Defining and measuring health equity effects in research on task shifting interventions in high-income countries: a systematic review protocol Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity amongst children Tackling inequalities in obesity: a protocol for a systematic review of the effectiveness of public health interventions at reducing socioeconomic inequalities in obesity among adults The impact of cash transfers on social determinants of health and health inequalities in Sub-Saharan Africa: a systematic review protocol Do school-based physical activity interventions increase or reduce inequalities in health? Socioeconomic inequalities in mortality and importance of perceived control: cohort study Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review. CONSORT-Equity 2017 extension and elaboration for better reporting of health equity in randomised trials Improving the reporting of public health intervention research: advancing TREND and CONSORT. Gender Obesity Inequities Are Huge but Differ Greatly According to Environment and Socio-Economics in a North African Setting: A National Cross-Sectional Study in Tunisia Impact on inequities in health indicators: Effect of implementing the integrated management of neonatal and childhood illness programme in Haryana, India Understanding psychological distress among mothers in rural Nepal: a qualitative grounded theory exploration Exploring antiretroviral treatment adherence in an urban setting in South Africa Uterine Tonus Assessment by Midwives versus Patient self-assessment in the active management of the third stage of labor (UTAMP): study protocol for a randomized controlled trial Feasibility and Acceptability of a Task-Shifted Intervention to Enhance Adherence to HIV Medication and Improve Depression in People Living with HIV in Zimbabwe, a Low Income Country in Sub-Saharan Africa Inequalities in physical comorbidity: a longitudinal comparative cohort study of people with severe mental illness in the UK Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries Task shifting and integration of HIV care into primary care in South Africa: The development and content of the streamlining tasks and roles to expand treatment and care for HIV (STRETCH) intervention The generational transmission of socioeconomic inequalities in child cognitive development and emotional health.
Introduction Task shifting interventions are intended to both deliver clinical ly effective treatments to reduce disease burden and address health inequities or population vulnerability . Little is known about how health equity and population vulnerability are defined and measured in research focused on task shifting . This systematic review will address the following questions : Among  task shifting interventions in high-income setting s that have been studied using r and omised controlled trials or variants , how are health inequity or population vulnerability identified and defined ? What methods and indicators are used to describe , characterise and measure the population ’s baseline status and the intervention ’s impacts on inequity and vulnerability ? Methods and analysis Studies were identified through data base search es ( MEDLINE , Embase , CINAHL , PsycINFO and Web of Science ) . Eligible studies will be r and omised controlled trials published since 2004 , conducted in high-income countries , concerning task shifting interventions to treat any disease , in any population that may face health disadvantage as defined by the PROGRESS-Plus framework ( place of residence , race/ethnicity/culture/ language , occupation , gender/sex , religion , social capital , socioeconomic position , age , disability , sexual orientation , other vulnerable groups ) . We will conduct independent and duplicate title and abstract screening , then identify related papers from the same programme of research through further data base and manual search ing . From each programme of research , we will extract study details , and definitions and measures of health equity or population vulnerability based on the PROGRESS-Plus framework . Two investigators will assess the quality of reporting and measurement related to health equity and vulnerability using a scale developed for this study . A narrative synthesis will highlight similarities and differences between the gathered studies and offer critical analyses and implication s. Ethics and dissemination This review does not involve primary data collection , does not constitute research on human subjects and is not subject to additional institutional ethics review or informed consent procedures . Dissemination will include open-access peer- review ed publication and academic conference presentations . PROSPERO Registration Number CRD42017049959 Background There is growing evidence of the impact of overweight and obesity on short- and long-term functioning , health and well-being . Internationally , childhood obesity rates continue to rise in some countries ( for example , Mexico , India , China and Canada ) , although there is emerging evidence of a slowing of this