The Relative Persuasiveness of Gain-Framed Loss-Framed Messages for Encouraging Disease Prevention Behaviors: A Meta-Analytic Review

A meta-analytic review of 93 studies (N = 21,656) finds that in disease prevention messages, gain-framed appeals, which emphasize the advantages of compliance with the communicator's recommendation, are statistically significantly more persuasive than loss-framed appeals, which emphasize the disadvantages of noncompliance. This difference is quite small (corresponding to r = .03), however, and appears attributable to a relatively large (and statistically significant) effect for messages advocating dental hygiene behaviors. Despite very good statistical power, the analysis finds no statistically significant differences in persuasiveness between gain- and loss-framed messages concerning other preventive actions such as safer-sex behaviors, skin cancer prevention behaviors, or diet and nutrition behaviors.     

The Relative Persuasiveness of Gain- and Loss-Framed Messages for Promoting Vaccination: A Meta-Analytic Review

Vaccination against disease is a powerful public health tool, and persuading people to be vaccinated is a correspondingly important challenge. A number of studies have compared the effectiveness of gain-framed and loss-framed appeals in this domain, often expecting gain-framed appeals to be more persuasive. A meta-analytic review (k?=?32, N?=?11,814), however, finds no significant difference in the persuasiveness of gain- and loss-framed appeals for encouraging vaccination. This conclusion is unaffected by differences in the phrasing of the outcomes invoked or by differences in the specific vaccination advocated. But the results contain a hint that parents might be more persuaded to vaccinate their children by loss-framed than by gain-framed appeals. Implications and directions for future research are discussed.     

Promotion and Persistence of HIV Testing and HIV/AIDS Knowledge: Evidence From a Randomized Controlled Trial in Ethiopia

We use data from a randomized controlled trial in Ethiopia and examine the causal effects of HIV/AIDS education, home‐based voluntary HIV counseling and testing (VCT), and conditional cash transfers (CCT) for facility‐based VCT on HIV/AIDS knowledge and demand for HIV testing. HIV/AIDS education significantly increases HIV/AIDS knowledge but has a limited effect on testing take‐up. However, when HIV/AIDS education is combined with either home‐based VCT or CCT for facility‐based VCT, take‐up increases substantially by about 63 and 57 percentage points, respectively. We also demonstrate evidence of persistence in test‐taking behavior, where past HIV testing does not dampen demand for testing. Lastly, we find suggestive evidence that home‐based VCT could be more effective at detecting HIV‐positive cases relative to CCT for facility‐based VCT. Our findings highlight the importance of geographic accessibility in the testing decision and persistence in demand for HIV testing. Copyright © 2016 John Wiley & Sons, Ltd.     

Effects of Written Informed Consent Requirements on HIV Testing Rates: Evidence From a Natural Experiment

