搜索结果：AIDS reviews

HIV/AIDS is not only a physiological condition requiring long-term medical intervention but also a complex public health issue embedded within social structures, psychological experiences and cultural contexts. Although the widespread use of highly active antiretroviral therapy (HAART) has significantly extended the life expectancy of people living with HIV and improved outcomes, socially stigmatized perceptions, persistent psychological trauma and systemic social exclusion remain obstacles that limit the effectiveness of care, forming a "physiologically manageable, psychologically and socially intractable" care paradox. Drawing on an interdisciplinary perspective integrating art therapy, public health, sociology and cultural studies, this paper reviews the value, mechanisms, and practical paradigms of visual arts, participatory arts, and arts education in HIV/AIDS care, prevention, and social support systems. By examining multiple globally documented art intervention projects, the study explores the logic of art as a non-clinical intervention medium in emotional empowerment, meaning reconstruction, and social network building, demonstrating its central role in supplementing limitations of traditional medical and social work approaches and addressing stigma surrounding HIV/AIDS. Ultimately, the paper proposes an integrated "art-medical-social" care pathway, providing theoretical support and practical guidance for establishing a more inclusive and human-centered HIV/AIDS care system.

Young people face challenges in accessing information on HIV and sexual and reproductive health services, with corresponding suboptimal uptake. Decision aids can provide information and decisional support to improve young people's engagement with health interventions. However, they have not been widely implemented among young people. The availability of different choices for HIV and pregnancy prevention means that it is important to implement interventions that facilitate informed choices for these methods. We describe a protocol for a scoping review that aims to explore the availability, acceptability and use of decision aids for HIV prevention and contraception for young people. We will identify relevant studies from the following electronic databases from inception to current date: PubMed, Scopus and Global Health; and grey literature databases, namely medRxiv and Open Access Theses and Dissertations. Eligible studies will report on HIV prevention and/or contraception decision aids and be written in English. Data extraction will be done by two reviewers independently using templates, with discrepancies resolved by consensus. Analysis will be done narratively, and separate for HIV prevention and contraception decision aids. Analysis will also include determination of the suitability of each decision aid for use by young people aged 15-24 years. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews will be employed to present results. This review does not require ethics approval. The findings from this work will be disseminated through peer-reviewed publications and presentations at local and international conferences. This scoping review protocol is registered in Open Science Framework with Project DOI: 10.17605/OSF/IO/46YWG (accessible via: https://doi.org/10.17605/OSF.IO/46YWG).

Human Immunodeficiency Virus (HIV) reported alarmingly increase daily, and poses threat to epidemic control globally. A significant number of these new cases (up to 70%) is being accounted for by the Key Population (KP). However, stigma and discrimination in our conventional healthcare systems lead to poor access to treatment among these populations. The current study reviews some of the healthcare models implemented for KP HIV program. A retrospective data review of KP patients accessing care using the One Stop Shop (OSS) and Community Clinical Service Assistant Points (CCSAPs) models for HIV care in Zamfara State, Nigeria (May 2022 to May 2023). Important patient data were extracted, analysed and explored in frequency and percentage. Pearson’s chi-square and fisher exact test were also used. Of the 4043 patients, 3737 patients with known viral load were used, CCSAPs had (77.8%) patients and OSS (22.2%). The majority were females (60.7%). The ages were between 25 and 34 years of ages (42.9%). The patients had a mean weight of 58.15Kg. Overal retention to care was (98.6%) with suppression rate of (99.4%), with CCSAPs (99.6%) suppression rate and OSS (99.0%) suppression. Both the CCSAPs and OSS models demonstrated a high rate of viral load suppression and retention in care for KP.The CCSAPs particularly excelled in viral suppression rates and patient retention. More HIV programs need to adopt these service delivery to improve access to care and sustain the progress for epidemic control.

