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Despite a fair amount of progress on understanding human immunodeficiency virus (HIV) epidemiology globally, the Middle East and North Africa (MENA) region is the only region where knowledge of the epidemic continues to be very limited, and subject to much controversy. It has been more than 25 years since the discovery of HIV, but no scientific study has provided a comprehensive data-driven synthesis of HIV/AIDS (acquired immunodeficiency syndrome) infectious spread in this region. The current report provides the first comprehensive scientific assessment and data-driven epidemiological synthesis of HIV spread in MENA since the beginning of the epidemic. It is based on a literature review and analysis of thousands of widely unrecognized publications, reports, and data sources extracted from scientific literature or collected from sources at the local, national, and regional levels. The recommendations provided here focus on key strategies related to the scope of this report and its emphasis on understanding HIV epidemiology in MENA as a whole. The recommendations are based on identifying the status of the HIV epidemic in MENA, through this synthesis, as a low HIV prevalence setting with rising concentrated epidemics among priority populations. General directions for prevention interventions as warranted by the outcome of this synthesis are also discussed briefly, but are not delineated because they are beyond the scope of this report. This report was not intended to provide intervention recommendations for each MENA country.

The HIV/AIDS epidemic has the potential to impede and even reverse development if not addressed early enough. Poverty and income inequality have been shown to facilitate the diffusion of HIV epidemics. While abject poverty in the Middle East and North Africa region remains low, a significant proportion of the population (23.2%) live under 2 per day and are extremely vulnerable in their ability to cope with shocks.In order to preserve the benefits of national and regional development investments put in place by governments, and donor agencies, greater investments to improve HIV/AIDS advocacy, information and prevention strategies are needed now to maintain the current low prevalence levels. This title outlines the role of the Bank in confronting the HIV/AIDS epidemic in the region based on a review of needs and gaps at the regional and country level.

Small food store interventions show promise to increase healthy food access in under-resourced areas. However, none have tested the impact of price discounts on healthy food supply and demand. We tested the impact of store-directed price discounts and communications strategies, separately and combined, on the stocking, sales and prices of healthier foods and on storeowner psychosocial factors. Factorial design randomized controlled trial. Twenty-four corner stores in low-income neighbourhoods of Baltimore City, MD, USA. Stores were randomized to pricing intervention, communications intervention, combined pricing and communications intervention, or control. Stores that received the pricing intervention were given a 10-30 % price discount by wholesalers on selected healthier food items during the 6-month trial. Communications stores received visual and interactive materials to promote healthy items, including signage, taste tests and refrigerators. All interventions showed significantly increased stock of promoted foods v. There was a significant treatment effect for daily unit sales of healthy snacks (β=6·4, 95 % CI 0·9, 11·9) and prices of healthy staple foods (β=-0·49, 95 % CI -0·90, -0·03) for the combined group v. control, but not for other intervention groups. There were no significant intervention effects on storeowner psychosocial factors. All interventions led to increased stock of healthier foods. The combined intervention was effective in increasing sales of healthier snacks, even though discounts on snacks were not passed to the consumer. Experimental research in small stores is needed to understand the mechanisms by which store-directed price promotions can increase healthy food supply and demand.

PurposeStenoses in mature arteriovenous fistulas (AVFs) are common and can negatively impact on the quality of haemodialysis, the longevity of the AVF and lead to debilitating symptoms. Multiple treatment options exist; however, management can vary between different centres. We aimed to establish multidisciplinary consensus on the optimal stepwise application of interventions based on evidence and consensus.MethodsA modified Delphi process was conducted with 13 participants from hospitals across the UK, all of whom have high-volume dialysis access practice.ResultsThe usual intervention to rectify de novo stenoses of mature AVFs is fistuloplasty, although surgery for inflow segment stenoses is also clinically acceptable. Appropriate first-line interventions include plain old balloon angioplasty or high-pressure balloon angioplasty; if these fail during the fistuloplasty, consider upsizing the balloon, prolonged balloon inflation or using alternative interventions, such as cutting or scoring balloons and ultra-high-pressure balloons. Alternative or subsequent interventions vary by anatomical site and may require additional multidisciplinary team input. For a stenoses recurring between 3 and 12 months, it is appropriate to consider interventions used de novo, but with a lower threshold for using drug-coated balloons (DCBs) in all regions and for using stent grafts in all regions but inflow segment. Recurrence after 12 months should be treated as a de novo lesion, with DCBs considered if they have been used successfully during previous interventions.ConclusionsThese recommendations aim to provide a practical guide to multidisciplinary teams in order to optimise the use of multiple interventions for rectifying AVF stenoses and provide unified evidence-based practice guidelines.

