THE URGENCY OF the HIV epidemic in China has created substantial interest in the prevention,treatment,care,and advocacy of HIV and AIDS. China has invested large portions of its public health structure to curb the spr...THE URGENCY OF the HIV epidemic in China has created substantial interest in the prevention,treatment,care,and advocacy of HIV and AIDS. China has invested large portions of its public health structure to curb the spread of the HIV epidemic within its borders. however,training and education of physicians has been traditionally less emphasized, stalled at the intersection between health education,clinical science,and public health.^2 The emerging HIV/AIDS clinician training needs must be revisited in light of the historical and biological context of HIV in China.This brief review of the clinician training needs in China will examine the history of STDs in China,the biological corollaries important to training,and the endpoints of recent studies assessing Chinese HIV and sexually transmitted disease (STI)clinician training.展开更多
Background:Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men(MSM).A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing amo...Background:Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men(MSM).A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing among MSM.Pay-it-forward offers an individual a gift(e.g.,a free test)and then asks the same person if they would like to give a gift to another person.This article reports the protocol of a randomized controlled trial to evaluate dual gonorrhea/chlamydia test uptake and other outcomes among MSM in three arms-a pay-it-forward arm,a pay-what-you-want arm,and a standard of care arm.Methods:Three hundred MSM will be recruited at three HIV testing sites in Guangzhou and Beijing.Testing sites include two hospital-based MSM sexually transmitted diseases clinics and one MSM community-based organization.Eligible participants will be born biologically male,aged 16 years or older,reporting previous anal sex with another man,having never participated in the pay-it-forward program,without previous gonorrhea and chlamydia testing in the past 12 months,and residing in China.Following a cluster randomized design,every cluster of ten participants will be randomly allocated into one of three arms:(1)a pay-it-forward arm in which men are offered free gonorrhea and chlamydia testing and then asked whether they would like to donate("pay it forward")toward testing for future testers;(2)a pay-what-you-want arm in which men are offered free testing and told to decide how much to pay after receiving the test;(3)a standard of care arm in which men can pay the full price for dual gonorrhoea and chlamydia testing.The primary outcome is dual gonorrhoea/chlamydia testing as verified by administrative records.Secondary outcomes include incremental cost per test,incremental cost per diagnosis,community connectedness,and social cohesion.Primary outcome will be calculated for each arm using intention-to-treat and compared using one-sided 95%confidence intervals with a margin of 20%increase defined as superiority.Discussion:This study will examine the pay-it-forward strategy in comparison to the standard of care in improving test uptake for gonorrhea and chlamydia.We will leverage the cluster randomized controlled trial to provide scientific evidence on the potential effect of pay-it-forward.Findings from this study will shed light on novel intervention methods for increasing preventive health service utilization and innovate ways to finance it among communities.Trial registration:ClinicalTrials.gov,NCT03741725.Registered on 12 November 2018.展开更多
Background:Crowdsourcing is used increasingly in health and medical research.Crowdsourcing is the process of aggregating crowd wisdom to solve a problem.The purpose of this systematic review is to summarize quantitati...Background:Crowdsourcing is used increasingly in health and medical research.Crowdsourcing is the process of aggregating crowd wisdom to solve a problem.The purpose of this systematic review is to summarize quantitative evidence on crowdsourcing to improve health.Methods:We followed Cochrane systematic review guidance and systematically searched seven databases up to September 4th 2019.Studies were included if they reported on crowdsourcing and related to health or medicine.Studies were excluded if recruitment was the only use of crowdsourcing.We determined the level of evidence associated with review findings using the GRADE approach.Results:We screened 3508 citations,accessed 362 articles,and included 188 studies.Ninety-six studies examined effectiveness,127 examined feasibility,and 37 examined cost.The most common purposes were to evaluate surgical skills(17 studies),to create sexual health messages(seven studies),and to provide layperson cardiopulmonary resuscitation(CPR)out-of-hospital(six studies).Seventeen observational studies used crowdsourcing to evaluate surgical skills,finding that crowdsourcing evaluation was as effective as expert evaluation(low quality).Four studies used a challenge contest to solicit human immunodeficiency virus(HIV)testing promotion materials and increase HIV testing rates(moderate quality),and two of the four studies found this approach saved money.Three studies suggested that an interactive technology system increased rates of layperson initiated CPR out-ofhospital(moderate quality).However,studies analyzing crowdsourcing to evaluate surgical skills and laypersoninitiated CPR were only from high-income countries.Five studies examined crowdsourcing to inform artificial intelligence projects,most often related to annotation of medical data.Crowdsourcing was evaluated using different outcomes,limiting the extent to which studies could be pooled.Conclusions:Crowdsourcing has been used to improve health in many settings.Although crowdsourcing is effective at improving behavioral outcomes,more research is needed to understand effects on clinical outcomes and costs.More research is needed on crowdsourcing as a tool to develop artificial intelligence systems in medicine.展开更多
