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Background: Pre-exposure prophylaxis (PrEP) is integral to the US End of AIDS strategy. However, low adherence, high costs, frequent testing and monitoring side effects make delivery of PrEP complicated. Gilead has sponsored PrEP-related research and access as part of its marketing efforts. We review conflict of interests (COI) in the scientific literature for the US PrEP-related articles to understand the impact of Gilead’s corporate sponsorship. Methods: We searched PubMed for US PrEP articles published in 2018 in the top 10 medical journals and top 10 HIV/AIDS journals and abstracted information on author/institutional COI, type of COI, and favorability of results and conclusions. We identified first three and senior authors from the articles and the leading institutions, defined as institution of three or more authors or participating institutions in a trial. We conducted on searches Google, PubMed, ClinicalTrials.gov, OpenPaymentsData.cms.gov, others to identify potential Gilead support to authors and institutions. Findings: Our search identified 93 articles. Of the 289 first three and senior authors in these articles, 34 (11%) declared a Gilead COI and 28 (10%) had undeclared Gilead COI. There were 51 leading institutions, of which, 12 (24%) declared Gilead COI and 22 (45%) had undeclared COI. Overall, 30 (32%) of the 93 articles had declared Gilead COI. Combining declared and undeclared COIs for authors and institutions provided an overall 83 (89%) articles with a potential Gilead COI. Declared Gilead support was significantly associated with favorable conclusions (p

Purpose of review The HIV and Mycobacterium tuberculosis syndemic remains a major global public health threat. HIV and tuberculosis (TB) global targets have been set. Success will depend on achieving combined disease control. We explore current policy, economic investment, and disease control strategies for HIV, TB, and HIV-associated TB. We review published HIV, TB, and HIV-associated TB data for 30 WHO priority countries and propose a comprehensive HIV and TB care continua. Recent findings In 2016, people living with HIV (PLHIV) on antiretroviral treatment (ART) ranged from 13 to 84%; viral suppression ranged from 21 to 79%. Only 5% of PLHIV without TB reported a course of isoniazid preventive therapy (IPT). TB treatment success (2015) ranged from 34 to 94%. Data for the combined indicators: TB treatment success and viral suppression and IPT and ART for PLHIV are not collected. Reported 2003-2017 global international and domestic resources for TB and HIV-associated TB averaged $2.9 billion per year; cumulative total was $43 billion. Summary Integrating HIV and TB control efforts including monitoring and evaluation systems will be necessary to end both TB and HIV. A comprehensive HIV and TB continuum supports integrated, comprehensive HIV and TB disease control efforts focused on improving both individual and public health.

Introduction and objectives: A public health project was conducted from first week of January 2018 to last week of March 2018 with a follow up in December 2018. The objective of the project was to study the impact of culturally relevant food and lifestyle guidelines on public health. i.e a Food systems approach versus a Food group approach to public health. The secondary objective was to broaden the definition of public health beyond weight loss and introduce the concept of metabolic health. Lastly, to demonstrate that social media can be an effective tool for disseminating food and lifestyle interventions to a large group of participants. Methodology: In this project, cumulative weekly guidelines were given to participants for 12 weeks. More than 125,000 participants from more than 40 countries across the globe registered for the project. At the beginning, the participants self-rated their score on six metabolic health parameters: energy levels during the day, sleep quality in the night, sweet cravings post meals, acidity/bloating/indigestion, exercise compliance, and pain during PMS/period (for women participants only). These parameters were than tracked throughout the 12 weeks through self-rating every 4 weeks. In addition, the participants tracked inch-loss from waist at the navel. The 12 weekly guidelines covered the following categories: Food and eating practices-related, Physical activity and exercise-related and Lifestyle and habits-related. Results: Incorporating the guidelines led to a significant improvement in metabolic health parameters (40 to 65 percent. on average) and also led to inches lost from the waist (more than 80 percent of participants lost at least an inch). The easy and sensible nature of the guidelines also ensured that even after one full year, most of the participants (more than 90 percent) continue to inculcate them in their daily lives. Conclusion: Public health messages therefore should focus on advocating local, culturally compliant and traditional foods and eating practices along with increase in physical activity and exercise and improvement in daily habits like gadget and plastic use.