To assess the prevalence and associated variables of spin bias in the abstracts of systematic reviews and meta-analyses of knee osteoarthritis (KOA) treatment with intra-articular platelet-rich plasma (PRP). PubMed and Embase were queried for peer-reviewed systematic reviews with or without meta-analysis reporting on intra-articular PRP treatment of KOA. Two authors independently analyzed the abstracts for the 15 most common types of spin by comparing details within the abstract to the full manuscript. Methodological quality was appraised using A Measurement Tool to Assess Systematic Reviews, Version 2 scoring. Descriptive statistics were used for spin and A Measurement Tool to Assess Systematic Reviews, Version 2 scores. Logistic regression and categorical association tests (Fisher's and chi-square) assessed the effect of study characteristics on the presence of spin. One or more forms of spin were found in 92% (45/49) of evaluated abstracts. The most common form of spin identified was type 11, "conclusion focuses selectively on statistically significant efficacy outcome," which was identified in 63% (31/49) of studies. A Measurement Tool to Assess Systematic Reviews, Version 2 ratings were high for 10% (5/49) of studies, moderate in 8% (4/49), low in 27% (13/49), and critically low in 55% (27/49). Decreasing level of evidence was associated with inappropriate extrapolation spin (odds ratio = 2.528, 95% confidence interval 1.037-6.161, P = .041). Spin bias is highly prevalent in the abstracts of systematic reviews and meta-analyses of intra-articular PRP to treat KOA. Findings should be interpreted in the context of the subjective scoring system used to assess spin. A lower level in the hierarchy of evidence was associated with the presence of inappropriate extrapolation spin. Identified spin tended to favor the use of PRP in treating KOA. In the present study, abstract conclusions were found to have a high prevalence of spin. Identifying and understanding spin aids in the critical appraisal of research with implications for clinical decision making in the usage of PRP.

Advanced care planning (ACP) can reduce hospitalizations, increase quality of life, and align treatment with patient wishes, while lowering healthcare costs. However, healthcare providers' discomfort, lack of training, and patient anxiety may hinder ACP. Furthermore, disparities exist among minority and low-income groups. Growing research highlights the need for standardized definitions and broader implementation, especially post-COVID-19, incorporating digital tools, economic impacts, ethics, and family roles to improve ACP worldwide. This study aims to update and synthesize knowledge from all published systematic reviews from the past ten years, focusing on ACP-related interventions. We conducted a comprehensive search across PubMed, Cochrane, and Scopus, including only English-language, peer-reviewed systematic reviews published between 2015 and 2025. We employed rigorous screening, dual-reviewer validation, and quality-assessment tools, and synthesized evidence on intervention effectiveness across diverse populations and settings to identify effective ACP strategies. Of the deduplicated 7513 records, 61 reviews met the inclusion criteria. For older adult patients, structured conversations reduce unnecessary aggressive treatments and align end-of-life care with preferences. Among racial groups, peer support and palliative consultations boost ACP completion. Patient-centric interventions include video decision aids and web tools, whereas provider-centric interventions include conversation guides, reminder systems, electronic coordination platforms, and facilitator training. ACP is an ongoing process tailored to patient preferences, requiring efforts to address stigmatized conversations, especially in minority communities and severe illnesses. Emphasis on research into digital tools, policy incentives, infrastructure, and family support is essential. Bridging research and practice will improve outcomes and patient-centered end-of-life care. This article describes an umbrella review of 61 systematic reviews on advanced care planning-related interventions. The analysis indicates that the reviews covered interventions focusing on both facility and community-based individuals and had a specific population or disease focus. The articles covered both patient and provider-centric interventions.

Chimeric antigen receptor T (CAR-T) cell therapy, originally developed for hematologic malignancies, has emerged as a transformative candidate for systemic rheumatic diseases and autoimmune disorders (AIDs). Its unique efficacy in refractory AIDs relies on depleting autoreactive B cells and driving antigen-naïve immune reconstitution, achieving durable drug-free remission in early-phase trials. Despite promising clinical and serological responses lasting 2-5 years without long-term immunosuppression, the field faces unmet needs: complex manufacturing, limited tissue penetration, antigen escape, immunological sequelae, and lack of predictive biomarkers. Existing reviews predominantly focus on oncology adaptations or isolated technical aspects, lacking systematic integration of mechanisms, challenges, and precision-oriented innovations for rheumatic diseases. This review comprehensively summarizes CAR-T's action mechanisms in AIDs, analyzes core clinical challenges, and highlights emerging strategies-including universal/in vivo-generated CAR-T cells, multitargeted/logic-gated designs, organ-homing engineering, and rational combinations with tolerance-enhancing agents. It further emphasizes multiomics integration (single-cell transcriptomics, spatial mapping, B-cell receptor/T-cell receptor repertoire analysis) for patient stratification and relapse prediction. By bridging mechanism-driven engineering with clinical translation, this work provides an actionable framework to advance CAR-T toward functional immune reset, enabling precision immunotherapy for refractory rheumatic diseases and AIDs.

