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Background Combination prevention is currently considered the best approach to combat HIV epidemic. It is based upon the combination of structural, behavioral, and biomedical interventions. Such interventions are frequently implemented in a health-promoting manner due to their aims, the approach that was adopted, and their complexity. The impact evaluation of these interventions often relies on methods inherited from the biomedical field. However, these methods have limitations and should be adapted to be relevant for these complex interventions. This systematic review aims to map the evidence-based methods used to quantify the impact of these interventions and analyze how these methods are implemented. Methods Three databases (Web of Science, Scopus, PubMed) will be used to identify impact evaluation studies of health promotion interventions that aimed at reducing the incidence or prevalence of HIV infection. Only studies based on quantitative design assessing intervention impact on HIV prevalence or incidence will be included. Two reviewers will independently screen studies based on titles and abstracts and then on the full text. The information about study characteristics will be extracted to understand the context in which the interventions are implemented. The information specific to quantitative methods of impact evaluation will be extracted using items from the Mixed Methods Appraisal Tool (MMAT), the guidelines for reporting Statistical Analyses and Methods in the Published Literature (SAMPL), and the guidelines for Strengthening The Reporting of Empirical Simulation Studies (STRESS). This review will be conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Discussion The impact evaluation of HIV prevention interventions is a matter of substantial importance given the growing need for evidence of the effectiveness of these interventions, whereas they are increasingly complex. These evaluations allow to identify the most effective strategies to be implemented to fight the epidemic. It is therefore relevant to map the methods to better implement them and adapt them according to the type of intervention to be evaluated. Systematic review registration PROSPERO CRD42020210825

Background The best strategy to control ESBL-producing Escherichia coli (ESBL-EC) spread in the community is lacking. Methods We developed an individual-based transmission model to evaluate the impact of hand hygiene (HH) improvement and reduction in antibiotic use on the within-household transmission of ESBL-EC. We used data from the literature and incorporated key elements of ESBL-EC transmission such as the frequency and nature of contacts among household members, antibiotic use in the community and hand hygiene behaviour. We introduced in a household a single ESBL-EC colonised person and simulated the transmission dynamics of ESBL-EC over a one-year time horizon. Results The probability of ESBL-EC transmission depended on the household composition and the profile of the initial carrier. In the two-person household, the probability of ESBL-EC transmission was 5.3% (95% CI 5.0-5.6) or 6.6% (6.3-6.9) when the index person was a woman or a man, respectively. In a four-person household, the probability of transmission varied from 61.4% (60.9-62.0) to 68.8% (68.3- 69.3) and was the highest when the index patient was the baby. Improving HH by 50% reduced the probability of transmission by 33-62%. Antibiotic restriction by 50% reduced the transmission by 2-6%.Conclusions The transmission of ESBL-EC is frequent in households and especially those with a baby. Antibiotic reduction had little impact on ESBL-EC. Improvement of hygiene in the community could help prevent transmission of ESBL-EC.

Background: The best strategy to control ESBL-producing Escherichia coli (ESBL-EC) spread in the community is lacking. Our objective was to evaluate the impact of hand hygiene (HH) improvement and reduction in antibiotic use on the within-household transmission of ESBL-EC . Methods: We developed an individual-based transmission model parametrised with data on daily contacts, HH practices, and antibiotic exposure in the community. We modelled four hypothetical households: two adults, family with a child/baby and family with a child and baby. We introduced in a household a single ESBL-EC colonised person and simulated the transmission dynamics of ESBL-EC over a one-year time horizon. Findings: The probability of ESBL-EC acquisition depended on the household composition and the profile of the initial carrier. In the two-person household, the probability of ESBL-EC acquisition by another household member was 5.3% (95% CI 5.0-5.6) and 6.6% (6.3-6.9) when the index person was a woman or a man, respectively. In a four-person household, the probability of acquisition varied from 61.4% (60.9-62.0) to 68.8% (68.3- 69.3) and was the highest when the index patient was the baby. Improving HH by 50% reduced the probability of transmission by 33-62%, according to the household composition and the category of the initial carrier. Antibiotic restriction by 50% reduced the transmission by 2-6%. Interpretation: Our findings suggest that the acquisition of ESBL-EC is frequent in households and especially those with a baby. Antibiotic reduction had little impact on ESBL-EC. Improvement of hygiene in the community could help prevent transmission of ESBL-EC. Funding Statement: This study was supported by the IAME research unity of French Institute for Medical Research (INSERM). Declaration of Interests: All authors declare no competing interests. Acknowledgments Ethics Approval Statement: Missing.

International audience; The aim of this study was to describe current antimicrobial stewardship programmes (ASPs) in France, both at policy level and at local implementation level, and to assess how ASP leaders (ASPL) worked and prioritised their activities. A qualitative study based on face-to-face semi-structured interviews with healthcare professionals responsible for ASPs across five French hospitals was conducted. Five infectious diseases specialists and one microbiologist were interviewed between April-June 2016. Stewards had dedicated time to perform ASP activities in two university-affiliated hospitals, whilst in the other hospitals (one university, one general and one semi-private), ASPLs had to balance these activities with clinical practice. Consequently, they had to adapt interventions according to their resources (IT or human). Responding to colleagues' consultation requests formed baseline work. Systematic and pro-active measures allowed for provision of unsolicited counselling, whilst direct counselling on wards required appropriate staffing. ASPLs aimed at increasing clinicians' ability to prescribe adequately and awareness of the unintended consequences of inappropriate use of antibiotics. Thus, persuasive, e.g. education, measures were preferred to coercive ones. ASPLs faced several challenges in implementing the ASP: overcoming physicians' or units' reluctance; and balancing the influence of medical hierarchy and professional boundaries. Beyond resources constraints, ASPLs' conceptions of their work, as well as contextual and cultural aspects, led them to adopt a persuasive and collaborative approach of counselling. This is the first qualitative study regarding ASPs in France exploring stewards' experiences and points of view.

International audience; Over the last decades, nosocomial infections have become a major Public Health problem in hospitals worldwide. In this context, it is very important to understand the underlying mechanisms of nosocomial pathogen transmission, in order to devise and assess the best control strategies. Here, we present an agent-based model of pathogen transmission in a hospital ward, NosoSim. In this model, the actions of patients and health-care workers are reproduced at all times in a spatially explicit environment, and pathogen colonization and transmission are simulated. NosoSim allows users to define simulation parameters such as: ward geography, including -but not limited to- the number of rooms; daily allocation and schedule of all present healthcare workers; patient status; microbiological and epidemiological characteristics of all circulating pathogens. After describing the model and its implementation, we illustrate its potential applications through an example addressing a real-life Public-health issue. In this application, NosoSim is used to assess the factors which promote so-called “super-spreading events” in hospital settings.