We reviewed published national HIV care continua for men who have sex with men (MSM), people who inject drugs (PWID), and female sex workers (FSWs) to track progress toward the 90-90-90 target. We searched the Internet, PubMed, surveillance reports, United Nations Programme on HIV/AIDS country reports, US President’s Emergency Plan for AIDS Relief country/regional operational plans, and conference abstracts for the continua and graded them on quality. We found 12 continua for MSM, 7 for PWID, and 5 for FSW from 12 countries. HIV diagnosis, antiretroviral therapy coverage, and viral suppression varied between (1) 5% and 85%, 2% and 73%, and 1% and 72%, respectively for MSM; (2) 54% and 96%, 14% and 80%, and 8% and 68%, respectively for PWID; and (3) 27% and 63%, 8% and 16%, and 2% and 14%, respectively for FSW. Two countries, using data from national cohorts, were high quality. There are limited key population continua in the public domain. Of the few available, none have achieved 90-90-90. Improved monitoring and evaluation of key population continua is necessary to achieve the 90-90-90 target.

Although human immunodeficiency virus (HIV) first came to our attention thirty-seven years ago, the acquired immunodeficiency syndrome (AIDS) which it causes is, without treatment, 100% fatal with devastating consequences for millions of people[1][1]. More than 35 million people have already died of

Due to the present day to day life, it becomes difficult to maintain a healthy lifestyle. Hence, it results in a lack of proper blood flow to various parts of the body. Acupuncture was a technique used by the Chinese to improve health conditions which were based on scientific methods. Improper walking patterns may result in poorer health conditions and as mentioned above, improper blood flow to various parts of the body. Long duration walking and standing can result in hypoxia which refers to the low level of oxygen at various parts of the body. Active reflexology Actuating and footwear mapping allow to monitor and regulate health in a smarter way. It provides a solution for optimized blood flow by using the technique of acupuncture. Optimizing the blood flow in real time will result in the more practical exploration and understanding of the blood circulation pattern in the human body.

The human immunodeficiency virus (HIV) and Mycobacterium tuberculosis syndemic remains a global public health threat. Separate HIV and tuberculosis (TB) global targets have been set; however, success will depend on achieving combined disease control objectives and care continua. The objective of this study was to review available policy, budgets, and data to reconceptualize TB and HIV disease control objectives by combining HIV and TB care continua. For 22 World Health Organization (WHO) TB and TB/HIV priority countries, we used 2015 data from the HIV90–90–90watch website, UNAIDS AIDSinfo, and WHO 2016 and 2017 Global TB Reports. Global resources available in TB and HIV/TB activities for 2003–2017 were collected from publicly available sources. In 22 high-burden countries, people living with HIV on antiretroviral therapy ranged from 9 to 70%; viral suppression was 38–63%. TB treatment success ranged from 71 to 94% with 14 (81% HIV/TB burden) countries above 80% TB treatment success. From 2003 to 2017, reported global international and domestic resources for HIV-associated TB and TB averaged $2.85 billion per year; the total for 2003–2017 was 43 billion dollars. Reviewing combined HIV and TB targets demonstrate disease control progress and challenges. Using an integrated HIV and TB continuum supports HIV and TB disease control efforts focused on improving both individual and public health.

Osteomalacia in neurofibromatosis is a rare entity and distinct from more common dysplastic skeletal affections of this disease. As a rule, it is characterized by later onset in adulthood. There is renal phosphate loss with hypophosphatemia and multiple pseudofractures in the typical cases. The hypophosphatemic conditions that interfere in bone mineralization comprise many hereditary or acquired diseases, all of them sharing the same pathophysiological mechanism-reduction in phosphate reabsorption by the renal tubuli. This process leads to chronic hyperphosphaturia and hypophosphatemia, associated with inappropriately normal or low levels of calcitriol, causing rickets in children and osteomalacia in adults.

