Heide Busse

HCV treatment rates and sustained viral response among people who inject drugs in seven UK sites: real world results and modelling of treatment impact.

Hepatitis C virus (HCV) antiviral treatment for people who inject drugs (PWID) could prevent onwards transmission and reduce chronic prevalence. We assessed current PWID treatment rates in seven UK settings and projected the potential impact of current and scaled‐up treatment on HCV chronic prevalence. Data on number of PWID treated and sustained viral response rates (SVR) were collected from seven UK settings: Bristol (37–48% HCV chronic prevalence among PWID), East London (37–48%), Manchester (48–56%), Nottingham (37–44%), Plymouth (30–37%), Dundee (20–27%) and North Wales (27–33%). A model of HCV transmission among PWID projected the 10‐year impact of (i) current treatment rates and SVR (ii) scale‐up with interferon‐free direct acting antivirals (IFN‐free DAAs) with 90% SVR. Treatment rates varied from <5 to over 25 per 1000 PWID. Pooled intention‐to‐treat SVR for PWID were 45% genotypes 1/4 [95%CI 33–57%] and 61% genotypes 2/3 [95%CI 47–76%]. Projections of chronic HCV prevalence among PWID after 10 years of current levels of treatment overlapped substantially with current HCV prevalence estimates. Scaling‐up treatment to 26/1000 PWID annually (achieved already in two sites) with IFN‐free DAAs could achieve an observable absolute reduction in HCV chronic prevalence of at least 15% among PWID in all sites and greater than a halving in chronic HCV in Plymouth, Dundee and North Wales within a decade. Current treatment rates among PWID are unlikely to achieve observable reductions in HCV chronic prevalence over the next 10 years. Achievable scale‐up, however, could lead to substantial reductions in HCV chronic prevalence.

Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings: a systematic review and meta-analysis

Objective To undertake a systematic review and meta-analysis to establish the effectiveness of handwashing in reducing absence and/or the spread of respiratory tract (RT) and/or gastrointestinal (GI) infection among school-aged children and/or staff in educational settings. Design Randomised-controlled trials (RCTs). Setting Schools and other settings with a formal educational component in any country. Patients Children aged 3–11 years, and/or staff working with them. Intervention Interventions with a hand hygiene component. Main outcome measures Incidence of RT or GI infections or symptoms related to such infections; absenteeism; laboratory results of RT and/or GI infections. Results Eighteen cluster RCTs were identified; 13 school-based, 5 in child day care facilities or preschools. Studies were heterogeneous and had significant quality issues including small numbers of clusters and participants and inadequate randomisation. Individual study results suggest interventions may reduce childrens absence, RT infection incidence and symptoms, and laboratory confirmed influenza-like illness. Evidence of impact on GI infection or symptoms was equivocal. Conclusions Studies are generally not well executed or reported. Despite updating existing systematic reviews and identifying new studies, evidence of the effect of hand hygiene interventions on infection incidence in educational settings is mostly equivocal but they may decrease RT infection among children. These results update and add to knowledge about this crucial public health issue in key settings with a vulnerable population. More robust, well reported cluster RCTs which learn from existing studies, are required.

Prevalence and associated harm of engagement in self-asphyxial behaviours (‘choking game’) in young people: a systematic review

Objective To assess the prevalence of engagement in self-asphyxial (risk-taking) behaviour (SAB) (‘choking game’) and associated morbidity and mortality in children and young people up to age 20. Design Systematic literature review. Search strategy Electronic database search of MEDLINE, Embase, PsycINFO, CINAHL, PubMed, Web of Science Core Collection, BIOSIS citation index and the Cochrane register with no language or date limits applied. References of key papers were reviewed, and experts were contacted to identify additional relevant papers. Eligibility criteria Systematic reviews, cross-sectional, cohort and case–control studies, and case reports examining SAB with regard to individuals aged 0–20 years, without explicitly stated autoerotic, suicidal or self-harm intentions were included. Results Thirty-six relevant studies were identified, and SAB was reported in 10 countries. In North America, France and Colombia, awareness of SAB ranged from 36% to 91% across studies/settings, and the median lifetime prevalence of engagement in SAB was 7.4%. Six studies identified the potential for SAB to be associated with engagement in other risk behaviours. Ninety-nine fatal cases were reported. Of the 24 cases described in detail, most occurred when individuals engaged in SAB alone and used a ligature. Conclusions The current evidence on SAB among young people is limited, and stems predominantly from North America and France. Awareness of SAB among young people is high, and engagement varies by setting. Further research is needed to understand the level of risk and harm associated with SAB, and to determine the appropriate public health response.