Objectives. I evaluated the effects of written informed consent requirements on HIV testing rates in New York State to determine whether such consent creates barriers that discourage HIV testing.Methods. New York streamlined its HIV testing consent procedures on June 1, 2005. If written informed consent creates barriers to HIV testing, then New York''s streamlining exercise should have reduced such barriers and increased HIV testing rates. I used logistic regression to estimate the effects of New York''s policy change.Results. New York''s streamlined consent procedures led to a 31.4% (95% confidence interval [CI] = 20.9%, 41.9%) increase in the state''s HIV testing rate. In absolute terms, 7% of the state''s population had been tested for HIV in the preceding 6 months under the streamlined procedures, whereas only 5.3% would have been tested under the original procedures. These estimates imply that the streamlined consent procedures accounted for approximately 328 000 additional HIV tests in the 6 months after the policy change.Conclusions. Written informed consent requirements are a substantial barrier to HIV testing in the United States.There may be a trade-off between efforts to increase HIV testing rates and efforts to improve patient awareness.In 2006, the Centers for Disease Control and Prevention (CDC) endorsed a shift from targeted HIV testing of high-risk groups to broad-based screening of the general population.¹ The CDC called for opt-out HIV screening of all patients in health care settings and argued that written informed consent procedures that are separate and distinct from general consent to medical treatment procedures should not be required for HIV testing.¹ The CDC recommendations reflect concerns that HIV testing rates are too low in the United States because a large number of people do not learn about their infection until it is too late for treatment to be effective.Opt-out screening has increased testing rates in other settings, including genitourinary clinics in the United Kingdom, and there is little doubt that it would increase HIV testing in the general population.^2,3 The effect of informed consent regulations on HIV testing rates is less clear. The CDC claims that such regulations create administrative and social barriers that discourage HIV testing.¹ There is also some evidence that written informed consent regulations represent a legal impediment to the implementation of opt-out testing.⁴ Such concerns might also explain the CDC''s advocacy of informed consent repeal.Critics of the recommendations argue that separate informed consent promotes important ethical and clinical objectives in public health policy and that removing informed consent regulations could lead to a more coercive HIV testing environment.^5–8 In summarizing the controversy, Bayer and Fairchild argued that the CDC''s informed consent recommendations signal an end to the practice of HIV exceptionalism, which leads the medical establishment to approach HIV/AIDS issues differently than it approaches other health conditions.⁹It is difficult to estimate the effects of informed consent regulations on HIV testing rates because variations in state consent requirements may be correlated with state-level characteristics that themselves predict testing rates; that is, state populations are not randomly assigned to different informed consent policies. Zetola et al. reported the best evidence to date. They found that monthly testing rates increased from 13.5 to 17.9 HIV tests per 1000 patients in a set of institutions in San Francisco after that city''s department of public health eliminated written informed consent requirements.⁵ However, the Zetola et al. study lacked a comparison group, which would have alleviated concerns that the increases observed were associated with underlying trends and changes in HIV testing that occurred in the same time frame as the San Francisco policy change.In addition, Zetola et al. relied on administrative data, for which observations were conditional on patients'' visits to particular institutions. It is possible that HIV testing rates among patients who visited these institutions were different than testing rates in the general population. As a result of such problems, it is difficult to generalize the effects of the San Francisco policy change on HIV testing rates in particular institutions to testing rates in the general population.A careful decision on whether to repeal or maintain written informed consent requirements in HIV testing depends on estimates of the effects of the regulations in terms of both testing rates and the physical and psychological risks to patient well-being. It also requires normative judgments regarding the relative importance of these effects in terms of public welfare.¹⁰ In this study, I investigated the CDC''s claim that informed consent regulations lead to reductions in HIV testing rates. I used data from the Behavioral Risk Factor Surveillance System (BRFSS) to examine HIV testing rates in New York State and a set of comparison states before and after the introduction of streamlined HIV test consent procedures in New York. The policy change in New York generated a natural experiment that helps address many of the challenges associated with evaluating the effects of consent procedures on testing rates.     

Evaluating the Persuasiveness of an HIV Mass Communication Campaign Using Gain-Framed Messages and Aimed at Creating a Superordinate Identity

This research assesses the coverage and impact of “United Against AIDS,” the 2012–2013 Italian National HIV/AIDS prevention campaign to promote safer sex behavior and voluntary HIV counseling and testing. The campaign used gain-framed messages and aimed at creating a superordinate identity. We conducted two studies. The first study employed a quasi-experimental design involving three groups of participants: general population (n = 858), men who have sex with men (MSM; n = 109), and migrants (n = 211). In the second study, we carried out a time-series design to analyze the archival data of the Italian National AIDS Help-Line. Exposure to the campaign was reported by 78.3%, 67.5%, and 57.8% of the general population, MSM, and migrant respondents, respectively. The probability of having unprotected sexual intercourse with multiple partners decreased significantly in the subsample of the general populations that was exposed to the campaign (compared to the nonexposed participants), but the same effect was not found among MSM and migrant participants. The probability of having unprotected sexual intercourse with someone of unknown HIV status decreased after the campaign in the exposed MSM subsample (compared to the nonexposed participants), but the same effect was not found among the general population and migrant participants. In addition, the probability of undertaking HIV testing increased significantly in the exposed participants belonging to the general population but not among MSM and migrant participants. Time-series analysis revealed that the number of calls at the Italian National AIDS Help-Line significantly increased during the campaign. This research provides evidence that the effect of the campaign was complex and varied across participants.     

