A Longitudinal Analysis of the Impact of Health Behavior Campaigns on HIV-Risk Behaviors and HIV Incidence in Eswatini.

Between 2010 and 2015, Eswatini conducted mass media health behavior campaigns (HBCs) designed to avert new HIV infections. Using longitudinal data from the nationally representative Swaziland HIV Incidence Measurement Survey of 2011, we describe the impact of exposure to HBCs on selected HIV risk behaviors and HIV incidence among sexually active, HIV-negative adults (n = 11,232). Exposure to partner reduction HBCs was significantly associated with reporting fewer (i.e., 1 versus 2, or 2 versus ≥ 3) sexual partners in the prior 6 months at baseline among women (aOR = 3.02; 95% CI 1.38, 6.62); and at both baseline and at 6-months follow-up for men (aOR = 2.26; 95% CI 1.49, 3.44; aOR = 1.95, 95% CI [1.26-3.00], respectively). Despite these reported partner reductions, there was no association between HBC exposure and prospectively observed HIV seroconversions (n = 121). This analysis strengthens the evidence that HIV prevention at the population level requires integrated strategies.

Expansion of HIV testing in Eswatini: stakeholder perspectives on reaching the first 90.

Achieving the United Nations' 90-90-90 goals has proven challenging in most settings and the ambitious 95-95-95 goals seem even more elusive. However, in Eswatini - a lower-middle-income country in sub-Saharan Africa with the highest HIV prevalence in the world - an estimated 92% of people living with HIV know their status. We conducted 26 in-depth interviews with stakeholders from policy, implementation, donor, local advocacy and academic sectors to elicit the facilitators and inhibitors to HIV testing uptake in Eswatini. Background data and related reports and policy documents (n = 57) were also reviewed. Essential facilitators included good governance via institutional and national budgetary commitments, which often led to swift adoption of globally recommended programs and standards. The integration of HIV testing into all points of care fostered a sense that testing was part of routine care, which reduced stigma. Challenges, however, centred on social norms that disadvantage certain groups with high ongoing HIV risk (such as key populations, adolescent girls and young women), a heavy reliance on external donor funding, and stigma that had subsided but nevertheless persisted. Amid concerns about whether the 90-90-90 targets could be achieved by 2020, the experience of Eswatini provides tangible insights into factors that have successfully influenced HIV testing uptake and may thus prove informative for other countries.

Warming strategies for preventing hypothermia and shivering during cesarean section: A systematic review with network meta-analysis of randomized clinical trials.

BACKGROUND: Hypothermia and shivering are undesirable morbidities that occur commonly during cesarean section. Although some active warming strategies, such as the use of forced-air, mattresses, and fluid warming, can attenuate such adverse events, no studies have yet performed multiple contrast assessments of these strategies. We, therefore, conducted a network meta-analysis to simultaneously assess the effects of various warming strategies for cesarean section and assist clinicians in making informed decisions. METHODS: We searched databases for randomized clinical trials that investigated the effects of warming strategies during cesarean section, with primary outcomes targeted on shivering and hypothermia. Trial quality was assessed using the Cochrane Risk of Bias Tool. Quantitative synthesis was performed using consistency model and surface under the cumulative ranking curve (SUCRA). Results were presented as risk ratio (RR) with 95% confidence interval (CI). RESULTS: We identified 18 trials wherein 1953 women underwent a cesarean section. These trials performed 11 active warming strategies for 1620 women, and the other 333 women were in the non-active warming group. According to SUCRA, the combination of forced-air, fluids, and warmed gown warming could be a better strategy for reducing shivering rates compared with the other strategies (SUCRA = 88.5), albeit with an insignificant result. Conduction mattress warming (SUCRA = 89.4) and combination of conduction mattress and fluids warming (SUCRA = 80.2) were better strategies than others in reducing hypothermia. No evidence showed inconsistency or small study effects in our results. CONCLUSIONS: In clinical practice, forced-air-based warming strategies can be considered to prevent shivering, and conduction mattress-based warming strategies can be used to reduce hypothermia in women undergoing cesarean section.