Hudson birden 15 march 2007
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HIV/AIDS: The development of the evidence base and public health policy 1981-1991 PowerPoint PPT Presentation


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Hudson Birden 15 March 2007. HIV/AIDS: The development of the evidence base and public health policy 1981-1991. Hierarchy of evidence. Systematic Reviews/ Meta-analyses Randomized Controlled Trials (RCTs) Cohort studies Case control studies Cross sectional studies (surveys) Case reports.

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HIV/AIDS: The development of the evidence base and public health policy 1981-1991

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Hudson birden 15 march 2007

Hudson Birden

15 March 2007

HIV/AIDS:The development of the evidence baseandpublic health policy1981-1991


Hierarchy of evidence

Hierarchy of evidence

  • Systematic Reviews/ Meta-analyses

  • Randomized Controlled Trials (RCTs)

  • Cohort studies

  • Case control studies

  • Cross sectional studies (surveys)

  • Case reports


Multicenter aids cohort study baltimore

Multicenter AIDS Cohort Study- Baltimore

  • Cohort recruited 1983-1985

  • baseline for 1983-84 subjects assessed retrospectively

  • cohort study group= 5,622 men

    • 2,195 HIV+ at baseline

    • 3,427 HIV- at baseline

      • 551 seroconverted through 1997


Opposition to pn for hiv

Opposition to PN for HIV

  • No treatment available

  • Long incubation period

  • Prevention messages should be sufficient

    • Safe sex avoids risk, need for PN

  • May provide a disincentive for testing

    • Fear of driving the epidemic underground

  • Lack of trust of PH process

    • Confidentiality of records

    • Mechanism of PN


Barriers to pn for hiv

Barriers to PN for HIV

  • insufficient funding or personnel

  • inability to retain staff

  • non-cooperation

    • private providers

    • community-based organizations

  • political opposition

    • men who have sex with men

    • organizations opposed to condom distribution

  • absence of mandatory HIV infection reporting

    • Source: Golden et al STD 2003:30(6);490-496


An innocent victim of aids

Fort Pierce, Fla.--A year after Kimberly Bergalis died of AIDS, her parents claim they are frustrated and angry that their daughter's death has not led to mandatory HIV testing of health-care workers

UPI 12/08/92

An “innocent victim of AIDS”


Hiv aids the development of the evidence base and public health policy 1981 1991

Gross: N Engl J Med, Volume 340(24).June 17, 1999.1881-1887


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