42 research outputs found

    Effectiveness and safety of oral HIV preexposure prophylaxis for all populations.

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    ObjectivePreexposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. This systematic review and meta-analysis evaluated the evidence for use of oral PrEP containing tenofovir disoproxil fumarate as an additional HIV prevention strategy in populations at substantial risk for HIV based on HIV acquisition, adverse events, drug resistance, sexual behavior, and reproductive health outcomes.DesignRigorous systematic review and meta-analysis.MethodsA comprehensive search strategy reviewed three electronic databases and conference abstracts through April 2015. Pooled effect estimates were calculated using random-effects meta-analysis.ResultsEighteen studies were included, comprising data from 39 articles and six conference abstracts. Across populations and PrEP regimens, PrEP significantly reduced the risk of HIV acquisition compared with placebo. Trials with PrEP use more than 70% demonstrated the highest PrEP effectiveness (risk ratio = 0.30, 95% confidence interval: 0.21-0.45, P < 0.001) compared with placebo. Trials with low PrEP use did not show a significantly protective effect. Adverse events were similar between PrEP and placebo groups. More cases of drug-resistant HIV infection were found among PrEP users who initiated PrEP while acutely HIV-infected, but incidence of acquiring drug-resistant HIV during PrEP use was low. Studies consistently found no association between PrEP use and changes in sexual risk behavior. PrEP was not associated with increased pregnancy-related adverse events or hormonal contraception effectiveness.ConclusionPrEP is protective against HIV infection across populations, presents few significant safety risks, and there is no evidence of behavioral risk compensation. The effective and cost-effective use of PrEP will require development of best practices for fostering uptake and adherence among people at substantial HIV risk

    Addressing marine and coastal governance conflicts at the interface of multiple sectors and jurisdictions

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    Marine and coastal activities are closely interrelated, and conflicts among different sectors can undermine management and conservation objectives. Governance systems for fisheries, power generation, irrigation, aquaculture, marine biodiversity conservation, and other coastal and maritime activities are typically organized to manage conflicts within sectors, rather than across them. Based on the discussions around eight case studies presented at a workshop held in Brest in June 2019, this paper explores institutional approaches to move beyond managing conflicts within a sector. We primarily focus on cases where the groups and sectors involved are heterogeneous in terms of: the jurisdiction they fall under; their objectives; and the way they value ecosystem services. The paper first presents a synthesis of frameworks for understanding and managing cross-sectoral governance conflicts, drawing from social and natural sciences. We highlight commonalities but also conceptual differences across disciplines to address these issues. We then propose a novel analytical framework which we used to evaluate the eight case studies. Based on the main lessons learned from case studies, we then discuss the feasibility and key determinants of stakeholder collaboration as well as compensation and incentive schemes. The discussion concludes with future research needs to support policy development and inform integrated institutional regimes that consider the diversity of stakeholder interests and the potential benefits of cross-sectoral coordination

    Economic analysis for marine protected resources management: Challenges, tools, and opportunities

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    Economic analysis is well suited to inform protected resources management in marine and coastal environments. The purpose of this review is to provide a connection between the challenges facing managers of marine protected resources and specific forms of economic analysis that can help address them. We identify and illustrate several common protected resources management challenges including scarcity in conservation resources, scientific uncertainty, and designing policies to promote species conservation and recovery. We then survey relevant economic tools and identify opportunities for informing marine protected resources management. We conclude by discussing important considerations for applying economic analysis to inform marine protected resources management

    Accounting for spatio-temporal variation and fisher targeting when estimating abundance from multispecies fishery data

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    Estimating trends in abundance from fishery catch rates is one of the oldest endeavors in fisheries science. However, many jurisdictions do not analyze fishery catch rates due to concerns that these data confound changes in fishing behavior (adjustments in fishing location or gear operation) with trends in abundance. In response, we develop a spatial dynamic factor analysis (SDFA) model that decomposes covariation in multispecies catch rates into components representing spatial variation and fishing behavior. SDFA estimates spatiotemporal variation in fish density for multiple species, and accounts for fisher behavior at large spatial scales (i.e., choice of fishing location) while controlling for fisher behavior at fine spatial scales (e.g., daily timing of fishing activity). We first use a multispecies simulation experiment to show that SDFA decreases bias in abundance indices relative to ignoring spatial adjustments and fishing tactics. We then present results for a case study involving Petrale sole in the California current, for which SDFA estimates initially stable and then increasing abundance for the period 1986-2003, in accordance with fishery-independent survey and stock assessment estimates.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author
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