Background:Diagnostics are essential for identifying and controlling diseases.However,limited access to diagnostics hinders public health efforts in many settings.Social innovation may provide a framework for expandin...Background:Diagnostics are essential for identifying and controlling diseases.However,limited access to diagnostics hinders public health efforts in many settings.Social innovation may provide a framework for expanding access to diagnostics in the global south.Here social innovation is defined as implementing a known public health tool via a novel,community-driven technique.Main Body:In this article,we discuss three diverse cases that show the potential for using social innovation in diagnostics.The cases chosen for inclusion here demonstrate the importance of social innovation in diagnostics across different geographic,cultural,and health system contexts.They include malaria testing via schools in Malawi,cervical human papillomavirus(HPV)sample self-collection in Peru,and crowdsourcing human immunodeficiency virus(HIV)testing in China.For each case,we present the public health problem and the impact of using social innovation to increase accessibility of diagnostics.We discuss implications of each diagnostic approach and the importance of social innovation in creating these potential solutions.We argue that social innovation is useful in improving the delivery of essential diagnostic tools in low-and middle-income countries.Conclusions:Interventions in Malawi,Peru,and China suggest social innovation increases uptake of diagnostics.The same tools and principles utilized in these cases can be adapted for use in other contexts.Such diagnostic innovations may help improve identification of and linkage to care for many diseases.The approach presents a unique opportunity to better address public health issues and increase accessibility in LMIC health systems.展开更多
Background:Human immunodefciency virus(HIV)self-testing may help improve test uptake among female sex workers.China has implemented many HIV self-testing programs among men who have sex with men,creating an opportunit...Background:Human immunodefciency virus(HIV)self-testing may help improve test uptake among female sex workers.China has implemented many HIV self-testing programs among men who have sex with men,creating an opportunity for promotion among female sex workers.However,there is a limited literature on examining HIV selftesting among female sex workers.This study aimed to examine HIV self-testing experiences and its determinants among female sex workers in China.Methods:A venue-based,cross-sectional study was conducted among Chinese female sex workers in 2019.Participants completed a survey including social-demographic characteristics,sexual behaviors,and HIV self-testing history,the distribution of which were analyzed using descriptive analysis.Multivariable logistic regression was conducted to identify associations with HIV self-testing.Results:Among 1287 Chinese female sex workers,1072(83.3%,95%confdence interval[CI]81.2-85.3%)had ever tested for HIV,and 103(8.0%,95%CI 6.6-9.6%)had ever used HIV self-testing.More than half reported that the selftest was their frst HIV test(59.2%,61/103),around one-ffth reported HIV self-testing results infuenced the price of sex(21.4%,22/103).A minority of individuals reported ever experiencing pressure to undertake HIV self-testing(6.8%,7/103).After adjusting for covariates,HIV self-testing was positively associated with receiving anal sex in the past month(adjusted odds ratio[aOR]=2.2,95%CI 1.4-3.5),using drugs before or during sex(aOR=2.8,95%CI 1.8-4.5),injecting drugs in the past 6 months(aOR=2.6,95%CI 1.2-6.0),being diagnosed with other sexually transmitted infections(aOR=1.6,95%CI 1.0-2.5),tested for other sexually transmitted infections in the past six months(aOR=3.4,95%CI 2.1-5.5),ever tested in the hospital(aOR=3.4,95%CI 2.0-5.6),and ever tested in the community(aOR=1.5,95%CI 1.2-1.9).Conclusions:Our fndings suggest that HIV self-testing could expand overall HIV testing uptake,increase HIV testing frequency,reach sub-groups of high-risk female sex workers and has limited potential harms among female sex workers.HIV self-testing should be incorporated among Chinese female sex workers as a complement to facility-based HIV testing services.展开更多
文摘THE URGENCY OF the HIV epidemic in China has created substantial interest in the prevention,treatment,care,and advocacy of HIV and AIDS. China has invested large portions of its public health structure to curb the spread of the HIV epidemic within its borders. however,training and education of physicians has been traditionally less emphasized, stalled at the intersection between health education,clinical science,and public health.^2 The emerging HIV/AIDS clinician training needs must be revisited in light of the historical and biological context of HIV in China.This brief review of the clinician training needs in China will examine the history of STDs in China,the biological corollaries important to training,and the endpoints of recent studies assessing Chinese HIV and sexually transmitted disease (STI)clinician training.