IntroductionHIV remains a major public health threat with over 75 million deaths, 2 million annual infections and over 1 million HIV-associated TB cases a year. Population-based studies suggest a marked decline in incidence, prevalence and deaths, mostly likely due to treatment expansion, in countries in East and Southern Africa. This calls into question the ART efficacy, effectiveness and coverage parameters used by many modelers to project HIV incidence and prevalence.MethodsFor 2015 and 2016 we reviewed global and national mathematical modeling studies regarding ART impact (with or without other HIV prevention interventions) and/or 90-90-90 on either new HIV infections or investment or both. We reviewed these HIV epidemiologic and costing models for their structure and parameterization around ART; we directly compared two models to illustrate differences in outcome.ResultsThe nine models published in 2015 or 2016 included parameters for ART effectiveness ranging from 20% to 86% for ART effectiveness. Model 1 limits eligibility for ART initiation to 80% coverage of people living with HIV and with a CD4+ cell count below 350 cells/μL, 70% retention, and ART reduces transmission by 80%, with a derived ART effectiveness of 20%. Model 2 assumes 90-90-90 by 2020 (i.e., 73% viral suppression of estimated PLHIV), ART reduces transmission by 96% in those on ART and virally suppressed, and by 88% in those on ART but not virally suppressed with a derived effectiveness of 86% and consequent decline towards ending AIDS and HIV elimination. ART parameter selection and assumptions dominate and low ART effectiveness translates into lower impact.DiscussionUsing more realistic parameters for ART effectiveness suggests that through expanding access and supporting sustainable viral suppression it will be possible to significantly reduce transmission and eliminate HIV in many settings.

The human immunodeficiency virus (HIV) infection and tuberculosis (TB) epidemics are major threats to global public health. About one third of the 35.3 million people living with HIV are latently infected with Mycobacterium tuberculosis, and are more likely to develop active TB disease than people who are not infected with HIV1,2 The World Health Organization (WHO) recommends the Three I’s for HIV/TB and early initiation of antiretroviral therapy (ART) to reduce the burden of TB in HIV-positive people.3 They include 1) intensified TB case finding (ICF), 2) TB prevention with isoniazid preventive treatment (IPT) and early ART, and 3) TB infection control (IC) in health care facilities and congregate settings. A recent systematic review confirmed that ART reduces the risk of developing TB by 65% across all CD4 count strata.4 The expansion of ART coverage also reduces TB incidence at the community and population levels in settings with a large burden of HIV-associated TB.5,6 The 2010 WHO ART guidelines recommend ART initiation at CD4 count ≤350 cells/mm3 for all asymptomatic people living with HIV, and irrespective of CD4 cell count for those with active TB.7 More recently, the WHO recognised the benefits of earlier treatment and recommended ART at CD4 count ≤500 cells/mm3 and irrespective of CD4 count for serodiscordant couples, pregnant women, children aged

Objective: This article reviews the antiretroviral therapy (ART) initiation criteria from national treatment guidelines for 70 countries and determines the extent of consistency with the current World Health Organization (WHO) recommendations. Methods: Published ART guidelines were collected from the Internet, databases, and WHO staff. ART eligibility criteria for asymptomatic people, pregnant women, people with HIV-associated tuberculosis, serodiscordant couples, injecting drug users, men who have sex with men, and sex workers were abstracted from them. Multiple regression analysis was used to determine the relation between ART eligibility criteria, ART coverage, and various population characteristics and policy interventions. Results: Of the 70 countries, 42 (60%) follow WHO’s ART guidelines for asymptomatic people and 31 (44%) for pregnant women, recommending ART at CD4 count of #350 cells/mm 3 . Twenty-three (33%) countries recommend ART for people with HIV-associated tuberculosis irrespective of CD4 count. Nineteen countries are also recommending or considering earlier ART above CD4 count #350 cell/mm 3 for asymptomatic people, pregnant women, and/or serodiscordant couples. Multiple linear regression analysis shows that HIV prevalence, year of publication of guidelines, and HIV expenditure are significantly associated with published ART eligibility criteria. On average, the ART coverage is similar irrespective of published guidelines being consistent with the WHO recommendation (P , 0.53). Conclusions: Published guidelines from a significant number of countries are not following WHO recommendations. Although published guidelines may not reflect practice, it is important to adapt recommendations and services quickly to reflect the emerging science on the health and prevention benefits of earlier access to ART.

Acute rheumatic fever and its sequelae, Rheumatic Heart Disease continues to be a major health problem in our country. Lack of specific criteria had lead to diagnostic chaos until the Jones Criteria in 1944. Despite Jones criteria and four revision and modifications Acute rheumatic fever is often under diagnosed. Modern facility like radiography and ECHO is not included in Jones criteria. Chest radiograph is an important part of the evaluation of patients with disease. Medical and Surgical treatment of mitral valve disease is particularly successful early in the course of the disease; therefore detection at initial presentation is of considerable importance. Characteristic changes in cardiac contour, are helpful in confirming the radiographic diagnosis in affected patients. The pulmonary parenchymal manifestations are the result of either pulmonary venous hypertension in mitral stenosis or abnormal regurgitation into pulmonary veins in mitral insufficiency. In this study we discuss and illustrate the imaging appearances of a variety of cardiac and pulmonary parenchymal manifestations of Rheumatic Heart Disease including selective chamber enlargement, pulmonary venous cephalization, pulmonary edema, diffuse alveolar hemorrhage, haemosiderosis and ossification. Familiarity with the gamut's of cardiac and pulmonary findings in patients with rheumatic heart disease, is crucial for early and rapid diagnosis and optimal patient care

