Incremental role of male circumcision on a generalised HIV epidemic through its protective effect against other sexually transmitted infections: from efficacy to effectiveness to population-level impact.

The protection of MC against STI contributes little to the overall effect of MC on HIV. Additional work is needed to determine whether, and under what conditions, the protective effect of MC efficacy against STIs can have a significant incremental benefit on the HIV epidemic

Modèle multi-agents pour la simulation de la dynamique de carbone à l'échelle du terroir villageois

Un système multi-agents (SMA) a été conçu et mis en oeuvre en vue d'étudier la dynamique des ressources organiques et azotée d'un terroir africain. Les simulations réalisées ont permis de mesurer l'impact des modes de gestion sur les ressources dans le long terme. Trois types d'enquêtes ont été nécessaires pour collecter les données nécessaires. Un premier modèle à l'échelle de la parcelle a permis de simuler le stockage du carbone et de l'azote dans les sols et dans la biomasse végétale. Ensuite la définition des règles individuelles et collectives de décision et de gestion des exploitations agricoles et du terroir ont nécessité des enquêtes approfondies avec les principaux groupes utilisant le terroir. . Pour la conception informatique du modèle, le formalisme UML a été utilisé. La représentation statique et dynamique du modèle a été formalisée sur la plate forme de modélisation CORMAS. . La méthode développée est appelée MIROT Modélisation Intégrée de la dynamique des Ressources Organiques et analyse de viabilité de Terroirs agro-sylvo-pastoraux des savanes ouest africaines). Le modèle MIROT utilise un fond de carte du terroir avec des contraintes spatiales pour simuler le fonctionnement de celui-ci

HIV Treatment as Prevention: Considerations in the Design, Conduct, and Analysis of Cluster Randomized Controlled Trials of Combination HIV Prevention

The rigorous evaluation of the impact of combination HIV prevention packages at the population level will be critical for the future of HIV prevention. In this review, we discuss important considerations for the design and interpretation of cluster randomized controlled trials (C-RCTs) of combination prevention interventions. We focus on three large C-RCTs that will start soon and are designed to test the hypothesis that combination prevention packages, including expanded access to antiretroviral therapy, can substantially reduce HIV incidence. Using a general framework to integrate mathematical modelling analysis into the design, conduct, and analysis of C-RCTs will complement traditional statistical analyses and strengthen the evaluation of the interventions. Importantly, even with combination interventions, it may be challenging to substantially reduce HIV incidence over the 2- to 3-y duration of a C-RCT, unless interventions are scaled up rapidly and key populations are reached. Thus, we propose the innovative use of mathematical modelling to conduct interim analyses, when interim HIV incidence data are not available, to allow the ongoing trials to be modified or adapted to reduce the likelihood of inconclusive outcomes. The preplanned, interactive use of mathematical models during C-RCTs will also provide a valuable opportunity to validate and refine model projections

Parent-Child Interaction Therapy for Children With Disruptive Behaviors and Autism: A Randomized Clinical Trial

A relatively large number of children with autism spectrum disorder (ASD) exhibit disruptive behavioral problems. While accumulating data have shown behavioral parent training programs to be efficacious in reducing disruptive behaviors for this population, there is a dearth of literature examining the impact of such programs across the range of ASD severity. To evaluate the effectiveness of Parent–Child Interaction Therapy (PCIT), an evidence-based treatment for children with problem behaviors and their families, in reducing disruptive behaviors among children (4–10 years) with ASD (without intellectual disabilities). Fifty-five children (85.5% male, 7.15 years; SD 1.72) were enrolled from pediatric offices and educational settings into a randomized clinical trial (PCIT: N = 30; Control: N = 25). PCIT families demonstrated a significant reduction in child disruptive behaviors, increase in positive parent–child communication, improvement in child compliance, and reduction in parental stress compared to the control group. Exploratory analyses revealed no differential treatment response based on ASD severity, receptive language, and age. Results are promising for the use of PCIT with children demonstrating disruptive behaviors across the autism spectrum