Effectiveness of the U.S. National HIV Testing Day Campaigns in Promoting HIV Testing: Evidence from CDC-Funded HIV Testing Sites, 2010

Objectives

We assessed if HIV testing and diagnoses increased during the week of National HIV Testing Day (NHTD) and if characteristics of people who were tested varied compared with control weeks.

Methods

We analyzed HIV testing data from the 2010 National HIV Prevention Program Monitoring and Evaluation system to compare NHTD week (June 24–30, 2010) with two control weeks (January 7–13, 2010, and August 12–18, 2010) for the number of HIV testing events and new HIV-positive diagnoses, by demographics and other HIV-related variables. Characteristics associated with testing during NHTD week compared with control weeks were identified using Chi-square analyses.

Results

In 2010, an average of 15,000 more testing events were conducted and 100 more new HIV-positive diagnoses were identified during NHTD week than during the control weeks (p<0.001). Compared with control weeks, people tested during NHTD week were significantly less likely to be aged 20–29 years and non-Hispanic white and significantly more likely to be (1) aged ≥50 years, (2) non-Hispanic black or African American, (3) men who have sex with men, (4) low-risk heterosexuals, (5) tested with a rapid HIV test, or (6) tested in a non-health-care setting.

Conclusion

In 2010, CDC-funded HIV testing events and new HIV-positive diagnoses increased during NHTD week compared with control weeks. HIV testing programs increased the use of rapid tests and returned a high percentage of test results. NHTD campaigns reached populations disproportionately affected by HIV and further expanded testing to people traditionally less likely to be tested. Incorporating strategies used during NHTD in programs conducted throughout the year may assist in increasing HIV testing and the number of HIV-positive diagnoses.Human immunodeficiency virus (HIV) continues to be a major public health problem in the United States. In 2009, the Centers for Disease Control and Prevention (CDC) estimated that 1.2 million people were living with HIV in the U.S. However, 18% are unaware they are infected and 32% of people diagnosed with HIV were also diagnosed with acquired immunodeficiency syndrome (AIDS) within 12 months of their diagnosis, which indicates they may have been infected with HIV for years before being diagnosed.¹ HIV testing identifies infected people and is the entry point to a continuum of HIV medical care and prevention services that improve health outcomes, including survival, and reduce the risk of HIV transmission. CDC recommends routine HIV testing in health-care settings for all people aged 13–64 years, annual HIV testing for those at high risk of infection, and routine testing as a part of prenatal care for all pregnant women.²CDC supports these HIV testing recommendations with a number of initiatives^3,4 designed to expand HIV testing to populations disproportionately affected by HIV, especially non-Hispanic black or African American people (hereafter, non-Hispanic black people), Hispanic or Latino people, and men who have sex with men (MSM).⁴ CDC-funded HIV testing events are an important part of national HIV prevention efforts.⁵ In 2010, 3.2 million CDC-funded HIV testing events were conducted, diagnosing 13,000 newly identified people living with HIV.⁶June 27 of each year is designated as National HIV Testing Day (NHTD). NHTD was founded in 1995 by the National Association of People with AIDS (NAPWA), an advocacy group for people living with HIV/AIDS. The objectives of NHTD are to encourage people to (1) get tested for HIV; (2) become aware of their HIV status; (3) get linked to prevention, care, and treatment services; and (4) work to reduce the stigma associated with HIV.^5,7 These objectives are in line with the major goals of the National HIV/AIDS Strategy, released by the White House in 2010.⁸ Through 2012, NAPWA organized and promoted NHTD activities with the support of CDC and other public and private partners, such as state and local health departments and community-based organizations. While the theme of each year''s NHTD remains the promotion of HIV testing, local organizations determine the specific activities they conduct during NHTD. Most NHTD events offer free HIV testing and include mass media and social marketing campaigns to improve knowledge about HIV testing, care, and prevention services; address barriers to getting tested; and encourage testing.