Tobacco use among people living with HIV results in excess morbidity and mortality. However, very little is known about the extent of tobacco use among people living with HIV in low-income and middle-income countries (LMICs). We assessed the prevalence of tobacco use among people living with HIV in LMICs. We used Demographic and Health Survey data collected between 2003 and 2014 from 28 LMICs where both tobacco use and HIV test data were made publicly available. We estimated the country-specific, regional, and overall prevalence of current tobacco use (smoked, smokeless, and any tobacco use) among 6729 HIV-positive men from 27 LMICs (aged 15-59 years) and 11 495 HIV-positive women from 28 LMICs (aged 15-49 years), and compared them with those in 193 763 HIV-negative men and 222 808 HIV-negative women, respectively. We estimated prevalence separately for males and females as a proportion, and the analysis accounted for sampling weights, clustering, and stratification in the sampling design. We computed pooled regional and overall prevalence estimates through meta-analysis with the application of a random-effects model. We computed country, regional, and overall relative prevalence ratios for tobacco smoking, smokeless tobacco use, and any tobacco use separately for males and females to study differences in prevalence rates between HIV-positive and HIV-negative individuals. The overall prevalence among HIV-positive men was 24·4% (95% CI 21·1-27·8) for tobacco smoking, 3·4% (1·8-5·6) for smokeless tobacco use, and 27·1% (22·8-31·7) for any tobacco use. We found a higher prevalence in HIV-positive men of any tobacco use (risk ratio [RR] 1·41 [95% CI 1·26-1·57]) and tobacco smoking (1·46 [1·30-1·65]) than in HIV-negative men (both p<0·0001). The difference in smokeless tobacco use prevalence between HIV-positive and HIV-negative men was not significant (1·26 [1·00-1·58]; p=0·050). The overall prevalence among HIV-positive women was 1·3% (95% CI 0·8-1·9) for tobacco smoking, 2·1% (1·1-3·4) for smokeless tobacco use, and 3·6% (95% CI 2·3-5·2) for any tobacco use. We found a higher prevalence in HIV-positive women of any tobacco use (RR 1·36 [95% CI 1·10-1·69]; p=0·0050), tobacco smoking (1·90 [1·38-2·62]; p<0·0001), and smokeless tobacco use (1·32 [1·03-1·69]; p=0·030) than in HIV-negative women. The high prevalence of tobacco use in people living with HIV in LMICs mandates targeted policy, practice, and research action to promote tobacco cessation and to improve the health outcomes in this population. South African Medical Research Council and the UK Medical Research Council.

Introduction Human resource shortages are a challenge to the rollout of antiretroviral therapy (ART) for HIV-infected patients, particularly in sub-Saharan Africa. Task-shifting has been recommended as an approach to reduce the impact of human resource shortages. We conducted a systematic review of randomized controlled trials and quasi-experimental studies to assess the effectiveness of task-shifting, and its impact on costs of ART provision. Methods We searched MEDLINE, EMBASE, PSYCINFO, Cochrane Library, Web of Knowledge and the Current Controlled Trials Register for articles published up to January 2011. We included studies evaluating any task-shifting model against any other intervention using any of the following outcomes: mortality (all causes); occurrence of new AIDS-defining illness; virological outcomes; CD4 cell count; adherence to ART medicines (e.g. self-report and pill counts); hospital admissions; clinic visits; toxicity or adverse events; quality of life indicators; costs and cost-effectiveness. We did not pool the results because of high levels of clinical heterogeneity. Results We identified six effectiveness studies including a total of 19 767 patients. Non-inferior patient outcomes were achieved with task-shifting from doctors to nurses, or from health care professionals to mid-level workers or lay health workers. However, most of the identified studies were underpowered to detect any difference. Three studies were identified on the cost implications of task-shifting. Task-shifting resulted in substantial cost and physician time savings. Conclusions The reviewed evidence suggests that task-shifting from doctors to nurses, or from health care professionals to lay health workers can potentially reduce costs of ART provision without compromising health outcomes for patients. Task-shifting is therefore a potentially effective and cost-effective approach to addressing the human resource limitations to ART rollout. However, most of the studies conducted were relatively small and more evidence is needed for each task-shifting model as it is currently limited.

An increased consumption of energy-dense, nutrient-poor food and beverages as a result of a changing obesogenic environment contributes substantially to the increasing prevalence of childhood overweight and obesity. This paper reviews the nature and extent of food industry influences which expose children to commercial influences and thus might affect unhealthy dietary behaviour and finally contributes to obesity. A systematic search of nine electronic databases (including PubMed, PsycINFO, EconLit) and reference lists of original studies and reviews using key search terms identified 1900 articles. Of these only thirty-six articles met the inclusion and quality criteria. A narrative synthesis of the reviewed studies revealed six key obesogenic environments by which the food industry possibly influences obesity-related dietary behaviours in young children. These were schools, retailers, mass media “television”, mass media “internet”, home and promotional campaigns. Identifying these obesogenic environments is critical for monitoring and controlling the food industry, the development of effective environmental-level interventions to prevent childhood overweight and obesity and to identify knowledge gaps to be addressed in future research to support informed decisions of policy makers.