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Thus, even if in our view this review provides the best available evidence, with low- and very low-quality evidence, the true effects of HIV diagnosis knowledge may be different from those we have calculated. To optimally inform mathematical modeling and policy decisions, the uncertainty around point estimates should be given careful consideration. By combining across transmission groups, we would assume that study context e. Further, by pooling across transmission groups, we would have artificially increased our sample size and increased the risk of type II error i.
Although this asymmetry could be due to publication bias, it could also be due to significant heterogeneity of studies, or due to chance. In our efforts to minimize the risk of publication bias, we conducted a comprehensive search for scientific evidence including the grey literature pertaining to the U. Further, we extracted data from all study designs in which the effect of HIV knowledge on condom use could be calculated.
Given the studies that we identified, our findings are mainly applicable to certain transmission groups in the U. Those who are diagnosed with HIV and receive treatment may differentially respond to HIV diagnosis knowledge compared to those without treatment.
Further, it is also plausible that transmission groups with partners who have access to pre-exposure prophylaxis PrEP may respond differently to knowledge of HIV diagnosis. Nearly all studies, however, were conducted before PrEP became widely available. We intend to assess the effect of HIV knowledge on a wider range of outcomes in future work.
While findings are generally consistent across populations and with partners of different serostatus, there are uncertainties around the magnitude of this effect due to statistical uncertainty as well as the generally very low-quality of evidence. Rigorous studies assessing HIV knowledge in the presence versus absence of ART, as well as the duration of effect, would be very useful to inform future policy and practice. We would like to extend our special gratitude to Dr.
Stephanie Sansom and Dr. We also would like to thank Amanda Viitanen for her assistance with data collection for a few studies, Erin Barker for providing support with updating citations, and authors of included studies who provided additional data not reported in their manuscripts. Conflict of interest The authors declare that they have no conflicts of interest. Informed Consent This review is a secondary analysis of published data and as such, did not require informed consent. AIDS Behav. Author manuscript; available in PMC Jun Hutchinson , 4 Ram K.
Kahn 1, 2, 3. Mohsen Malekinejad 1 Philip R. Janet Blodgett 1 Philip R. Hacsi Horvath 1 Philip R. Andrea Parriott 1 Philip R. Angela B. Ram K. Devon McCabe 1 Philip R. Paul Volberding 1 Philip R. James G. Kahn 1 Philip R. Author information Copyright and License information Disclaimer. Mohsen Malekinejad, ude. Copyright notice. Associated Data Supplementary Materials Supplement 1.
Supplement 2. Supplement 3. Supplement 4. Supplement 5. Supplement 6. Introduction In both the United States U. Rationale for Systematic Review We conducted this review to generate updated quantitative effect estimates of knowledge of HIV status on condom use behavior among various populations at high risk of HIV in the U.
Methods We followed Cochrane methods in our review process [ 13 ]. Study Eligibility We included studies conducted in the U. Table 1 Outcome definitions and groupings for meta-analysis. Transmission group Outcome Type of partner Men who have sex with men. Not always using condoms: Self-report of having at least one episode of condomless sex in the recall period. Condomless sex likelihood: Self-report of having unprotected sex at last episode, or the proportion of a set of episodes that were unprotected.
Open in a separate window. Data Extraction and Standardization We developed and used a data collection sheet which captured the following data: complete citation; geographical setting; details of interventions and comparators; age, sex and other participant data; outcome definitions and descriptions; details of outcome assessment methods; study inclusion and exclusion criteria; length of follow-up for study outcomes; data necessary for assessing risk of bias. Risk of Bias Assessment We used the Cochrane instrument for assessing the risk of bias [ 13 ] in each study.
Results and Discussion Study Screening Results Two reviewers working independently screened a total of unique articles and excluded based on the titles and abstracts Fig. Table 2 Characteristics of included studies: Men who have sex with men. Testing to validate participant self-report of HIV status, followed by survey At baseline: Condomless sex last sex with HIV-discordant partners in past 12 months.
For this analysis, we only included unaware and aware on ART—we excluded aware but out of care group and in care but not ART group, and only extracted data that are unique about being on ART.
We will not rely on previous appraisals of the certainty of the body of evidence, and instead assess this anew. Two reviewers will independently appraise the certainty of the body of evidence i. For KQ4, we will not use publication bias, and imprecision will rely on sample sizes. We will perform separate GRADE assessments for trials and observational studies for each outcome, as applicable. For the study limitations domain, we will consider not only the studies that reported on the outcome, but also studies where it appears that the outcome should have been reported but was not i.
Although all of evidence from KQs 2 and 3 are considered indirect for answering the primary question about screening effectiveness, we will not rate down this evidence for indirectness for this reason. In the absence of clear guidance on the applicability and interpretation of GRADE domains for prognostic studies, for KQ2 accuracy of screening tests calibration outcomes, we will work with experts in the field to modify existing guidance to produce an exemplar that is applicable for prognostic models.
