Effect of Social Support Interventions on Adherence to Antiretroviral Therapy Among People Living with HIV: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis examined the effects of social support interventions (SSIs) on adherence to antiretroviral therapy (ART) among people living with HIV. We systematically searched Web of Science, PubMed/MEDLINE, Scopus, and Cochrane Library in September 9, 2020. English-language publications of randomized controlled trials (RCTs) in peer-reviewed journals were considered eligible. To estimate the effects of SSIs on adherence to ART, odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using random effects models. Subgroup analysis was used to investigate the sources of heterogeneity. Of 243 records identified, 17 controlled trials were included. The meta-analysis found significant and moderate effect size in the improvement of adherence to ART from SSIs. Subgroup analysis showed that the study design, follow up duration, source of social support, and year of publication significantly moderated the effect sizes in the meta-analysis. Our findings support the hypothesis that social support interventions can improve adherence to ART. Using various types and sources of social support, further research is needed to assess the effect of SSIs on adherence to ART across different settings.

Concordance assessment between self-reports of substance use and urinalysis: A population-based study in Mashhad, Iran.

BACKGROUND: Few studies have addressed the validity of self-reports of substance use in Iran. This study was conducted to evaluate concordance between self-reported data on drug use and urinalysis results in an adult population in Mashhad as the second most populous city in Iran. METHODS: This population-based study recruited 2142 Mashhad residents aged over 16 years. The data were obtained from a study conducted in 2015 on the prevalence of chronic kidney disease (CKD) in an adult population in Mashhad. The participants were selected using multistage stratified cluster sampling. To evaluate the validity, the participants' responses to a single-question screening test of drug use were compared with their urinalysis results. The sensitivity, specificity, and positive and negative predictive values of the self-reports were also assessed. RESULTS: The prevalence of drug use was found to be 2.33% (95% CI: 1.75-3.09) based on the self-reported data and 17.74% (95% CI: 16.15-19.43) based on the urinalysis results. Opioids were the most prevalent form of drug used and the self-reports indicated low validity (sensitivity = 12.63%, 95% CI: 9.54-16.49). The women were found more predisposed than the men to misreporting their drug use. DISCUSSION: In line with other studies in Iran, the validity of the self-reports of drug use was found to be low. Policymakers should therefore avoid relying only on self-reported data to evaluate the effectiveness of interventions and preventive strategies.It is recommended that further in-depth studies be conducted to address the factors affecting the validity of self-reports in Iranian populations.

Direct Inpatient Cost and Payments of COVID-19 in Iran: Quantile Regression Analysis.

Background: COVID-19 pandemic imposes a substantial medical and socioeconomic burden on health systems. The study aimed to estimate the direct inpatient costs of COVID-19 in Iran. Methods: This is a Cost of Illness (COI) study with the bottom-up method. Provider perspective and prevalence approach were applied for cost identification. Data included inpatient charges and clinical characteristics of all COVID-19 cases (2015 patients) admitted to a teaching hospital during a financial year (March 2020 to February 2021). We extracted data from Hospital Information System (HIS) and applied the quantile regression to estimate determinant factors of COVID-19 inpatient cost using STATA software. Results: 1026 (50.92%) of admitted COVID-19 patients were female, and 42.3% were older than 65 years. More than 82% of discharged COVID-19 patients in this study recovered. 189 (9.38%) patients admitted to ICUs. Length of Stay (LOS) for about 70% of admitted COVID-19 cases was 7 days or less. The Total Inpatient Charges (TIC) was 155,372,056,826 Rials (5,041,836 PPP USD). The median charge was 42,410,477 Rials, and Average Inpatient Charges (AIC) was 77,107,720±110,051,702 (2,461 PPP USD) per person. Drugs and supplies accounted for 37% of total inpatient charges. Basic insurance companies would pay more than 79% of total claims and the share of Out-of-Pocket Payments (OOP) was 7%. ICUs admission and LOS of more than 3 days are associated with higher costs across all percentiles of the cost distribution (p<0.001). Conclusion: This study call attention to the substantial economic burden based on real-world data. According to the broad socio-economic impacts of COVID-19 and also multiple components of COI study designs, conducting meta-analysis approaches is needed to combine results from independent studies.

Perceived social support and compliance with stay-at-home orders during the COVID-19 outbreak: evidence from Iran.

BACKGROUND: Strong evidence demonstrates that social support plays a key role in facilitating preventive health behaviors. The aim of the current study was to assess the effects of perceived social support on compliance with stay-at-home orders in response to a COVID-19 outbreak during the Persian New Year (Nowruz) holydays, since Nowruz holidays of 2020 coincided with the peak of the coronavirus epidemic in Iran. METHODS: This cross-sectional survey was carried out based on phone interviews of 1073 adults aged over 18 years from 4 to 12 April 2020 in Mashhad, Khorasan-Razavi Province, as the second largest city of Iran. A systematic random sampling was carried out using fixed phone number lists provided by Telecommunication Company of Khorasan-Razavi Province. Phone interviews were carried out by trained interviewers from the Iranian Students Polling Agency (ISPA) at various times of the day. The survey included sociodemographic questions, perceived social support scale (MSPSS) and questions about self-isolation during the Nowruz holiday. Statistical analysis included Chi-square test, Mann-Whitney test and multivariate logistic regression. RESULTS: 20.5% of participants reported poor compliance with stay at home orders during the first 2 weeks of Nowruz. Clear social gradients were not found in stay-at-home compliance. When controlling socio-demographic factors, perceived social support, interestingly, both fostered and hindered people's compliance with stay at home orders, depending on the source of support from family members (OR = .874, 95% CI = .803, .950, p < .005), friends (OR = 1.147, 95% CI = 1.076, 1.222, p < .001) and a significant other person (OR = .926, 95% CI = .849, 1.010, p = .084). CONCLUSIONS: Public health messaging may need to emphasize the role that friends and families can play in helping to protect those in their friendship/family groups by promoting compliance with social distancing. Further in-depth studies are recommended to evaluate how this kind of messaging can most effectively encourage people to engage in social distancing practices.