⁷Because NHTD is a nationally recognized day to encourage HIV testing, it is important to document the effect this type of public health campaign has on increasing HIV testing and new HIV-positive diagnoses. Mass media campaigns can promote behavioral change for a wide range of HIV/AIDS preventive actions, including testing. A Cochrane review of 14 mass media interventions for promoting HIV testing found that these interventions have immediate and overall effects on promoting HIV testing in the targeted populations.⁹ However, most of these mass media interventions were designed and tested for specific populations or in limited geographical areas. In comparison, NHTD campaign activities are not predetermined at a national level, vary from place to place, and may incorporate a broad range of mass media campaigns. Therefore, the effectiveness of NHTD campaigns on increasing HIV testing nationally is unclear.Two previous reports have assessed HIV testing before and after NHTD.^5,10 In 2000, CDC compared the number of HIV tests and HIV-positive tests the week before and the week of NHTD from 1995 through 1998 among 43 CDC-funded health departments. CDC found that 4,266 more HIV tests were conducted and 57 more HIV-positive tests were identified during the week of NHTD compared with the week before NHTD.⁵ Similar results were found in a 2013 study by the HIV/AIDS and Hepatitis Program of the Florida State Bureau of Communicable Diseases. From 2003 through 2012, greater numbers of HIV tests and HIV-positive tests were documented, annually, during the week of NHTD compared with the week before NHTD.¹⁰We sought to update and expand the scope of the previous analyses. We assessed the effect national public health campaigns, such as NHTD, have on increasing the number of CDC-funded HIV testing events and the number of new HIV-positive diagnoses in the U.S. by asking two questions: (1) During the week of NHTD, how many additional CDC-funded HIV testing events were conducted and new HIV-positive diagnoses identified compared with the control weeks? and (2) Do characteristics of people tested during the week of NHTD differ from people tested during the control weeks? Specifically, do populations (e.g., MSM, non-Hispanic black people, and Hispanic or Latino people) disproportionately affected by HIV experience higher testing during the week of NHTD than during other times of the year?The previous studies documented the importance of NHTD campaigns in increasing the uptake of HIV testing and diagnosis of people living with HIV.^5,10 However, the CDC study was conducted more than a decade ago and did not examine the characteristics of people tested. While the Florida study was more recent, it reflected data from only one state and did not provide comparisons to examine the potential differences in the populations served the week before and the week of NHTD. In contrast with the previous studies, we selected control weeks throughout the year rather than the week before NHTD to reduce the risk of missing a true difference in HIV testing (Type II error) due to implementation of NHTD activities in the weeks leading up to NHTD.     

Reading or Listening to a Gain- or Loss-Framed Health Message: Effects of Message Framing and Communication Mode in the Context of Fruit and Vegetable Intake

Gain-framed health messages are found to be more effective when targeting prevention behaviors. However, framing research has only minimally investigated the role of communication mode, another important factor in health communication. This study explored the role of communication mode in interaction with message framing, and the influence of two individual differences related to involvement as conditions under which gain framing can lead to health behavior change. Participants (N = 258) were exposed to either an auditory or written health message concerning fruit and vegetable intake, with either gain- or loss-framed arguments. In addition, the online experiment consisted of baseline and posttest measures, among which intention to consume sufficient fruit and vegetables. Moderating effects of perceived baseline fruit and vegetable consumption and baseline intention were assessed. A significant interaction between message framing and communication mode was observed: In case of a gain-framed message, an auditory message resulted in a higher intention than a written message. This pattern was most explicitly found among those with a lower perceived fruit and vegetable intake at baseline. Although further research is warranted in health persuasion research, the findings can possibly be used to target health interventions better at specific groups of people who behave less healthy.     