Background: The World Health Organization (WHO) HIV treatment guidelines have been used by various countries to revise their national guidelines. Our study discusses the national policy response to the HIV epidemic in sub-Saharan Africa and quantifies delays in adopting the WHO guidelines published in 2009, 2013 and 2015.Methods: From the Internet, health authorities and experts, and community members, we collected 59 published HIV guidelines from 33 countries in the sub-Saharan African region, and abstracted dates of publication and antiretroviral therapy (ART) eligibility criteria. For these 33 countries, representing 97% regional HIV burden in 2015, the number of months taken to adopt the WHO 2009, 2013 and/or 2015 guidelines were calculated to determine the average delay in months needed to publish revised national guidelines.Findings: Of the 33 countries, 3 (6% regional burden) are recommending ART according to the WHO 2015 guidelines (irrespective of CD4 count); 19 (65% regional burden) are recommending ART according to the WHO 2013 guidelines (CD4 count ≤ 500 cells/mm3); and 11 (26% regional burden) according to the WHO 2009 guidelines (CD4 count ≤ 350 cells/mm3). The average time lag to WHO 2009 guidelines adoption in 33 countries was 24 (range 3–56) months. The 22 that have adopted the WHO 2013 guidelines took an average of 10 (range 0–36) months, whilst the three countries that adopted the WHO 2015 guidelines took an average of 8 (range 7–9) months.Conclusion: There is an urgent need to shorten the time lag in adopting and implementing the new WHO guidelines recommending ‘treatment for all’ to achieve the 90-90-90 targets.

Background In 2014, the Joint United Nations Program on HIV/AIDS (UNAIDS) issued treatment goals for human immunodeficiency virus (HIV). The 90-90-90 target specifies that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed. Consistent methods and routine reporting in the public domain will be necessary for tracking progress towards the 90-90-90 target. Methods and findings For the period 2010–2016, we searched PubMed, UNAIDS country progress reports, World Health Organization (WHO), UNAIDS reports, national surveillance and program reports, United States President’s Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans, and conference presentations and/or abstracts for the latest available national HIV care continuum in the public domain. Continua of care included the number and proportion of people living with HIV (PLHIV) who are diagnosed, on ART, and virally suppressed out of the estimated number of PLHIV. We ranked the described methods for indicators to derive high-, medium-, and low-quality continuum. For 2010–2016, we identified 53 national care continua with viral suppression estimates representing 19.7 million (54%) of the 2015 global estimate of PLHIV. Of the 53, 6 (with 2% of global burden) were high quality, using standard surveillance methods to derive an overall denominator and program data from national cohorts for estimating steps in the continuum. Only nine countries in sub-Saharan Africa had care continua with viral suppression estimates. Of the 53 countries, the average proportion of the aggregate of PLHIV from all countries on ART was 48%, and the proportion of PLHIV who were virally suppressed was 40%. Seven countries (Sweden, Cambodia, United Kingdom, Switzerland, Denmark, Rwanda, and Namibia) were within 12% and 10% of achieving the 90-90-90 target for “on ART” and for “viral suppression,” respectively. The limitations to consider when interpreting the results include significant variation in methods used to determine national continua and the possibility that complete continua were not available through our comprehensive search of the public domain. Conclusions Relatively few complete national continua of care are available in the public domain, and there is considerable variation in the methods for determining progress towards the 90-90-90 target. Despite bearing the highest HIV burden, national care continua from sub-Saharan Africa were less likely to be in the public domain. A standardized monitoring and evaluation approach could improve the use of scarce resources to achieve 90-90-90 through improved transparency, accountability, and efficiency., In a systematic review, Reuben Granich and colleagues assess the quality and comparability of publicly available data on national HIV care continua and progress towards the 90-90-90 targets., Author summary Why was this study done? Treatment prevents human immunodeficiency virus (HIV) illness, death, and transmission, prompting the Joint UN Program on HIV/AIDS (UNAIDS) to issue the 90-90-90 target. The 90-90-90 target specifies that by 2020, 90% of individuals living with HIV will know their HIV status, 90% of people with diagnosed HIV infection will receive antiretroviral treatment (ART), and 90% of those taking ART will be virally suppressed. Our review aims to answer three critical questions: (1) What data for national continua of care are available in the public domain? (2) What is the quality and comparability of the information presented? and (3) How close are we to achieving the UNAIDS 90-90-90 targets? What did the researchers do and find? For the period 2010–2016, we searched the public domain for the latest available national HIV care continuum with the number and proportion of people living with HIV (PLHIV) who are diagnosed, on ART, and virally suppressed. We found 53 national care continua with viral suppression estimates (representing 54% of the 2015 global estimate of PLHIV), and the average proportion of PLHIV on ART and the average proportion of PLHIV who were virally suppressed were 48% and 40%, respectively. Although seven countries (Sweden, Cambodia, UK, Switzerland, Denmark, Rwanda, and Namibia) had reached or were within 12% and 10% of achieving the 90-90-90 target for “on ART” and for “viral suppression,” only 9 countries in sub-Saharan Africa had care continua with viral suppression estimates in the public domain. Limitations include significant variation in the methods used to determine national continua and the possibility that complete continua were not available through our comprehensive search of the public domain. What do these findings mean? Many countries are progressing toward and will likely achieve 90-90-90; however, it will be important to use consistent and accurate methods to report on progress. Relatively few complete national continua of care are available in the public domain, and there is wide variation in the methods for determining progress towards the 90-90-90 target. Despite bearing the highest HIV burden, complete national care continua from sub-Saharan Africa were less likely to be in the public domain. A standardized monitoring and evaluation approach could improve the use of scarce resources to achieve 90-90-90 through improved transparency, accountability, and efficiency.