Background An estimated two billion people do not have sufficient access to nutritious food, and nearly half are dependent on small‐scale and subsistence farming. Projections show that the global population is not on track to reach the Sustainable Development Goals. With this in mind, development actors are increasingly seeking to better integrate rural farmers into agricultural markets. This synthesis of the literature can help to inform policy decisions to improve outcomes for smallholder farmers in low‐ and middle‐income countries, and to enable the realization of the Sustainable Development Goals. This work is the most comprehensive and up‐to‐date review synthesizing evidence from 262 interventions. Objectives The purpose of this systematic review is to appraise and synthesize evidence of the effects of five types of interventions facilitating farmers' access to output markets in low‐ and middle‐income countries. We examine how these effects vary across contexts and subgroups. We also identify evidence on program costs and evidence gaps in the literature. Search Methods The search of included studies was based on nine major databases/search engines and 25 institutional websites, using a set of English search terms. We also conducted forward and backward citation tracking of literature, published a public call for papers, and contacted key experts. Selection Criteria We included studies on the effects of five types of output market access interventions, focusing on participants residing in low‐ and middle‐income countries: (1) Farm‐to‐market transport infrastructure interventions; (2) Access to output market information interventions; (3) New marketplaces or alternative marketing opportunities interventions; (4) Contract farming interventions; (5) Improved storage infrastructure and technologies interventions. We included published and unpublished studies from 2000 onwards, with experimental and quasi‐experimental study designs focusing on relevant outcomes. Data Collection and Analysis We screened 52,366 studies, identifying a total of 439 papers representing 289 unique studies on the effects of 262 interventions in 53 countries. Data extraction and risk of bias assessments were completed by two independent reviewers. Main Results All five types of output market access interventions resulted in small‐to‐moderate positive effects on almost all measures of market participation, agricultural production, and welfare outcomes. These improvements occurred through a reduction in transaction costs, adoption of improved practices, greater farm investment, access to higher prices for farmers, greater volume sold, and increased farm income. Effects vary by intervention type. However, the body of evidence is comprised of a large share of included studies with a high risk of bias. Few studies have information on the cost of interventions, and there are gaps in the available evidence. Authors' Conclusions Output market access interventions are effective in reducing transaction costs and addressing market failures, thereby leading to higher income levels. Evidence of effects on food security and nutrition is sparse and has not provided conclusive findings. We also found that multi‐component interventions are not necessarily more effective than single component interventions. The specific needs and dynamics of each context should inform the choice of the intervention and approach. Investments in additional research with low risk of selection bias and confounding effects will improve the evidence base, especially for outcomes that constitute gaps in the literature. For example, the effects on quality of agricultural products and group participation are under‐researched, and we did not find any included studies focusing on North Africa or the Middle East. Collecting and reporting information on interventions' cost‐effectiveness will help decision‐makers to prioritize limited resources.