基金the National Key Research and Development Program of China(2017YFE0103800)the National Institutes of Health NIAID NIAID K24AI143471,1UG3HD096929-01,NIA P30(P30AG034420)+3 种基金UNC-South China STD Research Training Center(FIC 1D43TW009532-01)UNC Center for AIDS Research(NIAID 5P30AI050410)Doris Duke Charitable Foundation(International Clinical Research Fellowship to TZ)SESH(Social Entrepreneurship to Spur Health)Global.
文摘Background:Gonorrhea and chlamydia testing rates are poor among Chinese men who have sex with men(MSM).A quasi-experimental study suggested that a pay-it-forward strategy increased dual gonorrhea/chlamydia testing among MSM.Pay-it-forward offers an individual a gift(e.g.,a free test)and then asks the same person if they would like to give a gift to another person.This article reports the protocol of a randomized controlled trial to evaluate dual gonorrhea/chlamydia test uptake and other outcomes among MSM in three arms-a pay-it-forward arm,a pay-what-you-want arm,and a standard of care arm.Methods:Three hundred MSM will be recruited at three HIV testing sites in Guangzhou and Beijing.Testing sites include two hospital-based MSM sexually transmitted diseases clinics and one MSM community-based organization.Eligible participants will be born biologically male,aged 16 years or older,reporting previous anal sex with another man,having never participated in the pay-it-forward program,without previous gonorrhea and chlamydia testing in the past 12 months,and residing in China.Following a cluster randomized design,every cluster of ten participants will be randomly allocated into one of three arms:(1)a pay-it-forward arm in which men are offered free gonorrhea and chlamydia testing and then asked whether they would like to donate("pay it forward")toward testing for future testers;(2)a pay-what-you-want arm in which men are offered free testing and told to decide how much to pay after receiving the test;(3)a standard of care arm in which men can pay the full price for dual gonorrhoea and chlamydia testing.The primary outcome is dual gonorrhoea/chlamydia testing as verified by administrative records.Secondary outcomes include incremental cost per test,incremental cost per diagnosis,community connectedness,and social cohesion.Primary outcome will be calculated for each arm using intention-to-treat and compared using one-sided 95%confidence intervals with a margin of 20%increase defined as superiority.Discussion:This study will examine the pay-it-forward strategy in comparison to the standard of care in improving test uptake for gonorrhea and chlamydia.We will leverage the cluster randomized controlled trial to provide scientific evidence on the potential effect of pay-it-forward.Findings from this study will shed light on novel intervention methods for increasing preventive health service utilization and innovate ways to finance it among communities.Trial registration:ClinicalTrials.gov,NCT03741725.Registered on 12 November 2018.
基金This study was commissioned by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases.This project was also supported by NICHD UG3HD096929 and NIAID K24AI143471.