We assess the prospects for ending AIDS in South Africa using a dynamical model to fit data on time trends in HIV prevalence and anti-retroviral treatment (ART) coverage for adults. We estimate current and project future trends in HIV incidence, prevalence and AIDS related deaths, in ART coverage and incidence, and in TB notification rates. We consider two scenarios: constant effort under which people continue to be started on treatment at the current rate and expanded treatment and prevention under which testing rates are increased, everyone is started on treatment as soon as they are found to be infected with HIV, and voluntary medical male circumcision, pre-exposure prophylaxis and condom distribution programmes are expanded.As a result of the roll-out of ART the incidence of HIV has fallen from a peak of 2.3% per annum in 1996 to 0.65% in 2016, the AIDS related mortality from a peak of 1.4% per annum in 2006 to 0.37% p.a. in 2016 and both continue to fall at a relative rate of 17% p.a. Maintaining a policy of constant effort will lead to further declines in HIV incidence, AIDS related mortality and TB notification rates but will not end AIDS. Implementing a policy of expanded treatment and prevention in September 2016 should ensure that by 2020 new infections and deaths will be less than one per thousand adults and the UNAIDS Goal of Ending AIDS by 2030 will be reached. Scaling up voluntary medical male circumcision, pre-exposure prophylaxis and condom availability will avert some new infections but will save relatively few lives. Nevertheless, equity demands that people at very high risk of infection including commercial sex-workers, men-who-have-sex-with-men and young women should have access to the best available methods of prevention.The current cost to the health services of managing HIV and TB among adults in South Africa is about US$2.1 Bn p.a. (0.6% of GDP p.a.) and this will rise to a peak of US$2.7 Bn p.a. in 2018 (0.8% GDP p.a.). As treatment is scaled up and prevention made available to those at high risk, the cost will fall to US$ 1.8 Bn p.a. in 2030 and US$ 1.0 Bn p.a. in 2050 as those that are living with HIV on ART, die of natural causes. The cost of testing people for HIV is never more than about 8% of the total cost and since testing is the sine qua non of treatment it will be essential to invest sufficient resources in testing. The cost of treating tuberculosis is never more than about 10% of the total and since this is the major cause of AIDS related illness and deaths, efforts should be made to optimise TB treatment.Ending AIDS in the world will depend critically on what happens in South Africa which accounts for 20% of all people living with HIV. The increasing availability of ART has had a major impact on both HIV incidence and AIDS related mortality and universal access to ART is affordable. With the commitment to make treatment available to all those infected with HIV in September 2016, the South African government is well placed to eliminate HIV as a major threat to public health by 2020 and to end AIDS by 2030. Individuals at high risk of infection deserve access to the best available methods of protecting themselves and they will become increasingly important in the final stages of ending the epidemic.