A fuzzy set qualitative comparative analysis of 131 countries: which configuration of the structural conditions can explain health better?

BACKGROUND: According to the recommendations of the World Health Organization Commission On Social Determinants of Health (CSDH) for intersectoral action on health, the well-being of and equity in health within a population are achieved via a complex fusion of policies and actions. In this study, following the CSDH's approach and considering set-theoretic relations, we aimed to unravel this complexity and answer the kinds of questions that are outside the scope of conventional variable-oriented approach. METHODS: A fuzzy-set qualitative comparative analysis of 131 countries was conducted to examine the configurational effects of five macro-level structural conditions on life expectancy at birth. The potential causal conditions were level of country wealth, income inequality, quality of governance, education, and health system. The data collected from different international data sources were recorded during 2004-2015. RESULTS: The intermediate solution of the truth table analysis indicated a configuration of conditions including high level of governance, education, wealth, and affluent health system to be consistently sufficient for high life expectancy. On the other hand, four configurations, each containing two or three conditions, were consistent with being usually sufficient to cause low life expectancy. CONCLUSIONS: We were able to configurationally explore the cases and specify the combinations of potentially causal conditions which were usually sufficient to explain high or low life expectancy in different countries. As a result, particular cases were identified for further research. In addition, research may provide support for the CSDH's recommendations emphasizing the importance of intersectoral action for health.

Social Determinants of Adherence to COVID-19 Preventive Guidelines in Iran: A Qualitative Study.

INTRODUCTION: Adherence to COVID-19 preventative guidelines may be influenced by a variety of factors at the individual, societal, and institutional levels. The current study sought to investigate the social factors of adherence to those preventive measures from the perspective of health professionals. METHODS: In October 2020, we performed qualitative research in Tehran, Iran, using the directed content analysis method. For the preparation of our interview guide and data analysis, we employed the WHO conceptual framework of socioeconomic determinants of health. Semi-structured interviews were conducted with 15 health professionals and policymakers who were chosen using a purposive sampling approach. MAXQDA-18 software was used to analyze the data. The Goba and Lincoln criteria were used to assess the quality of the results. RESULTS: There are 23 subcategories and 9 categories, which include socio-economic and political context (unstable macroeconomic environment, poor management of the pandemic, media and knowledge transfer), cultural and social values (fatalism, cultural norms, value conflicts, social customs), socio-economic positions (livelihood conditions), social capital (social cohesion, low trust), living conditions (housing conditions), occupational conditions (precarious employment), individual characteristics (demographic characteristics, personality traits, COVID-19 knowledge, and attitude), psycho-social factors (normalization of the disease, social pressure, and stigma), and health system leadership (health system problems, not taking evidence-based decisions, non-comprehensive preventive guidelines, non-operational guidelines, inadequate executive committee) were obtained. CONCLUSION: To limit the new COVID-19 transmission, people must be encouraged to follow COVID-19 prevention instructions. Improving adherence to COVID-19 preventive guidelines necessitates dealing with the complexities of responding to social determinants of those guidelines. Increasing public health literacy and knowledge of COVID-19, informing people about the consequences of social interactions and cultural customs in the spread of COVID-19, strengthening regulatory lockdown laws, improving guarantees for adhering to preventive guidelines, providing easy access to preventive supplies, and strengthening financial support for households with precarious employment are all important.

Anxiety Severity Levels and Coping Strategies during the COVID-19 Pandemic among People Aged 15 Years and Above in Gonabad, Iran.

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak is a global health problem. It is necessary to provide evidence on its unprecedented psychological effects to develop effective psychological interventions. The current study aims to determine the anxiety severity level, coping strategies, and influencing factors in response to the COVID-19 pandemic among people aged 15 years and above in Gonabad, Iran. METHODS: We conducted a cross-sectional survey via online questionnaires between February and March 2020. We evaluated the anxiety severity levels and coping strategies using the Corona Disease Anxiety Scale (CDAS) and Coping Inventory for Stressful Situations-Short Form (CISS-SF), respectively. Multinomial and ordinal logistic regression models were used to identify the predictors of coping strategies and anxiety. RESULTS: Totally, 500 people completed the questionnaires (response rate: 73%). Of them, 53.4% (95% confidence interval [CI]: 48.9%- 57.8%) suffered moderate to severe levels of anxiety. More than half of the respondents (52.0%; 95% CI: 47.5%-56.4%) utilized emotional-based or avoidant coping strategies. People with no academic education (odds ratio [OR]: 2.16; 95% CI: 1.41- 3.31) and without physical exercise (OR: 2.04; 95% CI: 1.22-3.33) preferred emotional-based coping instead of problem-based coping strategy. Female gender (OR: 1.60, 95%, CI: 1.13-2.28), underlying medical conditions (OR: 2.52, 95% CI: 1.65-3.87), and emotional-based coping (OR: 4.06, 95% CI: 2.76-5.99) were associated with higher severity levels of anxiety. CONCLUSION: The severity of anxiety during the COVID-19 pandemic was significant among participants. Further attention is needed to enhance the mental health of the vulnerable population during the COVID-19 pandemic. Our findings also identified some factors related to the severity level of anxiety related to COVID-19 that could help formulate better psychological interventions.