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BMJ Glob Health ; 7(5)2022 May.
Article in English | MEDLINE | ID: covidwho-1846373
PLoS One ; 16(12): e0260555, 2021.
Article in English | MEDLINE | ID: covidwho-1546958


INTRODUCTION: In June 2021, United Nations (UN) Member States committed to ambitious targets for scaling up community-led responses by 2025 toward meeting the goals of ending the AIDS epidemic by 2030. These targets build on UN Member States 2016 commitments to ensure that 30% of HIV testing and treatment programmes are community-led by 2030. At its current pace, the world is not likely to meet these nor other global HIV targets, as evidenced by current epidemiologic trends. The COVID-19 pandemic threatens to further slow momentum made to date. The purpose of this paper is to review available evidence on the comparative advantages of community-led HIV responses that can better inform policy making towards getting the world back on track. METHODS: We conducted a scoping review to gather available evidence on peer- and community-led HIV responses. Using UNAIDS' definition of 'community-led' and following PRISMA guidelines, we searched peer-reviewed literature published from January 1982 through September 2020. We limited our search to articles reporting findings from randomized controlled trials as well as from quasi-experimental, prospective, pre/post-test evaluation, and cross-sectional study designs. The overall goals of this scoping review were to gather available evidence on community-led responses and their impact on HIV outcomes, and to identify key concepts that can be used to quickly inform policy, practice, and research. FINDINGS: Our initial search yielded 279 records. After screening for relevance and conducting cross-validation, 48 articles were selected. Most studies took place in the global south (n = 27) and a third (n = 17) involved youth. Sixty-five percent of articles (n = 31) described the comparative advantage of peer- and community-led direct services, e.g., prevention and education (n = 23) testing, care, and treatment programs (n = 8). We identified more than 40 beneficial outcomes linked to a range of peer- and community-led HIV activities. They include improved HIV-related knowledge, attitudes, intentions, self-efficacy, risk behaviours, risk appraisals, health literacy, adherence, and viral suppression. Ten studies reported improvements in HIV service access, quality, linkage, utilization, and retention resulting from peer- or community-led programs or initiatives. Three studies reported structural level changes, including positive influences on clinic wait times, treatment stockouts, service coverage, and exclusionary practices. CONCLUSIONS AND RECOMMENDATIONS: Findings from our scoping review underscore the comparative advantage of peer- and community-led HIV responses. Specifically, the evidence from the published literature leads us to recommend, where possible, that prevention programs, especially those intended for people living with and disproportionately affected by HIV, be peer- and community-led. In addition, treatment services should strive to integrate specific peer- and community-led components informed by differentiated care models. Future research is needed and should focus on generating additional quantitative evidence on cost effectiveness and on the synergistic effects of bundling two or more peer- and community-led interventions.

Delivery of Health Care/organization & administration , HIV Infections/prevention & control , Delivery of Health Care/standards , HIV Infections/diagnosis , HIV Infections/epidemiology , Health Knowledge, Attitudes, Practice , Health Literacy , Humans , Medication Adherence , Peer Group , Risk-Taking , Self Efficacy , United Nations
Health and Human Rights ; 22(2):1, 2020.
Article in English | ProQuest Central | ID: covidwho-1279092


In Donna Haraway's 1992 A Cyborg Manifesto, the medical anthropologist describes the cyborg as a "hybrid of machine and organism" living "on the boundary between fact and fiction": "We are all chimeras, theorized and fabricated hybrids of machine and organism." In 2020, the world that Haraway imagined has arrived, accelerated by the isolation and surveillance enforced in the COVID-19 pandemic. In this special section, contributors explore the role of big data, technology, and artificial intelligence in the prevention, detection, tracing, and treatment of COVID-19 in a world being rapidly reshaped by this pandemic. In 1992, Haraway observed that medicine was already witnessing the growth of people's dependency on computers or other machinery. But as of late 2020, the computer and the mobile phone have moved fully into the center of our lives. In order to mitigate the risk of COVID-19 transmission, a significant portion of the world's population now works, socializes, shops, and seeks entertainment and love online.

Health and Human Rights ; 22(2):41, 2020.
Article in English | ProQuest Central | ID: covidwho-1279091


The COVID-19 pandemic has massively accelerated a global shift toward new digital technologies in health, a trend underway before the crisis. In response to the pandemic, many countries are rapidly scaling up the use of new digital tools and artificial intelligence (AI) for tasks ranging from digital contact tracing, to diagnosis, to health information management, to the prediction of future outbreaks. This shift is taking place with the active support of numerous private actors and public actors. In particular, United Nations (UN) development agencies, such as the World Health Organization (WHO), are actively encouraging this trend through normative guidance and technical cooperation aimed at helping the governments of low- and middle-income countries to assess their needs for digital health, develop national digital health strategies, and scale up digital interventions.1 At the same time, global health financing agencies, such as the Global Fund to Fight AIDS, TB and Malaria, are financing these technologies through aid to national health programs and through their own public-private partnerships.