A comprehensive review of reviews of school-based interventions to improve sexual-health

ABSTRACT Objective: To systematically review systematic reviews of school-based sexual-health and relationship Education (SHRE) programmes and, thereby, identify interventions and intervention components that promote reductions in risky sexual behaviour among young people. Methods: Electronic bibliographies were searched systematically to identify systematic reviews of school-based interventions targeting sexual-health. Results were summarised using a narrative synthesis. Results: Thirty-seven systematic reviews (summarising 224 primary randomised controlled trials) met our inclusion and quality assessment criteria. In general, these reviews analysed distinct sets of primary studies, and no comprehensive review of available primary studies was identified. Interventions were categorised into five types that segment this review literature. Unfortunately, many reviews reported weak and inconsistent evidence of behaviour change. Nonetheless, integration of review findings generated a list of 32 design, content and implementation characteristics that may enhance effectiveness of school-based, sexual-health interventions. Abstinence-only interventions were found to be ineffective in promoting positive changes in sexual behaviour. By contrast, comprehensive interventions, those specifically targeting HIV prevention, and school-based clinics were found to be effective in improving knowledge and changing attitudes, behaviours and health-relevant outcomes. Conclusions: School-based interventions targeting risky sexual behaviour can be effective. Particular design, content and implementation characteristics appear to be associated with greater effectiveness. We recommend consideration of these characteristics by designers of school-based sexual-health interventions.

Individual-, family-, and school-level interventions for preventing multiple risk behaviours relating to alcohol, tobacco and drug use in individuals aged 8 to 25 years

To assess the effects of interventions at the individual, family and school level that aim to target multiple substance use behaviours (two or more from alcohol, tobacco, cannabis, other substance use) for the primary or secondary prevention of substance use and related harms in individuals aged 8 to 25.

Developing a typology of mentoring programmes for young people attending secondary school in the United Kingdom using qualitative methods

Mentoring programmes are commonplace and delivered in a range of different ways in the United Kingdom and North America. To better understand the type of programmes available and to inform future evaluations, we developed a typology of formal mentoring programmes for young people in secondary schools in the United Kingdom. Telephone interviews with 23 programme managers from purposively sampled mentoring organisations were conducted and analysed using thematic and framework analysis. The typology was consulted on with five experts in mentoring. The final typology differentiates mentoring programmes by three overarching categories: type of mentor (older student, school staff, adult volunteer, paid adult), programme setting (school, community, online) and programme aim. The findings suggest that although mentoring programmes are heterogeneous, it is possible to group programmes into ‘personal and developmental’ and ‘academic and employability’ mentoring programmes and to differentiate between 12 overall mentoring models. The typology helps understand what is being delivered and how, which is a necessary precursor to any evaluation of health, educational, relational and social outcomes.

OP36 Evaluating youth mentoring for young people at risk of exclusion from secondary school: results from a feasibility randomised control trial study

Background Youth mentoring is used with vulnerable young people to help improve their health, well-being and educational attainment. While there is growing interest in mentoring programmes among policy makers and practitioners the evidence base is weak with no randomised control trial (RCT) yet undertaken in the UK. The aim of this study was to assess the feasibility and acceptability of conducting a definitive RCT of the effectiveness and cost effectiveness of the Breakthrough Mentoring programme targeted at secondary school students who are at risk of exclusion from school. Methods Thirty-one young people were approached and twenty-one were recruited to the feasibility study. Participants were aged 12–16 years (mean age = 14.10 years) and randomised to either receive weekly 2-hour mentoring sessions for one academic year (n = 11, intervention) or care as usual (n = 10, control). Participants were asked to complete self-reported questionnaires on a range of measures including the Strength and Difficulties Questionnaire, which were analysed descriptively. Qualitative interviews were conducted with participants and with parents, schools staff, mentors and commissioners as part of the process evaluation. Interviews were facilitated using a topic guide, were audiotaped, transcribed verbatim and analysed thematically. Results Follow-up at 6 and 12 months was 100% and 86% for 18 months. Participants were happy to complete the self-report questionnaires, showed a good understanding of randomisation and were accepting of this study design. Control group participants reported wanting a mentor and some were mildly upset at not achieving this. Intervention group participants indicated that having an adult mentor, unconnected with the school that they could talk to about their problems helped them to give voice to and deal with difficult feelings. Some mentees reported negative experiences of the way that the mentoring relationship ended. The process evaluation showed that the study design and intervention were acceptable to parents, mentors, schools and commissioners. A need for further evidence on the effectiveness of mentoring was highlighted by commissioners, and parents and schools staff expressed a wish to be informed of progress made by mentees during mentoring sessions. Conclusion It is feasible and acceptable to recruit, randomise and retain students at risk of exclusion from school to an RCT for 6, 12 and 18 month follow-up. Further research is required to characterise youth mentoring in schools in the UK and to investigate how to best measure its effectiveness before a definitive trial can be considered.