Environmental Influences on Young Adult Weight Gain: Evidence From a Natural Experiment

ObjectivesThis study investigated the importance of environmental influences in explaining weight gain and related behaviors among freshman college students.MethodsWe exploited a natural experiment that takes place on most college campuses in the United States - randomized dormitory assignments. We estimated the effects of living in dormitories with varying physical environment characteristics on weight gain and related behaviors (daily number of meals and snacks, weekly frequency of exercise) among randomly assigned freshman students.ResultsWe found strong evidence linking weight and related behaviors to individual dormitories, as well as to specific characteristics of the dormitories. On average, students assigned to dormitories with on-site dining halls gained more weight and exhibited more behaviors consistent with weight gain during the freshman year as compared with students not assigned to such dormitories. Females in such dormitories weighed .85 kg (p = .03) more and exercised 1.43 (p < .01) times fewer; males consumed .22 (p = .02) more meals and .38 (p = .01) more snacks. For female students, closer proximity of the dormitory to a campus gym led to more frequent exercise (.54, p = .03), whereas living closer to central campus reduced exercise (?.97, p = .01).ConclusionsUsing a natural experiment to deal with the potential endogeneity of the living environment, this study found that the physical environment affects both students' weight changes and weight-related behaviors.     

Front-of-Package Labels on Unhealthy Packaged Foods in India: Evidence from a Randomized Field Experiment

Policies to require front-of-package labels (FOPLs) on packaged foods may help Indian consumers to better identify foods high in nutrients of concern, including sugar, saturated fat, and sodium, and discourage their consumption, which are outcomes that are critical for preventing rises in diet-related non-communicable disease. The objective was to test whether FOPLs helped Indian consumers identify “high-in” packaged foods and reduce intentions to purchase them. We conducted an in-person randomized experiment (n = 2869 adults between ages 18 and 60 years old) in six states of India in 2022. Participants were randomized to one of five FOPLs: a control label (barcode), warning label (octagon with “High in [nutrient]”), Health Star Rating (HSR), Guideline Daily Amount (GDA), or traffic light label. Participants then viewed a series of packaged foods high in sugar, saturated fat, or sodium with the assigned FOPL, and rated product perceptions and label reactions. Fewer than half of participants in the control group (39.1%) correctly identified all products high in nutrient(s) of concern. All FOPLs led to an increase in this outcome, with the biggest differences observed for the warning label (60.8%, p < 0.001), followed by the traffic light label (54.8%, p < 0.001), GDA (55.0%, p < 0.001), and HSR (45.0%, p < 0.01). While no FOPLs led to a reduction in intentions to purchase the packaged foods, the overall pattern of results suggested that warning labels are the most effective FOPL to help Indian consumers identify unhealthy foods.     

Effects of Gain- and Loss-Framed Quit Messages on Smokers: Test of the Ability to Process the Health Message as a Moderator

Health messages can emphasize the benefits of engaging in healthy behavior (gain-framed) or the costs of failing to engage in it (loss-framed). Previous research revealed that gain-framed messages tend to be more effective in motivating smokers to quit. As a supplement to previous studies, we questioned whether the ability to process health messages moderates the size of the gain-frame advantage. There were two competing theoretical ideas. First, some scholars have noted that a high ability to process a health message is a necessary precondition to observe the advantage of gain-framing. Second, risk aversion—a central concept used in previous theorizing to explain the gain-frame advantage—is associated with automatic processing and automatic processing has a stronger influence on decision making under a low ability to process. We utilized a 2 (exposure to gain- or loss-framed quit messages) × 2 (low or high ability to process) randomized controlled trial with a pre–post exposure change in quit intentions as the target outcome (N = 182 smokers). Although the analysis revealed the hypothesized gain-frame advantage, the ability to process did not moderate the effect. We discuss the theoretical implications.     