Throughout pregnancy, the immune microenvironment undergoes dynamic changes in patients with concomitant autoimmune diseases (AIDs). These alterations not only affect disease activity and clinical manifestations, but also play a pivotal role in sustaining maternal-fetal immune tolerance and pregnancy outcomes. Extensive preclinical studies have elucidated the mechanisms of immune regulation in normal pregnancy, whereas the dynamic immune changes in pregnancies complicated by AIDs remain poorly understood. Recent studies have revealed significant variations in immune responses to pregnancy among individuals with AIDs, which may contribute to distinct patterns of AIDs flares during this period. Despite substantial progress in immunology and reproductive medicine, comprehensive reviews addressing the dynamic changes in the immune microenvironment during pregnancy in the context of AIDs are lacking. In this review, we summarize existing knowledge and incorporate recent multidisciplinary findings, focusing on the dynamic changes in systemic immune adaptation and maternal-fetal immune interactions in the context of AIDs during pregnancy. We emphasize the clinical significance of these immune dynamics for optimizing management and therapeutic strategies. Additionally, we propose new perspectives and provide recommendations to guide future research and the development of personalized treatment approaches.

Conventional treatments have been frequently reported to offer partial relief for some individuals managing arthritis pain and related symptoms, leading many to consider alternative options, such as cannabis. Informed decision-making about cannabis use requires patients to weigh potential benefits and risks in light of their personal values and preferences. This study aims to systematically develop a theory-driven, evidence-based, user-centered decision aid (DA) for older adults with arthritis, considering medical cannabis. The Ottawa Decision Support Framework, the International Patient Decision Aids Standards, and the User-Centeredness approach guided the DA development process in 4 phases. Phase 1 (completed) involved scoping reviews to explore the development of shared decision-making (SDM) tools and the literature addressing cannabis use in arthritis, guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. Phase 2 (in progress) consists of semistructured interviews that are conducted with older adults living with arthritis to explore their decisional needs. Phase 3 (in progress) involves semistructured interviews that are conducted with clinicians to explore how they can participate with their patients during cannabis use decision-making. For phases 2 and 3, recruitment has been initiated in a large urban center in Alberta, Canada. Purposive sampling is conducted, and the sample size will be guided by the principle of information power. Phase 4 (not initiated yet) will involve the development of the DA and alpha testing to explore qualification as a DA and acceptability with advisory board members, including patients and clinicians who participate in the development process. Based on the feedback received, the prototype will be refined accordingly. Subsequently, a future study involving a beta testing phase will be conducted to evaluate the usability, accessibility, and comprehensibility of the DA among naive users. The University of Alberta Human Research Ethics Board approved this study. This protocol is based on the latest version of the ethics application, dated December 14, 2024 (Pro00133420). This project was funded in November 2022. Phase 1 is completed; the advisory board is assembled. Two scoping reviews have been published. The first review showed that the most commonly reported development bases for SDM tools were the Ottawa Decision Support Framework and International Patient Decision Aids Standards criteria, reported in 16% and 53% of tools, respectively. The second review highlighted limited high-quality evidence addressing medical cannabis use for arthritis. Phases 2 and 3 have been initiated. Phase 4 will be initiated when the findings from phases 2 and 3 are available. As of November 2025, we have recruited 10 patients for phase 2 and 7 clinicians for phase 3. This protocol outlines the systematic development of a patient-centered DA to support SDM about medical cannabis for arthritis pain. The findings will show the feasibility of development and inform the refinement of the DA, guiding its readiness for beta testing and future implementation.

Human immunodeficiency virus (HIV) prevention has advanced substantially, yet ending new transmissions by 2030 remains uncertain. Pre-exposure prophylaxis (PrEP) has high biological efficacy, but real-world effectiveness varies due to adherence, access, and delivery barriers. This review aims to synthesize evidence on the efficacy of PrEP in reducing HIV incidence and to discuss its implications for achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 2030 targets. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance, MEDLINE, Embase, Scopus, and Cochrane Library were searched for English-language studies published between January 2010 and January 2025 assessing PrEP efficacy in high-risk populations. Nine randomized controlled trials (RCTs) comprising more than 20,000 participants across multiple continents were included. Across oral tenofovir-based PrEP trials, risk reduction ranged from 49% to 86% in intention-to-treat (ITT) analyses, with markedly higher efficacy in adherence-defined subgroups (e.g., up to 92-99% in trials with pharmacokinetic confirmation). Long-acting injectable cabotegravir (CAB-LA) was superior to daily oral tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) in two large RCTs, with relative risk reduction up to 89% and high observed adherence consistent with clinic-based dosing. Adverse events were generally mild to moderate (gastrointestinal symptoms, headache), with expected renal marker changes in some oral PrEP trials and injection-site reactions for CAB-LA; no consistent evidence of risk compensation was observed. PrEP is highly effective when taken as prescribed, but achieving population-level impact aligned with UNAIDS targets requires scale-up, improved access, and interventions that support persistence and adherence, including expanded delivery models and longer-acting options.