We will use footnotes to explain all decisions where the evidence was rated down or upwards, and comment if applicable on differences between the findings for trials and observational studies. The Task Force may alter the appraisals when fully contextualizing the assessment while considering the findings across outcomes e. They will then will use this information to assess the net benefits and harms of screening, and then consider other elements of the GRADE methodology i.
The Osteoporosis Canada Guidelines are the most recent available national recommendations for screening to prevent fragility fracture in Canada. Since publication of the guidelines, new trial evidence has become available that may alter recommendations [ 4 , 5 ].
We will undertake an updated systematic review of the available research relevant to screening for fragility fracture. We anticipate some challenges in updating previous systematic reviews, due to some differences in eligibility criteria and variable reporting in the eligible reviews.
We have incorporated methods to overcome these challenges e. Summary of available screening guidelines. This file documents a variety of screening guidelines for fragility fracture.
DOCX 31 kb. DOCX 29 kb. Supplementary information on selection criteria, data extraction items, and risk of bias assessment. This file contains detailed information about the selection criteria, data extraction items, and risk of bias assessment. DOCX 36 kb.
Identified systematic reviews with adverse events data from observational studies for KQ3b. This file contains a list of systematic reviews identified for integration in KQ3b. DOCX 18 kb. Search strategies. This file contains the planned search strategies for the review. DOCX 46 kb. Becky Skidmore developed the searches in Embase and Central, peer-reviewed the searches, and drafted the KQ4 search. HL helped develop sections of the background. RF developed the draft Medline search strategies for KQs 1, 2, and 3 and provided text for the applicable section of the manuscript.
BV provided input for the sections on data extraction and analysis and reviewed these sections of the manuscript. All authors approve the submission of this version of the protocol. All authors read and approved the final manuscript as submitted. This protocol and the subsequent review will be conducted for the Public Health Agency of Canada; however, it does not necessarily represent the views of the Government of Canada.
Staff of the Global Health and Guidelines Division at the Public Health Agency of Canada HL, SC provided input during the development of this protocol and have reviewed the protocol, but will not be taking part in the selection of studies, data extraction, analysis, or interpretation of the findings. The funder will give approval to the final version of the review.
For the conduct of the review, the funder will also be given opportunity to comment, but final decisions will be made by the review team. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Michelle Gates, Email: ac. Jennifer Pillay, Email: ac. Heather Limburg, Email: ac. Roland Grad, Email: ac. Scott Klarenbach, Email: ac. Christina Korownyk, Email: ac. Donna Reynolds, Email: ac.
John J. Riva, Email: ac. Brett D. Thombs, Email: ac. Gregory A. Kline, Email: ac. William D. Leslie, Email: ac. Susan Courage, Email: ac. Ben Vandermeer, Email: ac. Robin Featherstone, Email: ac. Lisa Hartling, Email: ac. Syst Rev. Published online Aug Riva , 6, 7 Brett D. Thombs , 8 Gregory A. Kline , 9 William D. Author information Article notes Copyright and License information Disclaimer.
Corresponding author. Received Feb 18; Accepted Jul 2. Associated Data Supplementary Materials Additional file 1: Summary of available screening guidelines. Additional file 3: Supplementary information on selection criteria, data extraction items, and risk of bias assessment. Additional file 4: Identified systematic reviews with adverse events data from observational studies for KQ3b.
Additional file 5: Search strategies. Methods A modified update of an existing systematic review will evaluate screening effectiveness, the accuracy of screening tools, and treatment benefits.
Discussion Since the publication of other guidance in Canada, new trials have been published that are likely to improve understanding of screening in primary care settings to prevent fragility fractures. Electronic supplementary material The online version of this article Keywords: Systematic review, Guideline, Fragility fractures, Screening.
Description of the condition and disease burden Fragility fractures are those that occur spontaneously during normal daily activities or that result from minor impacts that would not normally cause a fracture in healthy adults [ 17 ].
Components of screening interventions Rationale for screening Since individuals without prior fracture but at risk for incident fragility fracture are asymptomatic, screening should be able to identify those who are at greater risk of fracture and potential candidates for preventive intervention.
Fracture risk assessment International guidelines Additional file 1 vary in their current recommendations on screening approaches, based on the country-specific population burden of fragility fractures and mortality, competing societal priorities, and resource availability [ 9 ].
Treatment thresholds and decisions Treatment thresholds vary considerably across countries and may take into account variation in population-specific risk of fracture and mortality [ 57 ], competing health care priorities, patient willingness-to-pay for fracture-related health care, resource availability e.