Bias Assessment in Outcomes Research: The Role of Relative Versus Absolute Approaches

ObjectivesBias assessment tools vary in content and detail, and the method used for assessment may produce different assessment results in a study if not carefully considered. Therefore, taking an approach to the assessment of studies that produces a similar result regardless of the tool used for assessment (tool independence) is important.MethodsA preexisting study that used 25 different quality scales was assessed to examine tool dependence of 2 common approaches to bias assessments—absolute value judgments (defined as the qualitative risk of bias judgment based on a threshold across studies) and relative ranks (defined as the relative probability toward bias of a study relative to the best assessed study). Agreement between each of the 25 scales and a composite scale (that includes all unique safeguards across all scales) was computed (using the intraclass correlation coefficient [ICC]; consistency). Tool dependence was considered present when the ICCs were inconsistent across the 25 scales for the same study.ResultsWe found that using relative ranks for tools with different numbers and types of items produced consistent results, with only small differences in the agreement for the various tools with the composite tool, whereas consistency (measured by the ICC) varied considerably when using absolute judgments. Inconsistency is problematic because it means that the assessment result is linked to the scale and not to the study.ConclusionsTool independence is an important attribute of a bias assessment tool. On the basis of this study, the use of relative ranks retains tool independence and therefore produces consistent ranks for the same study across tools.     

The Effect of Medicaid on Management of Depression: Evidence From the Oregon Health Insurance Experiment

Policy Points:

• We take advantage of Oregon's Medicaid lottery to gauge the causal effects of Medicaid coverage on mental health care, how effectively it addresses unmet needs, and how those effects differ for those with and without a history of depression.
• Medicaid coverage reduced the prevalence of undiagnosed depression by almost 50% and untreated depression by more than 60%. It increased use of medications and reduced the share of respondents reporting unmet mental health care needs by almost 40%.
• There are likely to be substantial mental health consequences of policy decisions about Medicaid coverage for vulnerable populations.

Context

Expanding Medicaid to previously uninsured adults has been shown to increase detection and reduce the prevalence of depression, but the ways that Medicaid affects mental health care, how effectively it addresses unmet needs, and how those effects differ for those with and without a history of depression remain unclear.

Methods

We take advantage of Oregon's Medicaid lottery to gauge the causal effects of Medicaid coverage using a randomized‐controlled design, drawing on both primary and administrative data sources.

Findings

Medicaid coverage reduced the prevalence of undiagnosed depression by almost 50% and untreated depression by more than 60%. It increased use of medications frequently prescribed to treat depression and related mental health conditions and reduced the share of respondents reporting unmet mental health care needs by almost 40%. The share of respondents screening positive for depression dropped by 9.2 percentage points overall, and by 13.1 for those with preexisting depression diagnoses, with greatest relief in symptoms seen primarily in feeling down or hopeless, feeling tired, and trouble sleeping—consistent with the increase observed not just in medications targeting depression but also in those targeting sleep.

Conclusions

Medicaid coverage had significant effects on the diagnosis, treatment, and outcomes of a population with substantial unmet mental health needs. Coverage increased access to care, reduced the prevalence of untreated and undiagnosed depression, and substantially improved the symptoms of depression. There are likely to be substantial mental health consequences of policy decisions about Medicaid coverage for vulnerable populations.     

The Differential Effects of an Opt-Out HIV Testing Policy for Pregnant Women in Ethiopia When Accounting for Stigma: Secondary Analysis of DHS Data

Individual factors associated with HIV testing have been studied across multiple populations; however, testing is not just an individual-level phenomenon. This secondary analysis of 2005 and 2011 Ethiopia Demographic and Health Survey data was conducted to determine the extent to which the 2007 institution of an opt-out policy of HIV testing during antenatal care increased testing among women, and whether effects differed by women’s stigmatizing beliefs about HIV. A logit model with interaction between pre-/post-policy year and policy exposure (birth in the past year) was used to estimate the increased probability of past-year testing, which may be attributable to the policy. Results suggested the policy contributed to a nine-point increase in the probability of testing (95% CI 0.06–0.13, p?<?0.0001). A three-way interaction was used to compare the effects of exposure to the policy among women holding higher and lower HIV stigmatizing beliefs. The increase in the probability of past-year testing was 16 percentage points greater among women with lower stigmatizing beliefs (95% CI 0.06–0.27, p?=?0.002). Women with higher stigmatizing beliefs were less likely to report attending antenatal care (ANC), testing at their last ANC visit, or being offered a test at their last ANC visit. We encourage researchers and practitioners to explore interventions that operate at multiple levels of socio-ecological spheres of influence, addressing both stigma and structural barriers to testing, in order to achieve the greatest results in preventing HIV.     