With the proliferation of digital technology, the health sector, like other sectors of society, has increasingly adopted digital technologies, resulting in a dynamic landscape where the roles and impacts of digital health tools in different contexts are constantly evolving. This integration of digital technology into the health space has extended into the field of HIV prevention, ushering in new possibilities and challenges. However, review studies documenting the evolving use of digital health tools in HIV prevention are scant, particularly in regions with many low- and middle-income countries, such as in Africa, which have some of the highest HIV prevalence and incidence rates in the world. This scoping review will follow the Joanna Briggs Institute (JBI) 2020 guidelines for methodological rigour and will be reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Review (PRISMA-ScR). Relevant published literature will be searched using a combination of keywords, Boolean terms and Medical Subject Headings in the following databases: CINAHL, Medline, Web of Science, Cochrane Library, Scopus, PubMed, WHO Digital Health ATLAS and Health Source with no date limits for the studies chosen. The Joint United Nations Programme on HIV/AIDS (UNAIDS) website and the reference lists of selected articles will also be used for backward searching, and Google Scholar will be used for forward citation tracking. The search strategy will be formulated following the guidelines provided by the Peer review of Electronic Search Strategies statement for peer assessment of electronic search strategies. Two reviewers will independently assess the references to ensure that they align with the predetermined eligibility criteria. Subsequently, the data from the included studies, published between January 2004 and January 2026, reflecting the period in which digital health innovations have rapidly expanded in Africa, will be extracted and any discrepancies resolved using a third reviewer. Thematic analysis will be used to analyse the data, and the findings will be reported using both tables and figures. The PRISMA-ScR will be followed to report this study's results. Quality appraisal of the included studies will be done using the mixed methods appraisal tool V.2018. This study does not involve human participants and only reviews existing literature in the public domain, and therefore ethical approval was not required. Our intention is to disseminate our research findings through a diverse range of channels, including peer-reviewed journals, conferences and webinars.

The aim of this study was to evaluate the effect of hearing devices for adults with mild-to-severe hearing losses. Specifically, we assessed the magnitude of change across outcome domains, identified measurement tools used, and reported adverse effects associated with device use. We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were performed in PubMed, CINAHL, and Embase. Included studies were randomized controlled trials (RCTs) involving adults (≥ 18 years of age) with mild-to-severe hearing loss, comparing any air-conduction hearing device to passive or active controls. Effect sizes were calculated as Hedges's g, and random-effects models estimated pooled effects. Thirty-three RCTs (N = 4,471 participants) met the inclusion criteria, although pooled estimates could be derived from only a subset of trials due to limited reporting. Hearing aids demonstrated moderate-to-large benefits on hearing-related self-report outcomes compared with no-intervention or waitlist controls; however, pooled meta-analytic estimates could not be generated for this comparison because of insufficient data across trials. Compared with placebo, hearing aids yielded a small pooled effect (g ≈ 0.37), driven largely by trials including participants with comorbid Alzheimer's disease. Personal sound amplification products (PSAPs) showed a pooled medium effect compared with no intervention (g ≈ 0.42), with benefits primarily observed for hearing-specific self-report outcomes and selected behavioral measures. In head-to-head comparisons, hearing aids showed a large pooled advantage over other hearing devices, including smartphone hearing aid applications (SHAAs) and extended-wear hearing aids (EWHAs; g ≈ 0.88), based on data from two trials. Across the included studies, most outcomes were self-reported (≈ 81%) and behavioral (≈ 45%), with very limited assessment of cognitive or neurophysiological domains. Nine studies reported adverse events, with only one device-related incident. Heterogeneity was high (I2 > 80%), but no publication bias was detected. Hearing aids provide substantial benefit for hearing-related self-reported outcomes in comparison to PSAPs, SHAAs, EWHAs, and placebo. However, high heterogeneity prevents reliable conclusions based on pooled estimates. There also remains limited evidence on cognitive, neurophysiological, and long-term behavioral outcomes, underscoring the need for more rigorous, domain-diverse RCTs in this field. https://doi.org/10.23641/asha.32086299.

