Sexual behaviour change following HIV testing services: a systematic review and meta-analysis.

INTRODUCTION: Learning one's HIV status through HIV testing services (HTS) is an essential step toward accessing treatment and linking to preventive services for those at high HIV risk. HTS may impact subsequent sexual behaviour, but the degree to which this varies by population or is true in the setting of contemporary HIV prevention activities is largely unknown. As part of the 2019 World Health Organization Consolidated Guidelines on HTS, we undertook a systematic review and meta-analysis to determine the effect of HTS on sexual behaviour. METHODS: We searched nine electronic databases for studies published between July 2010 and December 2019. We included studies that reported on at least one outcome (condom use [defined as the frequency of condom use or condom-protected sex], number of sex partners, HIV incidence, STI incidence/prevalence). We included studies that prospectively assessed outcomes and that fit into one of three categories: (1) those evaluating more versus less-intensive HTS, (2) those of populations receiving HTS versus not and (3) those evaluating outcomes after versus before HTS. We conducted meta-analyses using random-effects models. RESULTS AND DISCUSSION: Of 29 980 studies screened, 76 studies were included. Thirty-eight studies were randomized controlled trials, 36 were cohort studies, one was quasi-experimental and one was a serial cross-sectional study. There was no significant difference in condom use among individuals receiving more-intensive HTS compared to less-intensive HTS (relative risk [RR]=1.03; 95% CI: 0.99 to 1.07). Condom use was significantly higher after receiving HTS compared to before HTS for individuals newly diagnosed with HIV (RR = 1.65; 95% CI: 1.36 to 1.99) and marginally significantly higher for individuals receiving an HIV-negative diagnosis (RR = 1.63; 95% CI: 1.01 to 2.62). Individuals receiving more-intensive HTS reported fewer sex partners at follow-up than those receiving less-intensive HTS, but the finding was not statistically significant (mean difference = -0.28; 95% CI: -3.66, 3.10). CONCLUSIONS: Our findings highlight the importance of using limited resources towards HTS strategies that focus on early HIV diagnosis, treatment and prevention services rather than resources dedicated to supplementing or enhancing HTS with additional counselling or other interventions

Evaluating the Association between HBV Vaccination Coverage and the Incidence of Liver Cancer at a Global Level

Thesis (Master's)--University of Washington, 2015Background: Liver cancer today is the second most common cause of cancer-related death and ranks sixth most incident cancer worldwide. The most prevalent histopathological type of liver cancer is hepatocellular carcinoma (HCC). The most common cause for HCC is HBV, and it contributes to 50%-80% of HCC around the world. HepB vaccine was introduced in 1982 and incorporated to the Expanded Programme of Immunization (EPI) in 1992. The vaccine has proven to be associated with a reduced liver cancer incidence in studies from Taiwan, The Gambia and China. We aim to study the same association at a global level Methods: We collected data on HepB vaccine coverage for children less than 1-year old for 195 countries from the WHO, reported in percentages for every year starting from 1989 to 2013. We also collected data on liver cancer incidence rates for 5-year age groups (starting from 5-9) for 188 countries from the Institute of Health Metrics and Evaluation (IHME) reported in number of cases per 100,000 population for every year from 1980 to 2013. We created overlapping, consequent 5-year HepB vaccine coverage rates from the WHO data, calculated the median for each and matched with the respective cohort in the IHME data. For the statistical analysis, we chose the generalized linear latent and mixed model (GLLAMM). We used Microsoft Excel, R and Stata for our data management and analysis. Results: Overall, we had 2,129 birth cohorts form 153 countries. All observations were in 5-year age groups (5-9, 10-14, 15-19 and 20-24). Among 5-24 years, higher 5-year median vaccination coverage rates by 10% were associated with a relative risk that is lower by a factor of 0.948 cancer incidence after adjusting for age group and year of observation (95% CI: 0.916, 0.982). Conclusion and recommendation: Higher HepB vaccine coverage rates were associated with lower liver cancer incidence rates. We recommend that future studies evaluate this association at older age groups in order to demonstrate a larger effect size

Fungal infections in Sudan:An underestimated health problem

Fungal diseases are associated with high morbidity and mortality, yet their epidemiology and burden are not well addressed. While deaths probably exceed 1.5 million per year, many cases remain undiagnosed and underreported. Estimating the burden of these diseases is needed for prioritization and implementation of effective control programs. Here we used a model based on population at risk to estimate the burden of serious fungal infections in Sudan. The prevalence of the susceptible population including HIV, TB, cancer, asthma, and COPD was obtained from the literature. Incidence and prevalence of fungal infections were calculated using local data when applicable and if not available then regional or international figures were used. In total, the estimated number of Sudanese suffering from fungal disease is 5 M (10% of the total population). Tinea capitis, recurrent vulvovaginitis and keratitis are estimated to affect 4,127,760, 631,261, and 6,552 patients, respectively. HIV-related mycosis is estimated to affect 5,945 oral candidiasis, 1,921 esophageal candidiasis, 571 Pneumocystis pneumonia, and 462 cryptococcal meningitis cases. Aspergillus infections are estimated as follow: 3,438 invasive aspergillosis, 14,950 chronic pulmonary aspergillosis, 67,860 allergic bronchopulmonary aspergillosis cases, while the prevalence of severe asthma with fungal sensitization and fungal rhinosinusitis was 86,860 and 93,600 cases, respectively. The neglected tropical disease eumycetoma was estimated to affect 16,837 cases with a rate of 36/100,000. Serious fungal infections are quite common in Sudan and require urgent attention to improve diagnosis, promote treatment, and develop surveillance programs.</p