increase or a plateauing in some age groups . In most European countries , the United States and Australia , however , socioeconomic inequalities in relation to obesity and risk factors for obesity are widening . Addressing inequalities in obesity , therefore , has a very high profile on the public health and health services agendas . However , there is a lack of accessible policy-ready evidence on what works in terms of interventions to reduce inequalities in obesity . Methods and design This article describes the protocol for a National Health Service Trust ( NHS ) National Institute for Health Research -funded systematic review of public health interventions at the individual , community and societal levels which might reduce socioeconomic inequalities in relation to obesity amongst children ages 0 to 18 years . The studies will be selected only if ( 1 ) they included a primary outcome that is a proxy for body fatness and ( 2 ) examined differential effects with regard to socioeconomic status ( education , income , occupation , social class , deprivation and poverty ) or the intervention was targeted specifically at disadvantaged groups ( for example , children of the unemployed , lone parents , low income and so on ) or at people who live in deprived areas . A rigorous and inclusive international literature search will be conducted for r and omised and nonr and omised controlled trials , prospect i ve and retrospective cohort studies ( with and /or without control groups ) and prospect i ve repeat cross-sectional studies ( with and /or without control groups ) . The following electronic data bases will be search ed : MEDLINE , Embase , CINAHL , PsycINFO , Social Science Citation Index , ASSIA , IBSS , Sociological Abstract s and the NHS Economic Evaluation Data base . Data base search es will be supplemented with website and grey literature search es . No studies will be excluded on the basis of language , country of origin or publication date . Study inclusion , data extraction and quality appraisal will be conducted by two review ers . Meta- analysis and narrative synthesis will be conducted . The main analysis will examine the effects of ( 1 ) individual , ( 2 ) community and ( 3 ) societal level public health interventions on socioeconomic inequalities in childhood obesity . Interventions will be characterised by their level of action and their approach to tackling inequalities . Context ual information on how such public health interventions are organised , implemented and delivered will also be examined . Discussion In this review , we consider public health strategies which reduce and prevent inequalities in the prevalence of childhood obesity , highlight any gaps in the evidence base and seek to establish how such public health interventions are organised , implemented and delivered . PROSPERO registration number : Background Socioeconomic inequalities in obesity and associated risk factors for obesity are widening throughout developed countries worldwide . Tackling obesity is high on the public health agenda both in the United Kingdom and internationally . However , what works in terms of interventions that are able to reduce inequalities in obesity is lacking . Methods / Design The review will examine public health interventions at the individual , community and societal level that might reduce inequalities in  obesity among adults aged 18 years and over , in any setting and in any country . The following electronic data bases will be search ed : MEDLINE , EMBASE , CINAHL , PsycINFO , Social Science Citation Index , ASSIA , IBSS , Sociological Abstract s , and the NHS Economic Evaluation Data base . Data base search es will be supplemented with website and gray literature search es . No studies will be excluded based on language , country or publication date . R and omized and non-r and omized controlled trials , prospect i ve and retrospective cohort studies ( with/without control groups ) and prospect i ve repeat cross-sectional studies ( with/without control groups ) that have a primary outcome that is a proxy for body fatness and have examined differential effects with regard to socioeconomic status ( education , income , occupation , social class , deprivation , poverty ) or where the intervention has been targeted specifically at disadvantaged groups or deprived areas will be included . Study inclusion , data extraction and quality appraisal will be conducted by two review ers . Meta- analysis and narrative synthesis will be conducted . The main analysis will examine the effects of 1 ) individual , 2 ) community and 3 ) societal level public health interventions on socioeconomic inequalities in adult obesity . Interventions will be characterized by their level of action and their approach to tackling inequalities . Context ual information on how such public health interventions are organized , implemented and delivered will also be examined . Discussion The review will provide evidence , and reveal any gaps in the evidence base , of public health strategies which reduce and prevent inequalities