Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 3 appraisals
AIDS care
"It's a lifeline": perspectives and experiences of health technology use among HIV care providers in rural Florida
The use of health technology, such as telehealth and mobile health used to support or deliver health care, is a promising strategy to improve HIV outcomes among people with HIV (PWH) in the rural South. In-depth interviews were conducted with 21 HIV care providers in rural Florida to understand the perspectives and experiences of using health technology to deliver care for PWH. Thematic analysis was applied. Emerging themes were organized under four domains: current and prior health technology practices, drawbacks to health technology, benefits of health technology, and potential facilitators of health technology. Providers revealed that health technology use has expanded rapidly since onset of the COVID-19 pandemic, especially use of video calls, but they preferred multiple communication methods. Drawbacks to health technology included lack of human connection, increased burden to providers and patients, confidentiality concerns, technology malfunctioning, discomfort with technology, and financing constraints. Benefits included improved communication and access to care, social connection and community support, and reduced HIV-related stigma. Potential facilitators included health technology that is user-friendly, and economic incentives to increase technology use. Health technology holds promise for addressing barriers to HIV care, however, its drawbacks must be addressed to ensure effective implementation in the rural South.
3 Aug 2026
Read appraisal →PloS one
Integrating smoking cessation into HIV care settings: A systematic review and meta-analysis of effectiveness and the evidence gap in cost-effectiveness.
The prevalence of smoking among people living with HIV (PLWH) is higher than in the general population, and PLWH who smoke are at increased risk of both smoking- and HIV-related comorbidities. As most PLWH reside in low- and middle-income countries (LMICs), there is a need for effective and cost-effective smoking cessation interventions in resource-constrained settings. We systematically reviewed and meta-analyzed the effectiveness of smoking cessation interventions for PLWH and looked for economic evaluations. Four databases (PubMed, Cochrane, Scopus, Web of Science) were searched up to March 23rd, 2026. Interventional and quasi-experimental studies evaluating smoking cessation interventions for PLWH were included. Risk of bias was assessed using Cochrane's risk-of-bias tool for randomized studies and the Effective Public Healthcare Panacea Project tool for non-randomized studies. Thirty-two articles met the inclusion criteria. Most evidence originated from high-income countries, with three randomized controlled trials conducted in LMICs (Kenya, South Africa and Vietnam). No economic evaluations were identified. Smoking cessation interventions varied in type, duration, intensity, and mode of delivery. Overall, studies had low to moderate risk of bias. GRADE assessments indicated moderate-certainty evidence that pharmacological interventions (RR 1.86, 95% CI 1.42-2.45) and tailored, intensive behavioral support (RR 1.34, 95% CI 1.05-1.71) increase smoking abstinence compared with standard care. This review indicates that pharmacological and tailored, intensive behavioral support interventions can support smoking cessation among PLWH, including emerging evidence from LMICs, but the absence of economic evaluations limits guidance for resource-constrained settings. Future research should prioritise implementation strategies and economic evaluations to support scalable integration into routine HIV care. (PROSPERO Registration no: CRD42022313630).
1 Aug 2026
Read appraisal →African journal of reproductive health
A systematic review of unintended pregnancy among adolescents living with HIV in Africa
Adolescent pregnancy remains a significant public health concern across Africa, with Eastern and Southern regions experiencing the highest burden. Among adolescents living with HIV(ALHIV), the challenge is intensified by socio-economic, cultural, and healthcare factors that increase vulnerability to unintended pregnancy. This systematic review examined the prevalence of unplanned pregnancy and associated factors among adolescents living with HIV in Africa. Following PRISMA guidelines and registered in PROSPERO (CRD42024564479), a search of Medline, EMBASE, and CINAHL identified relevant studies published between 2011 and 2023. Of the 550 retrieved articles, only three met the inclusion criteria. Reported prevalence rates varied widely, ranging from 18.8% in South Africa to 60.0% and 73.9% in Kenya, indicating a substantial and uneven burden across settings. Factors associated with unintended pregnancy included involvement with boyfriends or acquaintances rather than spouses, reflecting limited agency and structural vulnerabilities. Documented adverse outcomes included miscarriage, stillbirth, and abortion, although one study did not specify outcomes. Overall, the review highlights persistently high rates of unplanned pregnancy among adolescents living with HIV and underscores the need to integrate sexual and reproductive health services into HIV care, address stigma, and strengthen context-specific interventions. Les grossesses adolescentes demeurent un problème majeur de santé publique en Afrique, les régions de l'Est et du Sud étant les plus touchées. Chez les adolescentes vivant avec le VIH (AVVIH), ce défi est exacerbé par des facteurs socio-économiques, culturels et liés aux soins de santé qui accroissent leur vulnérabilité aux grossesses non désirées. Cette revue systématique a examiné la prévalence des grossesses non planifiées et les facteurs associés chez les adolescentes vivant avec le VIH en Afrique. Conformément aux directives PRISMA et enregistrée dans PROSPERO (CRD42024564479), une recherche dans Medline, EMBASE et CINAHL a permis d'identifier les études pertinentes publiées entre 2011 et 2023. Sur les 550 articles recensés, seuls trois répondaient aux critères d'inclusion. Les taux de prévalence rapportés variaient considérablement, allant de 18,8 % en Afrique du Sud à 60,0 % et 73,9 % au Kenya, ce qui témoigne d'une prévalence importante et inégale selon les contextes. Parmi les facteurs associés aux grossesses non désirées figurait le fait d'avoir des relations avec des petits amis ou des connaissances plutôt qu'avec des conjoints, reflétant un manque d'autonomie et des vulnérabilités structurelles. Les issues défavorables documentées incluaient les fausses couches, les mortinaissances et les avortements, bien qu'une étude n'ait pas précisé ces issues. Globalement, cette analyse met en évidence des taux toujours élevés de grossesses non désirées chez les adolescentes vivant avec le VIH et souligne la nécessité d'intégrer les services de santé sexuelle et reproductive aux soins du VIH, de lutter contre la stigmatisation et de renforcer les interventions adaptées au contexte.
28 June 2026
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