The GRADE system is a transparent approach to assess the quality of evidence and strength of recommendations in health. It aids in converting evidence into guidelines, enhancing clarity and application in clinical practice. This study aims to identify scoping and systematic reviews using GRADE in top rehabilitation and neurology journals from 2020 to 2022. The top 13 journals of rehabilitation and/or neurology area were selected by Scopus Sources. All systematic reviews and scoping reviews published between 2020 and 2022 were included. Studies that did not use the original GRADE system or failed to describe the GRADE details were excluded. The data of interest were extracted and analyzed by three researchers for an Excel table. There is no relation between the journals' quality and the number of systematic reviews that used the GRADE system. The Neurorehabilitation and Neural Repair and Journal of Stroke and Cerebrovascular Diseases had the highest number of systematic reviews that used the GRADE system (16.7% and 4.8%, respectively). The most used downgrading criteria are both risk of bias and imprecision (100%). The GRADE system is not widely used in the top 13 journals in the rehabilitation and neurology journals.

To retrieve, evaluate, and integrate the best available evidence on prevention and management of wound procedural pain management in patients with open wounds, providing evidence-based guidance for clinical practice. Following the "6S" pyramid model, we systematically searched guideline websites, professional association websites, and databases for guidelines, clinical decision aids, expert consensus statements, evidence summaries, recommended practices, and systematic reviews related to wound procedural pain management in patients with open wounds. The search period was from the establishment of the database to July 2025. Two researchers independently conducted literature quality assessment, evidence extraction, and synthesis. A total of 23 documents were included: 5 guidelines, 1 expert consensus, 3 recommended practices, 3 clinical decisions, 6 evidence summaries, and 5 systematic reviews. Thirty-two best evidence statements were summarized across six aspects: pain assessment and documentation, education and training, dressing selection and replacement, wound cleansing, debridement, and negative pressure therapy, pharmacological intervention strategies, and non-pharmacological intervention strategies. This study reviews the best available evidence on managing procedural pain in open wounds. It offers guidance on the principles of pain management, standardization of procedural techniques, and the timely application of analgesic, emphasizing the importance of pain awareness. The research serves as a reference for developing specialized pain management protocols to improve wound care quality.

UNAIDS' ending AIDS targets include ensuring that less than 10% of people with HIV, at risk of HIV, or affected by HIV experience HIV stigma and discrimination. We aimed to estimate the effect of HIV stigma and discrimination on the HIV care cascade in eastern, southern, central, and western Africa-regions with the largest HIV burden worldwide. We used population-based surveys in countries in eastern, southern, central and western Africa from 2000 onward identified through previous reviews and data catalogues. Surveys eligible for inclusion were screened and selected if they contained at least one measure of HIV stigma and discrimination, and at least one HIV outcome (ie, HIV testing, antiretroviral therapy [ART] use, or viral suppression). The individual-level data from all included surveys were pooled for our analyses. We assessed three community-level HIV stigma exposures (continuous): discriminatory attitudes, perceived stigma, and shame of association with people with HIV. Among people with HIV, we examined individual-level, past-year anticipated, or experienced stigma in health-care settings (binary). Using Poisson regression, we estimated adjusted prevalence ratios (aPRs) for the effect of each stigma measure on past-year HIV testing, ART use, and viral suppression. We used segmented regression with a median breakpoint to model non-linear effects of community-level stigma. We identified 124 surveys in 38 countries published between 2000 and 2023. Stigma towards people with HIV was high. 51% of participants held discriminatory attitudes, 71% perceived HIV stigma, and 43% reported shame of association. Among people with HIV, 34% had anticipated, and 8% experienced, health-care stigma. Where the prevalence of community-level discriminatory attitudes was equal to or above the median, people were less likely to have tested for HIV (aPR 0·88 per 10% increase, 95% CI 0·87-0·88), and people with HIV had lower ART use (0·96 per 10% increase, 0·94-0·97) and viral suppression (0·96, 0·95-0·98). Similarly, communities with higher (≥median) shame of association levels had lower testing (aPR 0·97 per 10% increase, 95% CI 0·96-0·98) and viral suppression (0·98, 0·96-1·00). People with HIV who anticipated or experienced health-care stigma were 7% (95% CI 4-10) less likely to be on ART and 10% (6-14) less likely to be virally suppressed, possibly reaching 14% (7-21) and 16% (9-23) when adjusted for selection bias. HIV stigma and discrimination have measurable, widespread, negative effects on the full cascade of care: HIV testing, treatment, and viral suppression. These effects are most pronounced in communities with the highest levels of stigma. Stigma reduction strategies should be prioritised to improve health outcomes and reduce health inequities. Canadian Institutes of Health Research, Canada Research Chairs Program, and Wellcome Trust.