in the prevalence of obesity in adults and provide information on the organization , implementation and delivery of such interventions . Systematic review registration PROSPERO registration number : Background There is increasing pressure to address the social determinants of health ( SDoH ) and health inequities through the implementation of culturally acceptable interventions particularly in Sub-Saharan Africa ( SSA ) where health outcomes are generally poor . Available evaluation research on cash transfers ( CTs ) suggests that the programs may influence the wider determinants of health in SSA ; yet , there has been no attempt to synthesize the evidence regarding their contribution to tackling the SDoH and health inequalities . To date , nearly all the review s on CTs ' impact on health have predominantly featured evidence from Latin America with limited transferability to the social , cultural , and political environments in SSA . Therefore , the aim of this study is to undertake a systematic review to assess the role of CTs in tackling the wider determinants of health and health inequalities in SSA . Methods / design A systematic review of published and unpublished literature on CTs ’ impact on health and health determinants covering the period 2000–2016 will be undertaken . Studies will be considered for inclusion if they present quantitative or qualitative data , including all relevant study design s. The SDoH conceptual framework will be used to guide the data extraction process . EPPI Review er software will be used for data management and analysis . Studies included in the review will be analyzed by narrative synthesis and /or meta- analysis as appropriate for the nature of the data retrieved . Discussion This review will provide empirical evidence on the impact of CTs on SDoH to inform CT policy , implementation , and research in SSA . The protocol follows the Preferred Reporting Items for Systematic Review and Meta- Analysis Protocol s ( PRISMA -P ) . Systematic review registration This protocol has been registered with the PROSPERO international prospect i ve register of systematic review s , reference CRD42015025015 Little is known about the effectiveness of school-based health promotion on physical activity inequalities among children from low-income areas . This study compared the two-year change in physical activity among 10 - 11 year-old children attending schools with and without health promotion programs by activity level , body weight status , and socioeconomic background s to assess whether health promotion programs reduce or exacerbate health inequalities . This was a quasi-experimental trial of a Comprehensive School Health ( CSH ) program implemented in schools located in socioeconomically disadvantaged neighbourhoods in Edmonton , Alberta , Canada . In the spring of 2009 and 2011 , pedometer ( 7 full days ) and demographic data were collected from cross-sectional sample s of grade five children from 10 intervention and 20 comparison schools . Socioeconomic status was determined from parent self-report . Low-active , active , and high-active children were defined according to step-count tertiles . Multilevel linear regression methods adjusted for potential confounders were used to assess the relative inequity in physical activity and were compared between groups and over-time . In 2009 , a greater proportion of students in the intervention schools were overweight ( 38 % vs. 31 % p = 0.03 ) and were less active ( 10,827 vs. 12,265 steps/day p < 0.001 ) . Two years later , the relative difference in step-counts between intervention and comparison schools reduced from -15.5 % to 0 % among low-active students , from -13.4 % to 0 % among active students , and from -15.1 % to -2.7 % among high-active students . The relative difference between intervention and comparison schools reduced from -11.1 % to -1.6 % among normal weight students , from -16.8 % to -1.4 % among overweight students , and was balanced across socioeconomic subgroups . These findings demonstrate that CSH programs implemented in socioeconomically disadvantaged neighbourhoods reduced inequalities in physical activity . Investments in school-based health promotion are a viable , promising , and important approach to improve physical activity and prevent childhood obesity , and may also reduce inequalities in health Perceived control has convincingly been suggested to be a key concept in explaining socioeconomic differences in health.1 Some empirical evidence exists of a higher prevalence of low control beliefs ( such as powerlessness or fatalism ) in lower socioeconomic groups and that this is relevant to socioeconomic inequalities in general health.2 However , a systematic examination of the extent to which perceived control contributes to socioeconomic inequalities in mortality is lacking . This is important , as attention has recently shifted towards psychological and psychosocial explanations of socioeconomic inequalities in health . Data were collected in 1991 within the framework of a general population study of the health and