Field evaluation of a fast anti-Leishmania antibody detection assay in Ethiopia

A fast agglutination screening test (FAST) for the detection of Leishmania antibodies in human serum samples was evaluated under harsh field conditions in northern Ethiopia. Test performance was compared with a standard serological test, namely the direct agglutination test (DAT), and with parasitology. In total, 103 suspected cases were recruited for the study. Based on parasitological examination, 49 patients were confirmed of having visceral leishmaniasis (VL) and the other 54 suspected cases were parasitologically negative. Field evaluation of FAST was possible in blood samples of 89 patients. FAST had 4 false negative results and 13 false positive results. DAT had 2 false negative results and 20 false positive results. A good degree of agreement (86.9%) was observed between FAST and DAT (kappa value 0.73). In this field-based evalauation, the sensitivity and specificity of FAST were found to be 91.1% (95% CI 77.9-97.1) and 70.5% (95% CI 54.6-82.8), respectively, compared with 95.3% (95% CI 82.9-99.2) and 62.3% (95% CI 47.9-74.9) for DAT. FAST had a high predictive value of a negative test, demonstrating that FAST could be utilised to exclude rapidly non-VL patients from a large population of suspects with fever and splenomegaly in endemic areas.     

The Societal Impact of Inclisiran in England: Evidence From a Population Health Approach

ObjectivesAs first-in-class cholesterol-lowering small interfering ribonucleic acid, inclisiran provides effective reductions in low-density lipoprotein-cholesterol to achieve better cardiovascular (CV) health. We estimate the health and socioeconomic effects of introducing inclisiran according to a population health agreement in England.MethodsBuilding on the inclisiran cost-effectiveness model, a Markov model simulates health gains in terms of avoided CV events and CV deaths because of add-on inclisiran treatment for patients aged 50 years and older with pre-existing atherosclerotic CV disease. These are translated into socioeconomic effects, defined as societal impact. To that end, we quantify avoided productivity losses in terms of paid and unpaid work productivity and monetize them according to gross value added. Furthermore, we calculate value chain effects for paid work activities, drawing on value-added multipliers based on input-output tables. The derived value-invest ratio compares avoided productivity losses against the increased healthcare costs.ResultsOur results show that 138 647 CV events could be avoided over a period of 10 years. The resulting societal impact amounts to £8.17 billion, whereas additional healthcare costs are estimated at £7.94 billion. This translates into a value-invest ratio of 1.03.ConclusionsOur estimates demonstrate the potential health and socioeconomic value of inclisiran. Thereby, we highlight the importance to treat CVD and illustrate the impact that a large-scale intervention can have on population health and the economy.     

Factors affecting voluntary HIV counselling and testing among men in Ethiopia: a cross-sectional survey

