Early outcomes of a rural-oriented physician education programme against rural physician shortages in Guangxi province: a prospective cohort study.

OBJECTIVES: This study aimed to investigate early outcomes of one of the first medical undergraduate education programmes with a goal of mitigating severe rural physician shortages in China, which was developed by Guangxi Medical University (GXMU) and was called the Rural-oriented Free Tuition Medical Education (RTME)-GXMU programme. DESIGN: A prospective cohort study comprising a baseline investigation and follow-up research was conducted to dynamically observe the evolution of the RTME-GXMU programme that began since 2010. PARTICIPANTS: 380 RTME-GXMU graduates and 383 non-RTME-GXMU graduates from GXMU who completed trainings between 2015 and 2018 were recruited in the baseline investigation. Among them, 285 RTME-GXMU and 283 non-RTME-GXMU graduates responded to the follow-up research. MAIN OUTCOME MEASURES: Graduate practice location, registered specialty, passing rate of the National Medical Licensing Examination (NMLE), specialty of residency programme and contract compliance for the RTME-GXMU graduates. RESULTS: By the end of 2018, 100% of the 2015 RTME-GXMU graduates enrolled in this study practised in rural township health centres and registered themselves as general practitioners (GPs). All the RTME-GXMU graduates had completed or were attending residency programmes of general practice (GP). The above data stood in stark contrast to that of the non-RTME-GXMU graduates among whom as few as 1.06% worked in rural areas, 2.13% registered as GPs and less than 3% chose GP residency programmes. No significant differences were detected on passing rates of the NMLE between the two groups. Only one RTME-GXMU graduate broke the contract and dropped off the programme. CONCLUSIONS: The RTME-GXMU programme has achieved encouraging early outcomes. Reduced entry score and proper usage of urban primary care institutions are two key approaches contributing to these positive early results.

Social network strategy as a promising intervention to better reach key populations for promoting HIV prevention: a systematic review and meta-analysis.

INTRODUCTION: Key populations such as men who have sex with men (MSM), drug users and sex workers are at high risk of HIV infection, but they are marginalised and hidden. Social network strategy (SNS) is purposeful to use social networks to generate social influence, accelerate behaviour change and achieve desirable outcomes among individuals or communities and have been increasingly used for HIV interventions. This study aims to investigate the effects of SNS on HIV prevention among key populations. METHODS: We searched six databases, including PubMed, Web of Science, Embase, Cochrane Library, ScienceDirect and Wiley for randomised controlled trials published between January 1999 and May 2019. Eligibility criteria included SNS conducted among key populations for HIV interventions, with a comparator group. Outcomes included changes in HIV high-risk behaviour, HIV seroconversion and other HIV outcomes. We used the risk ratio (RR) or mean difference with associated 95% confidence interval (CI) to assess the comparative efficacy between SNS and control methods on the selected outcomes. The GRADE system was used to assess the quality of evidence for the studies. RESULTS: Of 2818 citations identified, 28 trails from 24 papers met the inclusion criteria. The results showed that SNS was associated with less unprotected intercourse (RR 0.79, 95% CI 0.72 to 0.86) and sex with multiple partners (0.46, 95% CI 0.33 to 0.65). Additionally, relative to the control methods, SNS significantly reduced HIV seroconversion (0.65, 95% CI 0.53 to 0.81), improved HIV testing uptake (1.11, 95% CI 1.07 to 1.15) and promoted participant retention (1.03, 95% CI 1.00 to 1.06) among key populations. The Grading of Recommendations Assessment, Development and Evaluation system showed that trails were of moderate quality. CONCLUSIONS: This review provides evidence that SNS can reach key populations who are currently not being reached by existing programmes and deliver HIV interventions through social networks, which decreases HIV sexual risk behaviour and HIV incidence and increases HIV testing uptake and participant retention. TRIAL REGISTRATION NUMBER: CRD42019140533.