living conditions of the population of Eindhoven and its surroundings ( the GLOBE study ) .3 We invited a r and om sub sample for interview . The response rate was 80 % and not related to demographic characteristics . Interview data were available for 1220 men and 1242 women aged 25 - 74 ( 51 on BACKGROUND Community-based health workers ( CBHWs ) are frontline public health workers who are trusted members of the community they serve . Recently , considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable population s who often face health inequities . OBJECTIVES We performed a systematic review to synthesize evidence concerning the types of CBHW interventions , the qualification and characteristics of CBHWs , and patient outcomes and cost-effectiveness of such interventions in vulnerable population s with chronic , noncommunicable conditions . SEARCH METHODS We undertook 4 electronic data base search es- PubMed , EMBASE , Cumulative Index to Nursing and Allied Health Literature , and Cochrane- and h and search ed reference collection s to identify r and omized controlled trials published in English before August 2014 . SELECTION We screened a total of 934 unique citations initially for titles and abstract s. Two review ers then independently evaluated 166 full-text articles that were passed onto review processes . Sixty-one studies and 6 companion articles ( e.g. , cost-effectiveness analysis ) met eligibility criteria for inclusion . DATA COLLECTION AND ANALYSIS Four trained research assistants extracted data by using a st and ardized data extraction form developed by the authors . Subsequently , an independent research assistant review ed extracted data to check accuracy . Discrepancies were resolved through discussion s among the study team members . Each study was evaluated for its quality by 2 research assistants who extracted relevant study information . Interrater agreement rates ranged from 61 % to 91 % ( average 86 % ) . Any discrepancies in terms of quality rating were resolved through team discussion s. MAIN RESULTS All but 4 studies were conducted in the United States . The 2 most common areas for CBHW interventions were cancer prevention ( n = 30 ) and cardiovascular disease risk reduction ( n = 26 ) . The roles assumed by CBHWs included health education ( n = 48 ) , counseling ( n = 36 ) , navigation assistance ( n = 21 ) , case management ( n = 4 ) , social services ( n = 7 ) , and social support ( n = 18 ) . Fifty-three studies provided information regarding CBHW training , yet CBHW competency evaluation ( n = 9 ) and supervision procedures ( n = 24 ) were largely underreported . The length and duration of CBHW training ranged from 4 hours to 240 hours with an average of 41.3 hours ( median : 16.5 hours ) in 24 studies that reported length of training . Eight studies reported the frequency of supervision , which ranged from weekly to monthly . There was a trend toward improvements in cancer prevention ( n = 21 ) and cardiovascular risk reduction ( n = 16 ) . Eight articles documented cost analyses and found that integrating CBHWs into the health care delivery system was associated with cost-effective and sustainable care . CONCLUSIONS Interventions by CBHWs appear to be effective when compared with alternatives and also cost-effective for certain health conditions , particularly when partnering with low-income , underserved , and racial and ethnic minority communities . Future research is warranted to fully incorporate CBHWs into the health care system to promote noncommunicable health outcomes among vulnerable population We outline CONSORT-Equity 2017 reporting st and ards , an extension to the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement that aims to improve the reporting of intervention effects in r and omised trials where health equity is relevant . Health inequities are unfair differences in health that can be avoided by reasonable action . We defined a r and omised trial where health equity is relevant as one that assesses effects on health equity by evaluating an intervention focused on people experiencing social disadvantage or by exploring the difference in the effect of the intervention between two groups ( or as a gradient across more than two groups ) experiencing different levels of social disadvantage , or both . We held a consensus meeting with diverse potential users from high , middle , and low income countries , including knowledge users such as patients and method ologists . We discussed evidence for each proposed extension item from empirical studies , review s , key informant interviews , and an online survey , aim ing to improve clarity of reporting without imposing undue burden on authors . The new guidance contains equity extensions to 16 items from CONSORT 2010 plus one new item on research ethics reporting , with examples of good practice and a brief explanation and elaboration for each . Widespread uptake of this guidance for the reporting of trials where health equity is relevant will make it easier for decision makers to find and use evidence from r and