Family Planning Counseling for Women Living with HIV in Low- and Middle-Income Countries: A Systematic Review of the Impact on Contraceptive Uptake, Intention to Use Contraception and Pregnancy Incidence, 2011 to 2022.

Women's ability to control their fertility and have the number of children they want when they want them is an internationally recognized human right. This right has been the driving force behind family planning programs in low- and middle-income countries for more than five decades. The HIV epidemic added greater urgency to those efforts once the risk of vertical transmission of the virus from mothers to their infants was recognized.

The Evidence Project: Protocol for Systematic Reviews of Behavioral Interventions and Behavioral Aspects of Biomedical Interventions for HIV Prevention, Treatment, and Health Service Delivery in Low- and Middle-Income Countries.

The Evidence Project conducts systematic reviews and meta-analyses of HIV behavioral interventions, behavioral aspects of biomedical interventions, combination prevention strategies, modes of service delivery, and integrated programs in low- and middle-income countries. Here, we present the overall protocol for our reviews. For each topic, we conduct a comprehensive search of five online databases, complemented by secondary reference searching.

The Impact of Needle and Syringe Exchange Programs on HIV-Related Risk Behaviors in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis Examining Individual- Versus Community-Level Effects.

We conducted a systematic review and meta-analysis of the impact of needle and syringe exchange programs (NSP) on both individual- and community-level needle-sharing behaviors and other HIV-related outcomes in low- and middle-income countries (LMIC). A search of five databases for peer-reviewed trial or quasi-experimental studies reported through July 2021 identified 42 interventions delivered in 35 studies, with a total of 56,751 participants meeting inclusion criteria. Random-effects meta-analysis showed a significant protective association between NSP exposure and needle-sharing behaviors at the individual-level (odds ratio [OR] = 0.

HIV-Related Intersectional Stigma and Discrimination Measurement: State of the Science.

Across settings, individuals from populations that are multiply stigmatized are at increased risk of HIV and experience worse HIV treatment outcomes. As evidence expands on how intersecting stigmatized identities and conditions influence HIV outcomes, researchers have used diverse quantitative approaches to measure HIV-related intersectional stigma and discrimination. To date, no clear consensus exists regarding how to best quantitatively measure and analyze intersectional stigma and discrimination.

Sexual partner concurrency: is it a useful concept for HIV prevention? A systematic review of the evidence for intervention effectiveness in low- and middle-income countries.

If sexual partner concurrency drives HIV transmission dynamics, shouldn't HIV prevention efforts be addressing this behavior? We systematically reviewed studies evaluating interventions to reduce sexual partner concurrency in low- and middle-income countries using pre/post or multi-arm designs. Only two studies met our inclusion criteria; neither found significant differences by intervention exposure on self-reported concurrency. Overall, very few interventions have specifically targeted concurrency, and those that did have not been rigorously evaluated.

"We are in this together:" dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP.

Background: A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners.

Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis.

Background: Economic compensation interventions may help support higher voluntary medical male circumcision (VMMC) coverage in priority sub-Saharan African countries. To inform World Health Organization guidelines, we conducted a systematic review of economic compensation interventions to increase VMMC uptake.

Methods: Economic compensation interventions were defined as providing money or in-kind compensation, reimbursement for associated costs (e.

Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review.

Background: Voluntary medical male circumcision (VMMC) remains an essential component of combination HIV prevention services, particularly in priority countries in sub-Saharan Africa. As VMMC programs seek to maximize impact and efficiency, and to support World Health Organization guidance, specific uptake-enhancing strategies are critical to identify.

Methods: We systematically reviewed the literature to evaluate the impact of service delivery interventions (e.

Condom Social Marketing Effects in Low- and Middle-Income Countries: A Systematic Review Update, 1990 to 2019.

Objective: To update the prior systematic review from studies published in the past 9 years that examine the effects of condom social marketing (CSM) programs on condom use in low- and middle-income countries.

Data Sources: PubMed, CINAHL, PsycINFO, Sociological Abstracts, and EMBASE. Hand searching of , , , and .

Do Sexual Partners Talk to Each Other About HIV? Exploring Factors Associated with HIV-Related Partner Communication Among Men and Women in Tanzania.

Communication between sexual partners is an important component of HIV prevention and occurs within a broader context of socio-culturally defined gender norms and dynamics. We analyzed cross-sectional data from a community-based random sample of men and women living in Kisarawe, Tanzania to understand factors related to partner communication about HIV. Bivariate and multivariate logistic regression analyses, disaggregated by gender, included variables at the individual-, relational-, and community-levels.

The gendered experience of HIV testing: factors associated with prior testing differ among men and women in rural Tanzania.

HIV testing remains below UNAIDS 90–90–90 goals in sub-Saharan Africa. The aim of this study was to understand gender-specific factors related to HIV testing in Kisarawe, Tanzania. Informed by Social Action Theory, we analyzed cross-sectional data from a population-based random sample using bivariate and multivariate logistic regression to identify the contextual, behavioral, and interpersonal factors associated with prior HIV testing – specifically, any prior testing and testing within the past year.

The Evidence Project risk of bias tool: assessing study rigor for both randomized and non-randomized intervention studies.

Background: Different tools exist for assessing risk of bias of intervention studies for systematic reviews. We present a tool for assessing risk of bias across both randomized and non-randomized study designs. The tool was developed by the Evidence Project, which conducts systematic reviews and meta-analyses of behavioral interventions for HIV in low- and middle-income countries.

Prevalence of CKD, Diabetes, and Hypertension in Rural Tanzania.