CITATION: Granich, R., Gupta, S. & Williams, B. G. 2019. Questionable assumptions mar modelling of Kenya home-based testing campaigns. Journal of the International AIDS Society, 22(1):e25230, doi:10.1002/jia2.25230.

SummarySettingThe Human Immunodeficiency Virus (HIV) and Mycobacterium tuberculosis syndemic remains a global public health threat. Separate HIV and TB global targets have been set, however, success will depend on achieving combined disease control objectives and care continua.ObjectiveReview available policy, budgets and data to re-conceptualize TB and HIV disease control objectives by combining HIV and TB care continua.MethodsFor 22 WHO TB and TB/HIV priority countries, we used 2014 and 2015 data from the HIV90-90-90watch website, UNAIDS Aidsinfo, and WHO 2016 Global TB Report. Global resources available in TB and HIV/TB activities for 2003-2017 was collected from publically available sources.ResultsIn 22 high burden countries people living with HIV (PLHIV) on ART ranged from 9-70%; viral suppression was 38-63%. TB treatment success ranged from 34-94% with 13 (43% HIV/TB burden) countries above 80% TB treatment success. From 2003-2017, global international and domestic resources for HIV-associated TB and TB averaged $2.6 billion per year; the total for 2003-2017 was 39 billion dollars.ConclusionReviewing combined HIV and TB targets demonstrate disease control progress and challenges. Using an integrated HIV and TB continuum supports HIV and TB disease control efforts focused on improving both individual and public health.FundingNone

Antiretroviral therapy (ART) policy for people living with human immunodeficiency virus (HIV) has historically been based on clinical indications, such as opportunistic infections and CD4 cell counts. Studies suggest that CD4 counts early in HIV infection do not predict relevant public health outcomes such as disease progression, mortality, and HIV transmission in people living with HIV. CD4 counts also vary widely within individuals and among populations, leading to imprecise measurements and arbitrary ART initiation. To capture the clinical and preventive benefits of treatment, the global HIV response now focuses on increasing HIV diagnosis and ART coverage. CD4 counts for ART initiation were necessary when medications were expensive and had severe side effects, and when the impact of early ART initiation was unclear. However, current evidence suggests that although CD4 counts may still play a role in guiding clinical care to start prophylaxis for opportunistic infections, CD4 counts should cease to be required for ART initiation.

BACKGROUND: Social media is increasingly used to deliver HIV interventions for key populations worldwide. However, little is known about the specific uses and effects of social media on human immunodeficiency virus (HIV) interventions. OBJECTIVE: This systematic review examines the effectiveness of social media interventions to promote HIV testing, linkage, adherence, and retention among key populations. METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and Cochrane guidelines for this review and registered it on the International Prospective Register of Systematic Reviews, PROSPERO. We systematically searched six databases and three conference websites using search terms related to HIV, social media, and key populations. We included studies where (1) the intervention was created or implemented on social media platforms, (2) study population included men who have sex with men (MSM), transgender individuals, people who inject drugs (PWID), and/or sex workers, and (3) outcomes included promoting HIV testing, linkage, adherence, and/or retention. Meta-analyses were conducted by Review Manager, version 5.3. Pooled relative risk (RR) and 95% confidence intervals were calculated by random-effects models. RESULTS: Among 981 manuscripts identified, 26 studies met the inclusion criteria. We found 18 studies from high-income countries, 8 in middle-income countries, and 0 in low-income countries. Eight were randomized controlled trials, and 18 were observational studies. All studies (n=26) included MSM; five studies also included transgender individuals. The focus of 21 studies was HIV testing, four on HIV testing and linkage to care, and one on antiretroviral therapy adherence. Social media interventions were used to do the following: build online interactive communities to encourage HIV testing/adherence (10 studies), provide HIV testing services (9 studies), disseminate HIV information (9 studies), and develop intervention materials (1 study). Of the studies providing HIV self-testing, 16% of participants requested HIV testing kits from social media platforms. Existing social media platforms such as Facebook (n=15) and the gay dating app Grindr (n=10) were used most frequently. Data from four studies show that HIV testing uptake increased after social media interventions (n=1283, RR 1.50, 95% CI 1.28-1.76). In the studies where social media interventions were participatory, HIV testing uptake was higher in the intervention arm than the comparison arm (n=1023, RR 1.64, 95% CI 1.19-2.26). CONCLUSIONS: Social media interventions are effective in promoting HIV testing among MSM in many settings. Social media interventions to improve HIV services beyond HIV testing in low- and middle-income countries and among other key populations need to be considered. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO): CRD42016048073; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42016048073 (Archived by WebCite at http://www. webcitation.org/6usLCJK3v).