omised trials to reduce unfair inequalities in health BACKGROUND Evidence -based public health decision-making depends on high quality and transparent accounts of what interventions are effective , for whom , how and at what cost . Improving the quality of reporting of r and omized and non-r and omized study design s through the CONSORT and TREND statements has had a marked impact on the quality of study design s. However , public health users of systematic review s have been concerned with the paucity of synthesized information on context , development and rationale , implementation processes and sustainability factors . METHODS This paper examines the existing reporting frameworks for research against information sought by users of systematic review s of public health interventions and suggests additional items that should be considered in future recommendations on the reporting of public health interventions . RESULTS Intervention model , theoretical and ethical considerations , study design choice , integrity of intervention/process evaluation , context , differential effects and inequalities and sustainability are often overlooked in reports of public health interventions . CONCLUSION Population health policy makers need synthesized , detailed and high quality a priori accounts of effective interventions in order to make better progress in tackling population morbidities and inequalities . Adding simple criteria to reporting st and ards will significantly improve the quality and usefulness of published evidence and increase its impact on public health program planning Introduction Southern Mediterranean countries have experienced a marked increase in the prevalence of obesity whose consequences for gender related health inequities have been little studied . We assessed gender obesity inequalities and their environmental and socio-economic modifiers among Tunisian adults . Methods Cross-sectional survey in 2005 ; national , 3 level r and om cluster sample of 35–70 years Tunisians ( women : n = 2964 , men : n = 2379 ) . Overall adiposity was assessed by BMI = weight(kg)/height(m)2 and obesity was BMI ≥30 , WHtR = waist circumference to height ratio defined abdominal obesity as WHtR≥0.6 . Gender obesity ine quality measure was women versus men Prevalence Proportion Odds-Ratio ( OR ) ; models featuring gender x covariate interaction assessed variation of gender obesity inequalities with area ( urban versus rural ) , age , marital status or socio-economic position ( profession , education , household income proxy ) . Results BMI was much higher among women ( 28.4(0.2 ) ) versus men ( 25.3(0.1 ) ) , P<0.0001 ) as was obesity ( 37.0 % versus 13.3 % , OR = 3.8[3.1–7.4 ] , P<0.0001 ) and abdominal obesity ( 42.6 % versus 15.6 % , 4.0[3.3–4.8 ] , P<0.0001 ) . Gender obesity inequalities ( women versus men adjusted OR ) were higher in urban ( OR = 3.3[1.3–8.7 ] ) than rural ( OR = 2.0[0.7–5.5 ] ) areas . These gender obesity inequalities were lower for subjects with secondary education or more ( OR = 3.3[1.3–8.6 ] ) , than among those with no schooling ( OR = 6.9[2.0–23.3 ] ) . They were also lower for those with upper/intermediate profession ( OR = 1.4[0.5–4.3 ] ) or even employees/workers OR = 2.3[1.0–5.4 ] than those not professionaly active at all ( OR = 3.3[1.3–8.6 ] ) . Similar results were observed for addominal obesity . Conclusion The huge overall gender obesity inequities ( women much more corpulent than men ) were higher in urban setting s , but lower among subjects of higher education and professional activity . Reasons for gender inequalities in obesity and their variation with socio-economic position should be sought so that appropriate policies to reduce these inequalities can be implemented in Tunisia and similar setting Background A trial to evaluate the Integrated Management of Neonatal and Childhood Illness ( IMNCI ) strategy showed that the intervention result ed in lower infant mortality and improved infant care practice s. In this paper , we present the results of a secondary analysis to examine the effect of the IMNCI strategy on inequities in health indicators . Methods The trial was a cluster – r and omized controlled trial in 18 primary health centre areas . For this analysis , the population was divided into subgroups by wealth status ( using Principal Component Analysis ) , religion and caste , education of mother and sex of the infant .  