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Background: Most studies evaluating the effect of Xpert MTB/RIF testing for tuberculosis (TB) concluded that it did not reduce overall mortality compared to usual care. We conducted a systematic review to assess whether key study design and execution features contributed to earlier identification of patients with TB and decreased pre-treatment loss to follow-up, thereby reducing the potential impact of Xpert MTB/RIF testing. Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Scopus for literature published from 1 st January 2009 to February 2019. We included all primary intervention studies that had evaluated the effect of Xpert MTB/RIF on mortality compared to usual care in participants with presumptive pulmonary TB. We critically reviewed features of included studies across: Study setting and context, Study population, Participant recruitment and enrolment, Study procedures, and Study follow-up. Results: We included seven randomised and one non-randomised study.  All included studies demonstrated relative reductions in overall mortality in the Xpert MTB/RIF arm ranging from 6% to 40%. However, mortality reduction was reported to be statistically significant in two studies. Study features that could explain the lack of observed effect on mortality included: the higher quality of care at study sites; inclusion of patients with a higher pre-test probability of TB leading to higher than expected empirical rates; performance of additional diagnostic testing not done in usual care leading to increased TB diagnosis or empiric treatment initiation; the recruitment of participants likely to return for follow-up; and involvement of study staff in ensuring adherence with care and follow-up. Conclusion: Most studies of Xpert MTB/RIF were designed and conducted in a manner that resulted in more patients being diagnosed and treated for TB, minimising the potential difference in mortality Xpert MTB/RIF testing could have achieved compared to usual care.

Women participating in studies in Brazil (n = 695) and South Africa (n = 230) performed rapid point-of-care tests for Trichomonas vaginalis on self-collected vaginal swabs. Using PCR as the gold standard, rapid self-testing achieved high specificity (99.1%; 95% confidence interval [CI], 98.2 to 99.6%) and moderate sensitivity (76.7%; 95% CI, 61.4 to 88.2%). These tests may be considered an alternative to syndromic management in resource-poor settings.

Practicing evidence-based health care (EBHC) typically involves five steps: (1) formulating an answerable question from a healthcare problem; (2) finding the best available evidence applicable to the question; (3) critically appraising the evidence for validity, clinical relevance, and applicability; (4) applying the results of the evidence in the healthcare setting; and (5) evaluating the performance (Dawes et al., 2005). An important aim of EBHC is that beneficial, effective health care practices are adopted, and that harmful and ineffective ones are abandoned. Consequently, this requires healthcare professionals to recognise their deficiencies in knowledge and to adopt a philosophy of life-long learning, which is the backbone of practicing EBHC (Greenhalgh & Macfarlane, 1997). E-learning--also called web-based learning, online learning, distributed learning, computer-assisted instruction, and internet-based learning-- can be defined as the delivery of training material via information and communication technology (ICT), including the Internet, CD-ROMs, DVDs, smartphones, and other media, both inside and outside of the classroom (Frehywot et al., 2013; Ruggeri, Farrington, & Brayne, 2013; Ruiz, Mintzer, & Leipzig, 2006). The objectives of this review are: (1) To assess the effectiveness of e-learning of EBHC on increasing EBHC competencies in healthcare professionals; (2) To assess the effectiveness of specific dimensions of e-learning in increasing EBHC competencies; (3) To assess how educational context influences the effectiveness of EBHC e-learning; and (4) To assess how implementation approaches influence the effectiveness of EBHC e-learning.