文摘Background:Crowdsourcing is used increasingly in health and medical research.Crowdsourcing is the process of aggregating crowd wisdom to solve a problem.The purpose of this systematic review is to summarize quantitative evidence on crowdsourcing to improve health.Methods:We followed Cochrane systematic review guidance and systematically searched seven databases up to September 4th 2019.Studies were included if they reported on crowdsourcing and related to health or medicine.Studies were excluded if recruitment was the only use of crowdsourcing.We determined the level of evidence associated with review findings using the GRADE approach.Results:We screened 3508 citations,accessed 362 articles,and included 188 studies.Ninety-six studies examined effectiveness,127 examined feasibility,and 37 examined cost.The most common purposes were to evaluate surgical skills(17 studies),to create sexual health messages(seven studies),and to provide layperson cardiopulmonary resuscitation(CPR)out-of-hospital(six studies).Seventeen observational studies used crowdsourcing to evaluate surgical skills,finding that crowdsourcing evaluation was as effective as expert evaluation(low quality).Four studies used a challenge contest to solicit human immunodeficiency virus(HIV)testing promotion materials and increase HIV testing rates(moderate quality),and two of the four studies found this approach saved money.Three studies suggested that an interactive technology system increased rates of layperson initiated CPR out-ofhospital(moderate quality).However,studies analyzing crowdsourcing to evaluate surgical skills and laypersoninitiated CPR were only from high-income countries.Five studies examined crowdsourcing to inform artificial intelligence projects,most often related to annotation of medical data.Crowdsourcing was evaluated using different outcomes,limiting the extent to which studies could be pooled.Conclusions:Crowdsourcing has been used to improve health in many settings.Although crowdsourcing is effective at improving behavioral outcomes,more research is needed to understand effects on clinical outcomes and costs.More research is needed on crowdsourcing as a tool to develop artificial intelligence systems in medicine.
文摘Background:Diagnostics are essential for identifying and controlling diseases.However,limited access to diagnostics hinders public health efforts in many settings.Social innovation may provide a framework for expanding access to diagnostics in the global south.Here social innovation is defined as implementing a known public health tool via a novel,community-driven technique.Main Body:In this article,we discuss three diverse cases that show the potential for using social innovation in diagnostics.The cases chosen for inclusion here demonstrate the importance of social innovation in diagnostics across different geographic,cultural,and health system contexts.They include malaria testing via schools in Malawi,cervical human papillomavirus(HPV)sample self-collection in Peru,and crowdsourcing human immunodeficiency virus(HIV)testing in China.For each case,we present the public health problem and the impact of using social innovation to increase accessibility of diagnostics.We discuss implications of each diagnostic approach and the importance of social innovation in creating these potential solutions.We argue that social innovation is useful in improving the delivery of essential diagnostic tools in low-and middle-income countries.Conclusions:Interventions in Malawi,Peru,and China suggest social innovation increases uptake of diagnostics.The same tools and principles utilized in these cases can be adapted for use in other contexts.Such diagnostic innovations may help improve identification of and linkage to care for many diseases.The approach presents a unique opportunity to better address public health issues and increase accessibility in LMIC health systems.
文摘Background:Human immunodefciency virus(HIV)self-testing may help improve test uptake among female sex workers.China has implemented many HIV self-testing programs among men who have sex with men,creating an opportunity for promotion among female sex workers.However,there is a limited literature on examining HIV selftesting among female sex workers.This study aimed to examine HIV self-testing experiences and its determinants among female sex workers in China.Methods:A venue-based,cross-sectional study was conducted among Chinese female sex workers in 2019.Participants completed a survey including social-demographic characteristics,sexual behaviors,and HIV self-testing history,the distribution of which were analyzed using descriptive analysis.Multivariable logistic regression was conducted to identify associations with HIV self-testing.Results:Among 1287 Chinese female sex workers,1072(83.3%,95%confdence interval[CI]81.2-85.3%)had ever tested for HIV,and 103(8.0%,95%CI 6.6-9.6%)had ever used HIV self-testing.More than half reported that the selftest was their frst HIV test(59.2%,61/103),around one-ffth reported HIV self-testing results infuenced the price of sex(21.4%,22/103).A minority of individuals reported ever experiencing pressure to undertake HIV self-testing(6.8%,7/103).After adjusting for covariates,HIV self-testing was positively associated with receiving anal sex in the past month(adjusted odds ratio[aOR]=2.2,95%CI 1.4-3.5),using drugs before or during sex(aOR=2.8,95%CI 1.8-4.5),injecting drugs in the past 6 months(aOR=2.6,95%CI 1.2-6.0),being diagnosed with other sexually transmitted infections(aOR=1.6,95%CI 1.0-2.5),tested for other sexually transmitted infections in the past six months(aOR=3.4,95%CI 2.1-5.5),ever tested in the hospital(aOR=3.4,95%CI 2.0-5.6),and ever tested in the community(aOR=1.5,95%CI 1.2-1.9).Conclusions:Our fndings suggest that HIV self-testing could expand overall HIV testing uptake,increase HIV testing frequency,reach sub-groups of high-risk female sex workers and has limited potential harms among female sex workers.HIV self-testing should be incorporated among Chinese female sex workers as a complement to facility-based HIV testing services.