Multiple linear regression analysis was used to examine inequity gradients in neonatal and post – neonatal mortality , care practice s and care seeking , and the differences in these gradients between intervention and control clusters . Findings Inequity in post – neonatal infant mortality by wealth status was lower in the intervention as compared to control clusters ( adjusted difference in gradients 2.2 per 1000 , 95 % confidence interval ( CI ) 0 to 4.4 per 1000 , P = 0.053 ) . The intervention had no effect on inequities in neonatal mortality . The intervention result ed in a larger effect on breastfeeding within one hour of birth in poorer families ( difference in inequity gradients 3.0 % , CI 1.5 to 4.5 , P < 0.001 ) , in lower caste and minorities families , and in infants of mothers with fewer years of schooling . The intervention also reduced gender inequity in care seeking for severe neonatal illness from an appropriate provider ( difference in inequity gradients 9.3 % , CI 0.4 to 18.2 , P = 0.042 ) . Conclusions Implementation of IMNCI reduced inequities in post – neonatal mortality , and newborn care practice s ( particularly starting breastfeeding within an hour of birth ) and health care – seeking for severe illness . In spite of the intervention substantial inequities remained in the intervention group and therefore further efforts to ensure that health programs reach the vulnerable population subgroups are required . Trial Registration Clinical trials.gov NCT00474981 ; ICMR Clinical Trial Registry Background There is a large burden of psychological distress in low and middle-income countries , and culturally relevant interventions must be developed to address it . This requires an underst and ing of how distress is experienced . We conducted a qualitative grounded theory study to underst and how mothers experience and manage distress in Dhanusha , a low-re source setting in rural Nepal . We also explored how distressed mothers interact with their families and the wider community . Methods Participants were identified during a cluster-r and omised controlled trial in which mothers were screened for psychological distress using the 12-item General Health Question naire ( GHQ-12 ) . We conducted 22 semi-structured interviews with distressed mothers ( GHQ-12 score ≥5 ) and one with a traditional healer ( dhami ) , as well as 12 focus group discussion s with community members . Data were analysed using grounded theory methods and a model was developed to explain psychological distress in this setting . Results We found that distress was termed tension by participants and mainly described in terms of physical symptoms . Key perceived causes of distress were poor health , lack of sons , and fertility problems . Tension developed in a context of limited autonomy for women and perceived duty towards the family . Distressed mothers discussed several strategies to alleviate tension , including seeking treatment for perceived physical health problems and tension from doctors or dhamis , having repeated pregnancies until a son was delivered , manipulating social circumstances in the household , and deciding to accept their fate . Their ability to implement these strategies depended on whether they were able to negotiate with their in-laws or husb and s for re sources . Conclusions Vulnerability , as a consequence of gender and social disadvantage , manifests as psychological distress among mothers in Dhanusha . Screening tools incorporating physical symptoms of tension should be envisaged , along with interventions to address gender inequity , support marital relationships , and improve access to perinatal healthcare Antiretroviral treatment requires high levels of adherence to be effective . This qualitative study explores the reasons for poor  adherence among 22 purposively selected poor urban participants in South Africa . Over a 4-month period in 2009 , we prospect ively investigated experiences of HIV diagnosis and treatment , adherence , and withdrawal from  treatment  . Patients with no stable food sources faced significant barriers in adhering to treatment regimens and staying sufficiently healthy to search for , obtain or retain a job . The narratives also identify the influence on adherence of self-esteem and social support , vulnerability generated by ill health , gendered conflict , social inequities amplified by HIV , and exhaustion due to the social burden of the epidemic . Multi-dimensional , inter-sectoral programs that tackle the social determinants of health , such as food insecurity , poverty , gendered inequities , and treatment adherence are more likely to be successful , than single interventions to support adherence Background Postpartum hemorrhage ( PPH ) is the leading cause of maternal mortality worldwide and accounts for one third of maternal deaths in low-income and middle-income countries . PPH can be prevented by active management of the third stage of labor ( AMTSL ) , a series of steps recommended by the World Health Organization to be performed by skilled birth attendants ( SBAs ) . Task shifting in the AMTSL step of uterotonic drugs administration to community health workers , traditional birth attendants and self-administration has been investigated as a strategy to increase access to quality obstetric care considering persistent SBA and facility-based delivery shortages . The aim of this study is to assess task shifting in the final step of AMTSL and compare uterine tonus assessment by a SBA to self- assessment . Methods and Design The study is an individual-level two-arm non-inferiority r and omized controlled trial ( RCT ) . A total of 800 women will be recruited in Korle Bu Teaching Hospital in Accra , Ghana . Adult women in labor at