To derive evidence-based and stakeholder-informed research priorities for implementation in African settings, the international research consortium Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) developed and applied a pragmatic approach. First, an online survey and face-to-face consultation between CEBHA+ partners and policy-makers generated priority research areas. Second, evidence maps for these priority research areas identified gaps and related priority research questions. Finally, study protocols were developed for inclusion within a grant proposal. Policy and practice representatives were involved throughout the process. Tuberculosis, diabetes, hypertension and road traffic injuries were selected as priority research areas. Evidence maps covered screening and models of care for diabetes and hypertension, population-level prevention of diabetes and hypertension and their risk factors, and prevention and management of road traffic injuries. Analysis of these maps yielded three priority research questions on hypertension and diabetes and one on road traffic injuries. The four resulting study protocols employ a broad range of primary and secondary research methods; a fifth promotes an integrated methodological approach across all research activities. The CEBHA+ approach, in particular evidence mapping, helped to formulate research questions and study protocols that would be owned by African partners, fill gaps in the evidence base, address policy and practice needs and be feasible given the existing research infrastructure and expertise. The consortium believes that the continuous involvement of decision-makers throughout the research process is an important means of ensuring that studies are relevant to the African context and that findings are rapidly implemented. Afin de determiner, a partir d'elements factuels et avec l'apport des parties prenantes, les priorites de recherche pouvant etre mises en oeuvre dans les pays d'Afrique, le consortium de recherche international Collaboration for Evidence-Based Health Care and Public Health In Africa (CEBHA+) a elabore et applique une demarche pragmatique. Tout d'abord, une enquete en llgne et une consultation en face a face entre les partenalres du CEBHA+ et les responsables politiques ont permis de mettre en lumiere les domaines de recherche priorltaires. Ensulte, des listes documentaires relatives a ces domaines de recherche prioritaires ont permis d'identifier les lacunes ainsi que des questions connexes prioritaires en matiere de recherche. Enfin, des protocoles d'etude ont ete mis au point en vue d'etre integres a une proposition de subvention. Des representants de la mise en oeuvre des politiques ont participe a l'ensemble du processus. La tuberculose, le diabete, l'hypertension et les blessures de la route ont ete selectionnes comme domaines de recherche prioritaires. Les listes documentaires portaient sur le depistage et les modeles de soins du diabete et de l'hypertension, sur la prevention de ces maladies ainsi que sur leurs facteurs de risque au niveau de la population, et sur la prevention et la prise en charge des blessures de la route. L'analyse de ces listes a permis de degager trois questions de recherche prioritaires portant sur l'hypertension et le diabete et une sur les blessures de la route. Les quatre protocoles d'etude en decoulant utilisent toute une serie de methodes de recherche primaire et secondaire; un cinquieme favorise une demarche methodologique integree sur l'ensemble des activites de recherche. La demarche du CEBHA+, en particulier la constitution de listes documentaires, a permis de formuler les questions de recherche et les protocoles d'etude qui reviendront aux partenaires africains, de combler les lacunes des bases de donnees et de repondre aux besoins en matiere de politiques et de pratiques; elle s'est egalement revelee applicable comptetenu de l'expertise et de l'infrastructure de recherche existantes. Pour le consortium, l'implication continue des decisionnaires dans le processus de recherche est un important moyen de garantir que les etudes soient pertinentes pour les pays africains et que leurs resultats soient rapidement mis en oeuvre. Para obtener las prioridades de investigacion documentadas y comunicadas a las partes interesadas para su implementacion en Africa, el consorcio de investigacion internacional Asociacion de Asistencia Medica Basada en Evidencia en Africa (CEBHA+, por sus siglas en ingles), desarrollo y aplico un enfoque pragmatico. En primer lugar, una encuesta en linea y una consulta presencial entre socios de la CEBHA+ y responsables politicos origino los sectores de investigacion prioritarios. En segundo lugar, unos mapas documentados para estos sectores de investigacion prioritarios identificaron disparidades y asuntos relativos a la Investigacion prioritaria. Por ultimo, se desarrollaron protocolos de estudio para incluirlos dentro de una propuesta de subvencion. Los representantes politicos y practicos participaron durante todo el proceso. Los sectores de investigacion prioritarios seleccionados fueron la tuberculosis, la diabetes, la hipertension y los traumatismos provocados por accidentes de trafico. Los mapas documentados abordaron el examen y los modelos de asistencia de la diabetes y la hipertension, la prevencion de la diabetes y la hipertension a nivel de poblacion, sus factores de riesgo y la prevencion y gestion de traumatismos provocados por accidentes de trafico. Los analisis de estos mapas generaron tres asuntos de Investigacion de prioridades sobre hipertension y diabetes y uno sobre traumatismos provocados por accidentes de trafico. Los cuatro protocolos de estudio resultantes emplean una amplia gama de metodos de investigacion primarios y secundarios; un quinto presenta un enfoque metodologico Integrado a traves de todas las actividades de Investigacion. El enfoque de la CEBHA+, concretamente los mapas documentados, contribuyo a formular cuestiones y protocolos de estudio sobre la investigacion que pertenecerian a socios africanos, subsanarian diferencias en la base de pruebas, abordarian las necesidades sobre politicas y practicas y serian viables gracias a la infraestructura y experiencia de investigacion existentes. El consorcio considera que la constante implicacion de los responsables de la toma de decisiones a lo largo del proceso de investigacion es un medio Importante para garantizar que los estudios se correspondan al contexto africano y que los resultados se mplementen con rapidez., Introduction Mortality in sub-Saharan Africa is still predominantly caused by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), malaria and other infectious diseases. However, premature deaths due to noncommunicable diseases and unintentional [...]