Cost-effectiveness of voluntary HIV-1 counseling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania.

Background Access to HIV-1 voluntary counseling and testing (VCT) is severely limited in less-developed countries. We undertook a multisite trial of HIV-1 VCT to assess its impact, cost, and cost-effectiveness in less-developed country settings.\ud Methods\ud The cost-effectiveness of HIV-1 VCT was estimated for a hypothetical cohort of 10 000 people seeking VCT in urban east Africa. Outcomes were modelled based on results from a randomised controlled trial of HIV-1 VCT in Tanzania and Kenya. Our main outcome measures included programme cost, number of HIV-1 infections averted, cost per HIV-1 infection averted, and cost per disability-adjusted life-year (DALY) saved. We also modelled the impact of targeting VCT by HIV-1 prevalence of the client population, and the proportion of clients who receive VCT as a couple compared with as individuals. Sensitivity analysis was done on all model parameters.\ud Findings\ud HIV-1 VCT was estimated to avert 1104 HIV-1 infections in Kenya and 895 in Tanzania during the subsequent year. The cost per HIV-1 infection averted was US$249 and$346, respectively, and the cost per DALY saved was $12·77 and$17·78. The intervention was most cost-effective for HIV-1-infected people and those who received VCT as a couple. The cost-effectiveness of VCT was robust, with a range for the average cost per DALY saved of $5·16-27·36 in Kenya, and$6·58-45·03 in Tanzania. Analysis of targeting showed that increasing the proportion of couples to 70% reduces the cost per DALY saved to $10·71 in Kenya and$13·39 in Tanzania, and that targeting a population with HIV-1 prevalence of 45% decreased the cost per DALY saved to $8·36 in Kenya and$11·74 in Tanzania.\ud Interpretation\ud HIV-1 VCT is highly cost-effective in urban east African settings, but slightly less so than interventions such as improvement of sexually transmitted disease services and universal provision of nevirapine to pregnant women in high-prevalence settings. With the targeting of VCT to populations with high HIV-1 prevalence and couples the cost-effectiveness of VCT is improved significantly

Portland Society of Art Annual Spring Exhibition, April 15 to May 15, 1927

A list of works and artists featured in an exhibit at the Portland Society of Art, Spring and High Streets, Portland, Maine, in 1927

How Does High Impact Practice Predict Student Engagement? A Comparison of White and Minority Students

This High Impact Practices (HIPS) contribute to higherretention and graduation rates. HIPS are effective for racial and ethnic minorities in particular, who disproportionately experience high and persistent levels of post-secondary attrition. Little is known aboutthe mechanism by which HIPS promote retention. Based on a random survey of 268 undergraduate students, we conclude that HIPS correlate with engagement, defined as the alignment of student and institution (identifiedin the present study by behavioral and cognitive measures) and posit that this is the likely mechanism by which HIPS affect retention. Moreover, exposure to HIPS and the relationship between HIPS and engagement varies based on race/ethnicity. HIPS that have an effect on engagement across racial categories are service learning, undergraduate research, group assignments, learning communities, sequence courses, and, especially, having a close faculty mentor. In addition to these factors, diversity-related course content is especially effective for racial/ethnic minority engagement. Implications for educators and policy-makers are elucidated

Low energy dense diet and high-intensity exercise : impact on weight and waist circumference in abdominally obese women