term with an expected vaginal delivery who received antenatal instructions for self- assessment of uterine tonus will be eligible for inclusion . Women with an increased risk for PPH will be excluded . Women will be r and omized to uterine tone assessment by a skilled birth attendant ( midwife ) or uterine tone self- assessment ( with the safety back-up of a midwife present in case of PPH or uterine atony ) . Postpartum blood loss will be measured through weighing of disposable mats . The main study endpoints are PPH ( ≥500 ml blood loss ) , severe PPH ( ≥1000 ml blood loss ) , mean blood loss , and routine maternal and neonatal outcomes . Participants and caregivers will not be blinded given the nature of the intervention . Discussion A reduction of PPH-related maternal mortality requires full implementation of AMTSL . Task shifting of uterine tone assessment may contribute to increased AMTSL implementation in ( clinical ) setting s where SBAs capacity is constrained . Trial registration Clinical trials.gov : NCT02223806 , registration August 2014 . PACTR : PACTR201402000736158 , registration July 2014 . University of Ghana , Medical School Ethical and Protocol Review Committee : MS-Et/M.8–P4.1/2014 - Abstract Using a pilot trial design in an HIV care clinic in Zimbabwe , we r and omised 32 adults with poor adherence to antiretroviral therapy and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression ( PST-AD ) delivered by an adherence counsellor , or to Enhanced Usual Care ( Control ) .  Acceptability of PST-AD was high , as indicated by frequency of session attendance and through qualitative analyses of exit interviews . Fidelity was > 80 % for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4 . Contamination occurred , in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment . Routine health records proved unreliable for measuring HIV viral load at follow-up . Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device . The study was not powered to detect clinical differences , however , promising change at 6-months follow-up was seen in electronic adherence , viral load suppression ( PST-AD arm 9/12 suppressed ; control arm 4/8 suppressed ) and depression ( Patient Health Question naire—4.7 points in PST-AD arm vs. control , adjusted p value = 0.01 ) . Results inform and justify a future r and omised controlled trial of task-shifted PST-AD Objectives Little is known about the prevalence of comorbidity rates in people with severe mental illness ( SMI ) in UK primary care . We calculated the prevalence of SMI by UK country , English region and deprivation quintile , antipsychotic and antidepressant medication prescription rates for people with SMI , and prevalence rates of common comorbidities in people with SMI compared with people without SMI . Design Retrospective cohort study from 2000 to 2012 . Setting 627 general practice s contributing to the Clinical Practice Research Data link , a UK primary care data base . Participants Each identified case ( 346 551 ) was matched for age , sex and general practice with 5 r and omly selected control cases ( 1 732 755 ) with no diagnosis of SMI in each yearly time point . Outcome measures Prevalence rates were calculated for 16 conditions . Results SMI rates were highest in Scotl and and in more deprived areas . Rates increased in Engl and , Wales and Northern Irel and over time , with the largest increase in Northern Irel and ( 0.48 % in 2000/2001 to 0.69 % in 2011/2012 ) . Annual prevalence rates of all conditions were higher in people with SMI compared with those without SMI . The discrepancy between the prevalence of those with and without SMI increased over time for most conditions . A greater increase in the mean number of additional conditions was observed in the SMI population over the study period ( 0.6 in 2000/2001 to 1.0 in 2011/2012 ) compared with those without SMI ( 0.5 in 2000/2001 to 0.6 in 2011/2012 ) . For both groups , most conditions were more prevalent in more deprived areas , whereas for the SMI group conditions such as hypothyroidism , chronic kidney disease and cancer were more prevalent in more affluent areas . Conclusions Our findings highlight the health inequalities faced by people with SMI . The provision of appropriate timely health prevention , promotion and monitoring activities to reduce these health inequalities are needed , especially in deprived areas People living with HIV ( PLWH ) experience greater psychological distress than the general population . Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms , quality of life , and HIV care engagement . However , little is known about the effectiveness of mental health interventions for PLWH in low- and middle-income countries ( LMICs ) , where the large majority of PLWH reside . This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these setting s. A systematic search strategy was undertaken to identify peer- review ed published papers of intervention trials addressing negative psychological states or disorders ( e.g. depression , anxiety ) among PLWH in LMIC setting s. Search results were assessed against pre-established inclusion and exclusion criteria . Data from papers meeting criteria were extracted for synthesis . Twenty-six papers , published between 2000 and 2014 , describing 22 unique interventions were identified . Trials were implemented in sub-Saharan Africa ( n = 13 ) , Asia ( n = 7 ) , and the Middle East ( n = 2 ) , and addressed mental health using a variety of approaches , including cognitive-behavioral ( n = 18 ) , family-level ( n = 2 ) , and pharmacological ( n = 2 ) treatments . Four r and omized controlled trials reported significant intervention effects in mental health outcomes , and 11 preliminary studies demonstrated promising findings . Among the limited mental health intervention trials with PLWH in LMICs , few demonstrated efficacy .  Mental health interventions for PLWH in LMICs must be further developed and adapted for re source -limited setting s to improve effectiveness Background Task shifting and the integration of human immunodeficiency virus ( HIV ) care into primary care services have been identified as possible strategies for improving access to antiretroviral treatment ( ART ) . This paper describes the development and content of an intervention involving these two strategies , as part of the Streamlining Tasks and Roles to Exp and Treatment and Care for HIV ( STRETCH ) pragmatic r and omised controlled trial . Methods : Developing the interventionThe intervention was developed following discussion s with senior management , clinicians , and clinic staff . These discussion s revealed that the establishment of separate antiretroviral treatment services for HIV had result ed in problems in accessing care due to the large number of patients at ART clinics . The intervention developed therefore combined the shifting from doctors to nurses of prescriptions of antiretrovirals ( ARVs ) for uncomplicated patients and the stepwise integration of HIV care into primary care services . Results : Components of the interventionThe intervention consisted of regulatory changes , training , and guidelines to support nurse ART prescription , local management teams , an implementation toolkit , and a flexible , phased introduction . Nurse supervisors were equipped to train  intervention clinic nurses in ART prescription using outreach education and an integrated primary care guideline . Management teams were set up and a STRETCH coordinator was appointed to oversee the implementation process . Discussion Three important processes were used in developing and implementing this intervention : active participation of clinic staff and local and provincial management , educational outreach to train nurses in intervention sites , and an external facilitator to support all stages of the intervention rollout . The STRETCH trial is registered with Current Control Trials IS RCT N46836853 Socioeconomic inequalities in the health of adults have been largely attributed to lifestyle inequalities . The cognitive development ( CD ) and emotional health ( EH ) of the child provides a basis for many of the health-related behaviours which are observed in adulthood . There has been relatively little attention paid to the way CD and EH are transmitted in the foetal and childhood periods , even though these provide a foundation for subsequent socioeconomic inequalities in adult health . The Mater-University of Queensl and Study of Pregnancy ( MUSP ) is a large , prospect i ve , pre-birth cohort study which enrolled 8556 pregnant women at their first clinic visit over the period 1981 - 1983 . These mothers ( and their children ) have been followed up at intervals until 14 years after the birth . The socioeconomic status of the child was measured using maternal age , family income , and marital status and the gr and fathers ' occupational status . Measures of child CD and child EH were obtained at 5 and 14 years of age . Child smoking at 14 years of age was also determined . Family income was related to all measures of child CD and EH and smoking , independently of all other indicators of the socioeconomic status of the child . In addition , the gr and fathers ' occupational status was independently related to child CD ( at 5 and 14 years of age ) . Children from socioeconomically disadvantaged families ( previous generations ' socioeconomic status as well as current socioeconomic status ) begin their lives with a poorer platform of health and a reduced capacity to benefit from the economic and social advances experienced by the rest of society
Some research provided robust analyses of the affected population s ’ health inequities and demonstrated how a task shifting intervention redressed those concerns .
Introduction Task shifting interventions have been implemented to improve health and address health inequities .
Little is known about how inequity and vulnerability are defined and measured in research on task shifting .
We conducted a systematic review to identify how inequity and vulnerability are identified , defined and measured in  task shifting research from high-income countries .