To retrieve, screen, appraise, and synthesize the best evidence on nutritional management for adult patients undergoing continuous renal replacement therapy (CRRT) to inform the development of standardized clinical nutrition management protocols for CRRT. Using the 5S evidence pyramid model, we conducted a top-down search of domestic and international sources, including databases of systematic reviews, guideline portals, professional association websites, and comprehensive databases, to identify clinical decision aids, evidence summaries, guidelines, standards, protocols, systematic reviews, and expert consensus statements. The search period was from January 1, 2006, to December 31, 2025. Two evidence-based nursing experts independently performed quality appraisal, evidence extraction, and grading for the included literature. A total of 12 documents were included: one clinical decision aid, one evidence summary, eight guidelines, and two expert consensus statements. After systematic extraction and integration of the relevant evidence, 16 evidence points were summarized across three domains: nutritional assessment and selection of nutritional pathways, energy and protein provision, and monitoring and supplementation of electrolytes and micronutrients. The best available evidence on nutritional management for adults undergoing CRRT synthesized in this study is comprehensive and scientifically sound. It provides a reference for clinical practice. However, personalized nutritional plans should be developed based on patients' clinical conditions to improve outcomes.

Sub-Saharan Africa (SSA) continues to be the hub of the global HIV/AIDS pandemic, globally. Despite several attempts to meet their HIV prevention needs, men continue to have high rates of HIV infection. Pre-exposure prophylaxis (PrEP) is an effective treatment that, when taken as prescribed, can be very efficient in preventing and reducing the risk of HIV acquisition. HIV self-testing (HIVST) has been demonstrated to be acceptable among men in SSA. As such, this review aims to explore the existing literature on the integration of PrEP dispensing with HIVST among men in SSA. We will systematically search bibliometric databases, including PubMed/MEDLINE, Embase, Scopus, the Cumulative Index to Nursing and Allied Health Literature Plus, Sociological Abstracts, ProQuest Dissertations and Theses global. Our review will be guided by the Arskey and O'Malley framework and Levac et al. The review results will be reported using the preferred reporting items for systematic reviews and meta-analysis: extension for scoping reviews guidelines. To assess the methodological quality of the included articles, the mixed methods appraisal tool version 2018 will be used. We will use NVivo software (V.11) to synthesise data from the included studies using a thematic approach. Ethical approval is not required, as this review uses publicly available data. Findings will be disseminated through peer-reviewed publication, conference presentations and engagement with key stakeholders in HIV prevention and treatment across SSA.