Background Maintaining the effectiveness of the currently recommended malaria vector control interventions while integrating new interventions will require monitoring key recommended indicators to identify threats to effectiveness including physiological and behavioural resistance to insecticides. Methods Country metadata on vector surveillance and control activities was collected using an online survey by National Malaria Control Programmes or partner organization officials. Country and regional surveillance activities were analysed for alignment with indicators for priority vector surveillance objectives recommended by the World Health Organization. Surveillance activities were also compared for countries in the E2020 (eliminating countries) and countries with more intense transmission. Results Significant differences in monitoring priority vector indicators between Africa and Asia-Pacific country programmes were found as well as differences between countries approaching elimination and those controlling malaria. Gaps were found between vector data collected and country management strategies (i.e., for insecticide resistance management and integrated vector control strategies) and for making programmatic decisions on surveillance and control using vector surveillance data. Conclusions Significant opportunities exist for increasing vector data collection on priority indicators and using these data for national programmatic decisions for both proactive insecticide resistance management and enhancing vector control.

Background Vascular access (VA) intervention therapy (VAIVT) has been increasingly used for treating VA failure (VAF) in patients undergoing hemodialysis; however, clinical evidence demonstrating the efficacy of prevention of VAF after VAIVT is limited. Therefore, we aimed to assess characteristics of patients developing VAF after VAIVT and analyze risk factors for VAF after VAIVT. Methods This retrospective study included 96 patients with VAF who underwent ultrasound-guided VAIVT by interventional nephrologists between January 2013 and March 2018 at the Department of Nephrology, University of Tokyo Hospital, Japan. Patient information included age, sex, medication history, and comorbidities that could potentially affect VAF onset. Patients were categorized into two groups based on antiplatelet treatment. Multivariate Cox regression analysis was performed for evaluating effect of various factors on VAF after VAIVT. Results Median age of patients at the time of VAIVT was 71 years (interquartile range 63–79); the most prevalent etiology underlying end-stage renal disease was diabetic nephropathy (40.7%). Comparison between the antiplatelet and non-antiplatelet groups revealed that the incidence of VAF was significantly lower in the antiplatelet group. Multivariate analysis revealed that antiplatelet treatment was associated with a lower risk of VAF after VAIVT. Conclusion Administration of antiplatelet agents was associated with a significant reduction in VAF risk after VAIVT.

Abstract Chronic kidney disease (CKD) is a worldwide public health problem and is associated with high morbidity and mortality. The majority of patients with CKD stage 5 (CKD-5), who cannot undergo renal transplant, depend on maintenance hemodialysis by surgically created access sites. Native fistulae are preferred over grafts due to their longevity. More than half of these vital portals for dialysis access will fail over time. Screening procedures to select high-risk patients before thrombosis or stenosis appears have resulted in aggressive management. These patients are referred for angiographic evaluation and/or therapy. We present the patterns of dialysis-related interventions done in our institution.

This article describes EXCEL, a program that encourages youth underrepresented in higher education to enroll in higher education, specifically at the sponsoring university. Eighty-three eighth grade students with GPA of B and above and standardized test scores at grade level or above were randomly assigned to the program or to a control group. The program guaranteed a scholarship to the sponsoring university and provided enrichment activities throughout high school. Program students were more likely to enroll at the sponsoring university than were control students. However, program and control students enrolled in higher education at rates that did not differ significantly. No differences were detected in self-esteem or high school GPA. Program students desired more education than control students. The results suggest that scholarship incentive and support programs that target average to above average achieving students in the eighth grade may not raise the overall number of aspiring minority youth attending college, but may be useful to specific universities to raise their minority enrollment.

The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria's neighbouring countries as well as in Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Most refugees do not have access to mental health services for these problems because of multiple barriers in national and refugee specific health systems, including limited availability of mental health professionals. To counter some of challenges arising from limited mental health system capacity the World Health Organization (WHO) has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered through individual or group face-to-face or smartphone formats by lay, non-professional people who have not received specialized mental health training, We provide an evidence-based rationale for the use of the scalable PM+ oriented programmes being adapted for Syrian refugees and provide information on the newly launched STRENGTHS programme for adapting, testing and scaling up of PM+ in various modalities in both neighbouring and European countries hosting Syrian refugees.