Pharmacological treatment According to the Osteoporosis Canada guideline, for postmenopausal women, the first-line therapy is either one of three bisphosphonates i. Non-pharmacological treatment Non-pharmacological interventions e. Negative consequences of screening and treatment The development of recommendations for screening requires consideration of the potential for negative consequences i.
Inaccurate prediction of risk Individuals can experience physical and psychological harm if their risk of fracture is over- or under-estimated e. Adverse events associated with pharmacological treatment Two systematic reviews have assessed adverse events for multiple bisphosphonates as well as for denosumab.
Methods Systematic review scope and approach The Evidence Review and Synthesis Centre at the University of Alberta will conduct this review on behalf of the Task Force and following the research methods outlined in the Task Force methods manual [ ].
Open in a separate window. Table 1 Key question 1 benefits and harms of screening study eligibility criteria. Table 2 Key question 2 accuracy of screening tests study eligibility criteria. Table 3 Key question 3 benefits and harms of treatment study eligibility criteria.
Data extraction We will develop a standardized form to assist in extracting relevant data. Risk of bias assessment For KQ1 benefits and harms of screening , KQ2 accuracy of screening tests , and KQ3a benefits of treatment , we will use previous risk of bias or quality assessments reported in the USPSTF review to represent a single reviewer; another reviewer will conduct an independent assessment and develop consensus with the reported assessments.
Data synthesis We will provide a summary of the average effect across studies using approaches relevant to the outcomes for each KQ. Key questions 1 and 3 We will inspect studies for methodological and clinical heterogeneity, and if appropriate, for KQ1 benefits and harms of screening and KQ3 benefits and harms of treatment , we will pool data for each outcome via pairwise meta-analysis using the DerSimonian and Laird random effects model [ ] in Review Manager version 5.
Key question 4 We expect to perform a narrative synthesis given the likely heterogeneity in study designs, exposure characteristics e. Dealing with missing data If data required for meta-analysis are not directly reported by individual studies, whenever possible, we will compute or estimate these using other statistics presented in the studies, based on available guidance [ , ].
Assessment of the certainty of effects in the body of evidence We will not rely on previous appraisals of the certainty of the body of evidence, and instead assess this anew. Discussion The Osteoporosis Canada Guidelines are the most recent available national recommendations for screening to prevent fragility fracture in Canada.
Additional files Additional file 1: 31K, docx Summary of available screening guidelines. Additional file 3: 36K, docx Supplementary information on selection criteria, data extraction items, and risk of bias assessment.
Additional file 4: 18K, docx Identified systematic reviews with adverse events data from observational studies for KQ3b. Additional file 5: 46K, docx Search strategies. Funding This protocol and the subsequent review will be conducted for the Public Health Agency of Canada; however, it does not necessarily represent the views of the Government of Canada. Availability of data and materials Not applicable. Ethics approval and consent to participate Not applicable.
Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Contributor Information Michelle Gates, Email: ac. References 1. Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: results from the CaMos and Manitoba cohorts.
Osteoporos Int. BMC Musculoskel Disord. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Low bone mineral density and fracture burden in postmenopausal women.
A review of osteoporosis diagnosis and treatment options in new and recently updated guidelines on case finding around the world. Curr Osteoporos Rep. Crit Care. Outbreaks of Middle East respiratory syndrome in two hospitals initiated by a single patient in Daejeon, South Korea. Mahase E. Asian Pac J Allergy Immunol. Natl Sci Rev. Cell Mol Life Sci.
How does Europe PMC derive its citations network? Protein Interactions. Protein Families. Nucleotide Sequences.
Functional Genomics Experiments. Protein Structures. Gene Ontology GO Terms. Data Citations. Proteomics Data. Menu Abstract. Full Text. Nanshan Chen Kaiyuan Sun Jie Li Dawei Wang Chaolin Huang Weijie Guan Yang Yang Lei Chen Chinese Adam Bernheim Feng Pan Jin Zhang Yichun Cheng Sijia Tian Qun Li De Chang Fengxiang Song Michael Chung Zunyou Wu CDC SARS studies Total of 51 studies, 10 patients.
Ali S. Omrani Christl A Donnelly Christopher Monali Varia Robert A Fowler J S M Peiris Wong Kamaljit Singh Kenneth W. Tsang N S Zhong Nelson Lee Ho Ping Tim Tsui Raymond S M Wong Thomas W Timothy H Rainer Zhao Susan M. Poutanen Hung Hoang Thu Vu Chena Leung Monica Avendano Padmini Srikantiah Kwok H. Chan Wannian Liang Xinchun Chen LCL Heung Dwosh Ari Bitnun Alice S. Leonard Grinblat Endnote X7 Author Year Free Let us remind you that your property was in the public domain and that is the only reason it was published on our site.
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