Introduction: Chronic kidney disease (CKD), diabetes, and hypertension play a disproportionate role in the growing public health challenge posed by noncommunicable diseases (NCDs) in East Africa. The impact of these NCDs may pose the greatest challenge in rural areas with limited screening and treatment facilities, although precise prevalence estimates of these conditions in rural Tanzania are lacking.

Methods: The prevalence of CKD, diabetes, and hypertension, were estimated from a probability sample of adults (n = 739) residing in 2 communities within Kisarawe, a rural district of Tanzania.

Modeling excess zeros and heterogeneity in count data from a complex survey design with application to the demographic health survey in sub-Saharan Africa.

Purpose To show a novel application of a weighted zero-inflated negative binomial model in modeling count data with excess zeros and heterogeneity to quantify the regional variation in HIV-AIDS prevalence in sub-Saharan African countries. Methods Data come from latest round of the Demographic and Health Survey (DHS) conducted in three countries (Ethiopia-2011, Kenya-2009 and Rwanda-2010) using a two-stage cluster sampling design. The outcome is an aggregate count of HIV cases in each census enumeration area of each country.

Increasing HIV serostatus disclosure in low and middle-income countries: a systematic review of intervention evaluations.

Objective: To review the effectiveness of interventions to increase HIV serostatus disclosure in low and middle-income countries.

Design: Systematic review of peer-reviewed articles providing prepost or multiarm evaluations of disclosure interventions, defined broadly as any intervention with the goal of increasing rates of voluntary disclosure of HIV serostatus through self-disclosure or partner notification.

Methods: Articles were included if they reported postintervention evaluation results and were published between 1 January 1990 and 1 August 2014.

A Systematic Review of the Effects of Behavioral Counseling on Sexual Risk Behaviors and HIV/STI Prevalence in Low- and Middle-Income Countries.

The purpose of this study was to assess the effectiveness of behavioral counseling interventions in reducing sexual risk behaviors and HIV/STI prevalence in low- and middle-income countries. A systematic review of papers published between 1990 and 2011 was conducted, identifying studies that utilized either a multi-arm or pre-post design and presented post-intervention data. Standardized methods of searching and data abstraction were used, and 30 studies met inclusion criteria.

School based sex education and HIV prevention in low- and middle-income countries: a systematic review and meta-analysis.

Objectives: School-based sex education is a cornerstone of HIV prevention for adolescents who continue to bear a disproportionally high HIV burden globally. We systematically reviewed and meta-analyzed the existing evidence for school-based sex education interventions in low- and middle-income countries to determine the efficacy of these interventions in changing HIV-related knowledge and risk behaviors.

Methods: We searched five electronic databases, PubMed, Embase, PsycInfo, CINAHL, and Sociological Abstracts, for eligible articles.

Development of methods for cross-sectional HIV incidence estimation in a large, community randomized trial.

Background: Accurate methods of HIV incidence determination are critically needed to monitor the epidemic and determine the population level impact of prevention trials. One such trial, Project Accept, a Phase III, community-randomized trial, evaluated the impact of enhanced, community-based voluntary counseling and testing on population-level HIV incidence. The primary endpoint of the trial was based on a single, cross-sectional, post-intervention HIV incidence assessment.

Systematic assessment of condom use measurement in evaluation of HIV prevention interventions: need for standardization of measures.

When evaluating HIV prevention interventions, condom use is a common outcome measure used to assess changes in HIV-related behaviors; however, no widely accepted standards exist for its measurement. Using systematic review data on HIV prevention interventions conducted in low- and middle-income countries, we examined trends in condom use measurement since 1990. We abstracted data from standardized forms on six dimensions of condom use: partner type, temporal period, measurement scale, consistency, controlling for abstinence, and type of sex.

A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention.

Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. The authors conducted a systematic review by searching electronic databases from 1990 to 2012, examining secondary references, and hand-searching key journals.

Family planning counseling for women living with HIV: a systematic review of the evidence of effectiveness on contraceptive uptake and pregnancy incidence, 1990 to 2011.

Background: Family planning is an important public health intervention with numerous potential health benefits for all women. One of those key benefits is the prevention of mother-to-child transmission of HIV, through the prevention of unintended pregnancies among women living with HIV.

Methods: We conducted a systematic review of the effectiveness of family planning counseling interventions for HIV infected women in low- and middle-income countries.

Estimating the impact of reducing violence against female sex workers on HIV epidemics in Kenya and Ukraine: a policy modeling exercise.

Problem: Female sex workers (FSWs) worldwide suffer disproportionate burdens of HIV and gender-based violence. Despite evidence linking these threats, little is known about the potential HIV epidemic impact of reducing abuse.

Method Of Study: The Goals model approximated the impact of reducing violence against FSWs on HIV epidemics in Ukraine and Kenya, measured by reductions in new infections among FSWs and adults.

Effects of condom social marketing on condom use in developing countries: a systematic review and meta-analysis, 1990-2010.

Objective: To examine the relationship between condom social marketing programmes and condom use.

Methods: Standard systematic review and meta-analysis methods were followed. The review included studies of interventions in which condoms were sold, in which a local brand name(s) was developed for condoms, and in which condoms were marketed through a promotional campaign to increase sales.

Provider-initiated HIV testing and counseling in low- and middle-income countries: a systematic review.

Provider-initiated HIV testing and counseling (PITC) has expanded since 2007 WHO guidelines were established. We conducted a systematic review of PITC in low- and middle-income countries. Peer-reviewed studies were included if they measured pre-post or multi-arm outcomes.