Aging, obesity and increased waist circumference (WC) increases risk for metabolic syndrome (MetS). MetS is a cluster of symptoms (elevated WC, triglycerides, blood pressure, fasting glucose, and decreased high-density lipoprotein cholesterol [HDL-C]) increasing risk for chronic disease. Low-energy dense (LED) diets, emphasizing whole food eating patterns, have not been examined in combination with moderate (mod)/high-intensity physical activity (PA) or dietary protein levels to determine their impact on changes in body weight (BW) and WC in premenopausal, abdominally obese women. PURPOSE: To determine the effect of two 16-wk diet and PA interventions, differing in protein intake, on BW, WC, MetS risk factors, dietary patterns, energy density (ED), and min of Mod-Hi PA. METHODS: Healthy, abdominally obese (WC≥80cm) women (n=38; 34±10y) were randomly assigned to either a 15 or 25% (+18 g/d whey protein) en from protein diet. Individualized LED diets plans decreased energy intake (EI) by ~300kcal/d; PA 5 d/wk (30-60 min/d) consisted of supervised, high-intensity Zumba classes 3d/wk (≥65%HRmax; ≥6METs) and self-selected mod-intensity PA (≥3METs) 2d/wk. Servings of fruits/vegetables, whole grains, and low-fat/fat-free dairy (LFD), fiber, high calorie beverages (BEV), ED, and PA were monitored before (T1), during (T2) and after (T3) the intervention using repeated measures ANOVA. Bonferroni simultaneous testing procedure was used in analysis of multiple comparisons. RESULTS: At T1, groups did not differ in dietary patterns, PA, BW, WC, or MetS risk. Groups responded similarly to the interventions so data were combined, with BW and WC decreasing (p<0.0001) by -4.8±2.7kg and -7.1±3.6cm, respectively. Comparing T1 vs. T2, there were increases (p<0.0001) in fruits/vegetables, (Δ=+1.5 ser/d), whole grains (Δ=+1.0 ser/d), LFD (Δ=+0.5 ser/d), fiber (Δ=+5.7g/1000 kcal), and decreases in BEV (Δ=-165 kcal/d) and ED (Δ=-0.55 kcal/g). During the intervention high-intensity Zumba PA was 87min/wk; total min of all mod-intensity PA increased by 75 min/d (p<0.0001); VO2max improved from 29.3±4.7 (T1) to 34.4±5.3 (T3) mL/kg/min (p<0.0001). Triglycerides significantly decreased (-24±52 mg/dl; p=0.006), no other significant changes occurred in MetS risk factors. Exploratory analysis indicated that increases in fruits/vegetables and LFD, and decreases ED were associated with BW loss, while increases in whole grains, fiber, LFD, and min/wk of high-intensity PA (Zumba) were associated with WC reductions. CONCLUSION: For abdominally obese women, an intervention focused on LED foods and high-intensity PA significantly reduced BW and WC and improved dietary patterns regardless of protein intake. Helping clients identify a few key factors that positively promote reductions in BW and WC may improve weight loss success, while reducing MetS risk factors

Age-related differences in socio-demographic and behavioral determinants of HIV testing and counseling in HPTN 043/NIMH Project Accept

Youth represent a large proportion of new HIV infections worldwide, yet their utilization of HIV testing and counseling (HTC) remains low. Using the post-intervention, cross-sectional, population-based household survey done in 2011 as part of HPTN 043/NIMH Project Accept, a cluster-randomized trial of community mobilization and mobile HTC in South Africa (Soweto and KwaZulu Natal), Zimbabwe, Tanzania and Thailand, we evaluated age-related differences among socio-demographic and behavioral determinants of HTC in study participants by study arm, site, and gender. A multivariate logistic regression model was developed using complete individual data from 13,755 participants with recent HIV testing (prior 12 months) as the outcome. Youth (18–24 years) was not predictive of recent HTC, except for high-risk youth with multiple concurrent partners, who were less likely (aOR 0.75; 95% CI 0.61–0.92) to have recently been tested than youth reporting a single partner. Importantly, the intervention was successful in reaching men with site specific success ranging from aOR 1.27 (95% CI 1.05–1.53) in South Africa to aOR 2.30 in Thailand (95% CI 1.85–2.84). Finally, across a diverse range of settings, higher education (aOR 1.67; 95% CI 1.42, 1.96), higher socio-economic status (aOR 1.21; 95% CI 1.08–1.36), and marriage (aOR 1.55; 95% CI 1.37–1.75) were all predictive of recent HTC, which did not significantly vary across study arm, site, gender or age category (18–24 vs. 25–32 years)

Economics methods in Cochrane systematic reviews of health promotion and public health related interventions.

Peer reviewedPublisher PD

Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here