ABSTRACT: BACKGROUND: Voluntary HIV counselling and testing (VCT) is one of the key strategies in the HIV/AIDS prevention and control programmes in Ethiopia. However, utilization of this service among adults is very low. The aim of the present study was to investigate factors associated with VCT utilization among adult men since men are less likely than women to be offered and accept routine HIV testing. METHODS: The study utilized data from the Ethiopian Demographic Health Survey (EDHS) 2005, which is a cross-sectional survey conducted on a nationally representative sample. Using cluster sampling, 6,778 men aged 15-59 years were selected from all the eleven administrative regions in Ethiopia. Logistic regression was used to analyze potential factors associated with VCT utilization. RESULTS: Overall, 21.9% of urban men and 2.6% of rural men had ever tested for HIV through VCT and most of them had learned their HIV test result. Having no stigmatizing attitudes toward people living with HIV/AIDS was found to be strongly and positively associated with VCT utilization in both urban and rural strata. In rural areas HIV test rates were higher among younger men (aged [less than or equal to]44 years) and those of higher socio-economic position (SEP). Among urban men, risky sexual behaviour was positively associated with VCT utilization whereas being Muslim was found to be inversely associated with use of VCT utilization. Area of residence as well as SEP strongly affected men's level of stigmatizing attitudes toward people living with HIV/AIDS. CONCLUSIONS: VCT utilization among men in Ethiopia was low and affected by HIV/AIDS-related stigma and residence. In order to increase VCT acceptability, HIV/AIDS prevention and control programs in the country should focus on reducing HIV/AIDS-related stigma. Targeting rural men with low SEP should be given first priority when designing, expanding, and implementing VCT services in the country. Key words: HIV testing, VCT utilization, stigma, knowledge, men, Ethiopia.     

The Contributions of Maternity Care to Reducing Adverse Pregnancy Outcomes: A Cohort Study in Dabat District,Northwest Ethiopia

This study was designed to evaluate the effect of maternity care by skilled providers on the occurrence of adverse pregnancy outcomes. A community-based cohort study was conducted at Dabat district, northwest Ethiopia, from December 1, 2011 to August 31, 2012. During the study period, 763 pregnant women were registered and followed until 42 days of their postpartum period. Use of skilled maternal care was the exposure variable. Reductions in occurrence of serious complications or death (adverse pregnancy outcomes) were used as outcome indicators. Data was collected at four time points; first contact, during the 9th month of pregnancy, within 1 week after delivery and at 42 days of postpartum. The effects of the exposure variable were evaluated by controlling potential confounders using logistic regression. One hundred and fifty-three (21 %) of the women encountered at least one obstetric complication or death during delivery and postpartum period. Hemorrhage and prolonged labor were the major types. Pregnancy outcomes for 41 women (5.6 %) were fetal, neonatal, or maternal deaths. Four or more ANC (antenatal care) visits, <4 ANC visits and delivery by skilled attendant showed 25 % (OR 0.75; 95 % CI 0.25, 2.75), 9 % (OR 0.91; 95 % CI 0.43, 1.69) and 31 % (OR 0.69; 95 % CI 0.36, 1.33) reduction in the occurrence of adverse pregnancy outcomes, respectively. Skilled maternal care showed reduction in adverse pregnancy outcomes (complications and deaths). However, the associations were not significant. Improving the quality of maternity care services and ensuring continuum of care in the health care system are imperative for effective maternal health care in the study area.     

成都市男男性行为人群HIV检测影响因素分析

目的 了解成都市男男性行为(MSM)人群的性行为状况以及HIV检测情况,探索成都市MSM人群HIV检测的影响因素.方法 采用立意抽样与“滚雪球”抽样相结合方法对成都市291名男男性行为者进行一对一问卷调查,并采用Logistic回归模型对该人群HIV检测的影响因素进行分析.结果 调查对象中48.5％的人在近6个月存在多性伴的现象;90.2％的人有肛交性行为;51.6％的人没有坚持使用安全套;在对肛交中的性角色回答中,49.8％的对象表示1/0皆有,只做0或1的分别为26.2％和24.0％;近1年接受过HIV检测的占59.3％.30个艾滋病知识/信息条目平均知晓率为76.4％.Logistic回归显示,条目“成都同志关爱小组每周五、周日提供免费艾滋病检测服务”以及“《艾滋病防治条例》规定相关机构应为艾滋病感染者的个人信息保密”的知晓对MSM人群HIV检测起促进作用.结论 成都市MSM人群HIV检测率不高,影响因素主要为该人群缺乏HIV检测的具体信息以及害怕因为检测而暴露自己的身份,建议今后有针对性地进行干预,从检测条件以及检测信息的保密性等方面加大宣传力度,以降低艾滋病的感染风险.