortality were weighted per 1∙0 mmol/L reduction in LDL cholesterol and effects in men and women compared using a Cox model that adjusted for non‐gender differences. For subgroup analyses, 99% confidence intervals were used to make allowance for the multiplicity of comparisons. Findings Overall, 46675 (27%) of 174,149 randomised participants were women. Allocation to a statin had similar absolute effects on 1‐year lipid concentrations in both men and women (LDL cholesterol reduced by ~1∙1mmol/L in statin vs. control trials and ~0∙5mmol/L in more vs. less trials). The proportional reductions per 1∙0 mmol/L reduction in LDL cholesterol in major vascular events were similar in women (RR 0∙84, 99% CI 0∙78‐0∙91) and men (RR 0∙78, 99% CI 0∙75‐0∙81), both overall (adjusted p value for heterogeneity by gender=0∙33) and among those at <10% predicted 5‐year risk (adjusted heterogeneity p=0∙11). Likewise, the proportional reductions in major coronary events, coronary revascularisation and stroke did not differ by gender. Since there were similar proportional reductions in vascular mortality in women (RR 0∙92, 99% CI 0∙82‐1∙03) and men (RR 0∙87, 99% CI 0∙82‐0∙92) (adjusted heterogeneity p=0∙84), but no apparent effect on non‐vascular deaths in either sex, all‐cause mortality was reduced in both women (RR 0∙91, 99% CI 0∙84‐0∙99) and men (RR 0∙90, 99% CI 0∙86‐0∙95). Interpretation Other things being equal, statin therapy is of comparable effectiveness for the prevention of major vascular events in women as in men, even among those at low risk of vascular disease

Progressive stage transition does mean getting better: a further test of the Transtheoretical Model in recovery from alcohol problems

Aims To test two central assumptions of the Transtheoretical Model (TTM) regarding recovery from alcohol problems: (i) individuals making a forward transition from pre-action to action stages will show greater drinking improvements than those remaining in pre-action stages; and (ii) individuals remaining in pre-action stages will not demonstrate improvements in drinking outcomes. Design and setting Large, multi-centre, randomized controlled trial of treatment for alcohol problems [United Kingdom Alcohol Treatment Trial (UKATT)]. Measurements Stage of change, drinks per drinking day and percentage days abstinent at baseline, 3- and 12-month follow-ups. Findings In support of TTM assumption 1, improvements in drinking outcomes were consistently greater among clients who showed a forward stage transition (Cohen's d = 0.68) than among those who did not (d = 0.10). Two tests of assumption 2 showed a significant improvement in drinking outcomes in non-transition groups, inconsistent with the TTM; one test showed a significant deterioration and the other showed equivalent drinking outcomes across time. An explanation is offered as to why, under the relevant assumption of the TTM, clients in non-transition groups showed small changes in drinking outcomes. Conclusions In contrast to a previous study by Callaghan and colleagues, our findings largely support the TTM account of recovery from alcohol problems in treatment. The discrepancy can be explained by the use in our study of a more reliable and valid method for assigning stage of change

Female-initiated prevention: Integrating female condoms into HIV risk-reduction activities in Kenya

The Female Condom (FC) is the only female-initiated prevention product on the market today that provides simultaneous protection against STIs, including HIV, and unintended pregnancy. However, the FC remains limited in supply, not widely available, and underutilized in many settings. Improvements in FC programming are essential to achieve increased uptake and public health impact, and to pave the way for future women’s HIV prevention products. The Population Council’s Female-Initiated Prevention Methods project aimed to stimulate action and generate evidence around FC access through innovative program experimentation. The study was conducted to understand the challenges and opportunities these different access models present: FP/RH clinics, VCT centers, and private sector workplaces. This study suggests that consistent and free or low-cost supply of FC in a variety of settings is feasible and acceptable. Across the three service environments, FC appears to be an acceptable method; almost all participants were willing to recommend FC to others, and agreed that FC should be made widely available in Kenya. Almost all were willing to pay for FC, though at amounts lower than market prices

Montgomery County Poisoning Death Review - 2012

In 2012, 162 unintentional drug overdose deaths, the highest number on record, occurred in Montgomery County, Ohio. This finding comes from the Poisoning Death Review (PDR), a process involving the compilation and interpretation of multiple data sets from the Montgomery County Coroner’s Office. The PDR is carried out by faculty and staff at the Wright State University Boonshoft School of Medicine in collaboration with the Montgomery County Coroner’s Office. The designation of deaths being either unintentional (accident) or intentional (suicide) is made by the Montgomery County Coroner. This is the third year the PDR has been conducted. In 2011, 130 unintentional drug overdose deaths occurred in Montgomery County; 127 in 2010

Prescription Drug Abuse and Diversion: Results of a Survey of Physicians & Dentists

To identify the training needs of prescribers for prevention and intervention efforts to address the problem of Unintentional Prescription Drug Poisoning, a web-based survey was created and administered in September, 2010. The survey was publicized to the Dayton area health care providers (largely physicians and dentists) via postcards, Medical and Dental Societies, and list-serves. The survey contained 17 questions and took about 5 minutes to complete. A total of 130 people completed the on-line survey. As seen from the Figure 1, the majority of respondents were physicians, and about 70% were male. More than 80% reported prescribing opioids at their practice. About 10% did not prescribe any controlled substances, and they were excluded from responding to some of the questions, as indicated below