Issuance of national policy guidance is a critical step to ensure quality HIV-TB (human immunodeficiency virustuberculosis) coordination and programme implementation. From the database of the Joint United Nations Programme on HIV/AIDS (UNAIDS), we reviewed 62 national HIV and TB guidelines from 23 high-burden countries for recommendations on HIV testing for TB patients, criteria for initiating antiretroviral therapy (ART) and the Three I’s for HIV/TB (isoniazid preventive treatment [IPT], intensified TB case finding and TB infection control). We used UNAIDS country-level programme data to determine the status of implementation of existing guidance. Of the 23 countries representing 89% of the global HIV-TB burden, Brazil recommends ART irrespective of CD4 count for all people living with HIV, and four (17%) countries recommend ART at the World Health Organization (WHO) 2013 guidelines level of CD4 count 6500 cells/mm3 for asymptomatic persons. Nineteen (83%) countries are consistent with WHO 2013 guidelines and recommend ART for HIV-positive TB patients irrespective of CD4 count. IPT is recommended by 16 (70%) countries, representing 67% of the HIV-TB burden; 12 recommend symptom-based screening alone for IPT initiation. Guidelines from 15 (65%) countries with 79% of the world’s HIV-TB burden include recommendations on HIV testing and counselling for TB patients. Although uptake of ART, HIV testing for TB patients, TB screening for people living with HIV and IPT have increased significantly, progress is still limited in many countries. There is considerable variance in the timing and content of national policies compared with WHO guidelines. Missed opportunities to implement new scientific evidence and delayed adaptation of existing WHO guidance remains a key challenge for many countries.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) Treatment 2015 calls for expanded access to HIV care and treatment, including cotrimoxazole preventive therapy (CPT), for prevention of HIV-related morbidity and mortality. We review 115 national guidelines from 92 countries for recommendations on CPT for adults and adolescents and determine the level of consistency with the World Health Organization (WHO) guidelines. Of the 66 countries with recommendations, 5 (8%) countries recommend lifelong CPT for people living with HIV; 19 (29%) countries recommend a CD4 count threshold of ≤350 cells/mm3 or WHO clinical stages III and IV or II, III, and IV; and 19 (29%) countries recommend a CD4 count threshold of ≤200 cells/mm3. Of the 48 countries with recommendations on discontinuing CPT, 25 (52%) countries recommend discontinuation of cotrimoxazole when the CD4 count is >200 cells/mm3. World Health Organization guidelines offer countries flexibility on the use of CPT, and countries are recommending a wide range of CD4 counts and WHO clinical stage criteria for prophylaxis initiation and discontinuation.

There is considerable scientific evidence supporting the use of antiretroviral therapy (ART) in prevention of human immunodeficiency virus (HIV) and tuberculosis (TB) infections. The complex nature of the HIV and TB prevention responses, resource constraints, remaining questions about cost and feasibility, and the need to use a solid evidence base to make policy decisions, and the implementation challenges to translating trial data to operational settings require a well-organised and coordinated response to research in this area. To this end, we aimed to catalogue the ongoing and planned research activities that evaluate the impact of ART plus other interventions on HIV- and/or TB-related morbidity, mortality, risk behaviour, HIV incidence and transmission. Using a limited search methodology, 50 projects were identified examining ART as prevention, representing 5 regions and 52 countries with a global distribution. There are 24 randomised controlled clinical trials with at least 12 large randomised individual or community cluster trials in resource-constrained settings that are in the planning or early implementation stages. There is considerable heterogeneity between studies in terms of methodology, interventions and geographical location. While the identified studies will undoubtedly advance our understanding of the efficacy and effectiveness of ART for prevention, some key questions may remain unanswered or only partially answered. The large number and wide variety of research projects emphasise the importance of this research issue and clearly demonstrate the potential for synergies, partnerships and coordination across funding agencies.