Stepped-wedge design (SWD) has gained prominence as a versatile research methodology, particularly in public health and implementation science, due to its ability to balance ethical concerns with methodological rigor. This systematic review aims to evaluate the implementation and effectiveness of SWD in sub-Saharan African (SSA) research contexts, focusing on the types of interventions, primary outcomes, and the unique geographic and cultural factors influencing the studies. A systematic review protocol was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under identification number CRD42024530774. A comprehensive search strategy was employed to identify studies conducted in SSA using SWD from January 2000 to March 2024 across five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO, and Cochrane Library), along with Google Scholar and citation tracking. Studies were included if they utilized SWD in SSA settings and reported relevant public health, clinical, or social interventions. Data were extracted on study characteristics, SWD implementation details, statistical methods, and sample size calculations. A total of 85 studies were included after screening 873 titles and abstracts and conducting full-text reviews of 93 articles. The 85 studies included in the review spanned a wide range of health domains, including HIV/AIDS, maternal and child health, tuberculosis, and malaria, conducted across diverse SSA settings such as hospitals, communities, and schools. The studies involved a total of 1,895,788 participants, with sample sizes ranging from 17 to 780,000. Most studies (84.7%) were facility-based, while 15.3% were community-based. The number of clusters per study varied, with some studies using as few as four clusters, while others utilized up to 54 clusters. The number of steps ranged from two to twelve, depending on the complexity and scale of the intervention. Sample size calculations were often based on expected changes in primary outcomes, with many studies assuming an intra-cluster correlation coefficient to account for clustering effects. The SWD was primarily chosen to address ethical concerns, logistical challenges, and resource limitations. The review highlights significant variability in study designs, interventions, and outcomes, reflecting the adaptability of SWD to different contexts and challenges. The SWD has been effectively utilized in SSA research to evaluate a wide range of interventions across diverse settings, demonstrating its flexibility and suitability for addressing complex public health challenges. However, the review also identifies challenges related to study duration, logistical implementation, randomization processes, and statistical analysis, suggesting the need for careful planning and methodological rigor in future studies using SWD. The findings provide valuable insights for researchers and policymakers seeking to optimize the use of SWD in resource-limited settings, ensuring that interventions are both effective and ethically implemented. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024530774, PROSPERO CRD42024530774.

People living with HIV (PLWH) have a substantially increased risk of both AIDS-defining cancers (ADCs) and non-AIDS-defining cancers (NADCs), which remain a major cause of morbidity despite effective antiretroviral therapy (ART); this review aims to integrate current epidemiological, molecular, and clinical evidence on HIV-associated oncogenesis. A structured literature search was conducted in PubMed (2000-2026) using predefined keywords, including "HIV", "cancer", "oncogenesis", and "immune dysregulation", with inclusion of original studies, systematic reviews, and meta-analyses meeting predefined quality criteria. Available evidence indicates that HIV contributes to cancer development through both direct and indirect mechanisms: viral proteins such as Tat, Nef, and Vpr disrupt apoptosis, DNA repair, and cell cycle regulation, while chronic immune activation, persistent inflammation, and immunosuppression impair tumor immune surveillance and facilitate oncogenic viral co-infections, including Epstein-Barr virus, human papillomavirus, and human herpesvirus 8. Emerging pathways, such as epigenetic alterations, microRNA dysregulation, metabolic reprogramming, and the contribution of HIV reservoirs to pro-tumorigenic microenvironments, further modulate cancer risk. HIV may function as a cofactor that enhances the effects of oncogenic viruses by promoting viral persistence and immune dysregulation; while biologically plausible, direct evidence linking HIV to amplification of tumorigenesis in humans remains limited.

Previous studies found that online communities are critical in supporting stroke survivors and caregivers for stroke recovery. However, it is unclear how such online communities are designed, or could be designed. This review aims to identify the key design elements of an online community to support stroke survivors and caregivers, that is, the actors, types of community support, and supporting technologies. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We included journal articles related to online community support for stroke. Editorials, registers, opinion pieces, letters, and conference papers were excluded. Online databases PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and ProQuest were searched for articles published from January 2015 to June 2025. Articles were screened based on the title, abstract, and full text using Covidence software. After screening and full-text review, we read the selected articles in detail to analyze and synthesize information on key actors, types of support, and technologies used to support stroke survivors and caregivers. A total of 77 articles were included. These articles discussed digital support technologies (52 articles), community functions and roles (18 articles), online stroke community systems (6 articles), and the stroke ecosystem (1 article). Our review found that the online community of support for stroke survivors and caregivers includes the caregivers themselves (46 articles), health workers (24 articles), and the local community/society (14 articles). Online communities mainly provide informational support, including giving advice (28 articles) and tangible aids (29 articles), followed by social support to create a sense of belonging (26 articles). Technologies discussed included mobile health (25 articles), web-based systems (12 articles), virtual/augmented reality (8 articles), sensors/wearable technology (8 articles), video-guided exercise apps (4 articles), and telehealth/telerehabilitation/teleconsultation/telestroke (4 articles). Only one examined how cultural differences influence technology. Although technologies are essential in online communities of support for stroke survivors and caregivers, this review shows a lack of studies that analyze the use and role of technologies in such online communities. This could be because the key actors of the online communities are the caregivers, who mainly seek social support and therefore do not require sophisticated technology. Nevertheless, technologies such as telerehabilitation and video-guided exercise apps could be important for other actors, including the local community and health workers, to enable them to support stroke survivors and their caregivers.