Background: Women with a history of certain pregnancy complications are at higher risk for cardiovascular (CVD) disease. However, most clinical guidelines only recommend postpartum follow-up of those with a history of preeclampsia, gestational diabetes mellitus, or preterm birth. This systematic review was undertaken to determine if there is an association between a broader array of pregnancy complications and the future risk of CVD. Methods: We systematically searched PubMed, MEDLINE and EMBASE (via Ovid), CINAHL, and the Cochrane Library from inception to September 22, 2017, for observational studies of the association between the hypertensive disorders of pregnancy, placental abruption, preterm birth, gestational diabetes mellitus, low birth weight, small-for-gestational-age birth, stillbirth, and miscarriage and subsequent CVD. Likelihood ratio meta-analyses were performed to generate pooled odds ratios (OR) and 95% intrinsic confidence intervals (ICI). Results: Our systematic review included 83 studies (28 993 438 patients). Sample sizes varied from 250 to 2 000 000, with a median follow-up of 7.5 years postpartum. The risk of CVD was highest in women with gestational hypertension (OR 1.7; 95% ICI, 1.3–2.2), preeclampsia (OR 2.7; 95% ICI, 2.5–3.0), placental abruption (OR 1.8; 95% ICI, 1.4–2.3), preterm birth (OR 1.6; 95% ICI, 1.4–1.9), gestational diabetes mellitus (OR 1.7; 95% ICI, 1.1–2.5), and stillbirth (OR 1.5; 95% ICI, 1.1–2.1). A consistent trend was seen for low birth weight and small-for-gestational-age birth weight but not for miscarriage. Conclusions: Women with a broader array of pregnancy complications, including placental abruption and stillbirth, are at increased risk of future CVD. The findings support the need for assessment and risk factor management beyond the postpartum period.

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Objective: HIV testing services (HTS) are a crucial component of national HIV responses. Learning one's HIV diagnosis is the entry point to accessing life-saving antiretroviral treatment and care. Recognizing the critical role of HTS, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the 90-90-90 targets stipulating that by 2020, 90% of people living with HIV know their status, 90% of those who know their status receive antiretroviral therapy, and 90% of those on treatment have a suppressed viral load. Countries will need to regularly monitor progress on these three indicators. Estimating the proportion of people living with HIV who know their status (i.e., the "first 90"), however, is difficult. Methods:We developed a mathematical model (henceforth referred to as "F90") that formally synthesizes population-based survey and HTS program data to estimate HIV status awareness over time. The proposed model uses country-specific HIV epidemic parameters from the standard UNAIDS Spectrum model to produce outputs that are consistent with other national HIV estimates. The F90 model provides estimates of HIV testing history, diagnosis rates, and knowledge of HIV status by age and sex. We validate the F90 model using both in-sample comparisons and out-of-sample predictions using data from three countries: Côte d'Ivoire, Malawi, and Mozambique. Results: In-sample comparisons suggest that the F90 model can accurately reproduce longitudinal sex-specific trends in HIV testing. Out-of-sample predictions of the fraction of PLHIV ever tested over a 4-to-6-year time horizon are also in good agreement with empirical survey estimates. Importantly, out-of-sample predictions of HIV knowledge are consistent (i.e., within 4% points) with those of the fully calibrated model in the three countries, when HTS program data are included. The F90 model's predictions of knowledge of status are higher than available selfreported HIV awareness estimates, however, suggesting -in line with previous studies-that these self-reports could be affected by non-disclosure of HIV status awareness. Conclusion: Knowledge of HIV status is a key indicator to monitor progress, identify bottlenecks, and target HIV responses. The F90 model can help countries track progress towards their "first 90" by leveraging surveys of HIV testing behaviors and annual HTS program data.

Background: There are no head-to-head randomized controlled trials comparing different direct oral anticoagulants (DOACs). Thus, we systematically reviewed and meta-analyzed observational studies assessing the comparative effectiveness and safety of DOACs for stroke prevention in patients with atrial fibrillation (AF). Methods:We systematically searched MEDLINE and EMBASE up to February 2019 for observational studies comparing head-to-head different DOACs in patients with AF. Two independent reviewers identified studies, extracted data, and assessed the risk of bias using the ROBINS-I tool. Random-effects models were used to meta-analyze data across higher quality studies.Results: We identified 25 cohort studies including 1,079,565 patients with AF treated with DOACs. Meta-analysis of the 19 studies at moderate risk of bias yielded a similar risk of ischemic stroke for rivaroxaban versus dabigatran (6 studies; hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.83 to 1.04; I 2 : 0%), for apixaban versus dabigatran (5 studies; HR, 0.94; 95% CI, 0.82 to 1.09; I 2 : 0%), and for apixaban versus rivaroxaban (4 studies; HR, 1.07; 95% CI, 0.93 to 1.23; I 2 : 0%). Regarding major bleeding, there was an increased risk for rivaroxaban versus dabigatran (6 studies; HR, 1.33; 95% CI, 1.20 to 1.47; I 2 : 22%) and decreased risks for apixaban versus either dabigatran (8 studies; HR, 0.71; 95% CI, 0.64 to 0.78; I 2 : 0%) or rivaroxaban (8 studies; HR, 0.56; 95% CI, 0.48 to 0.65; I 2 : 69%). Conclusions:As head-to-head trials comparing different DOACs do not exist, available evidence derives exclusively from observational studies. These data suggest that while dabigatran, rivaroxaban, and apixaban have a similar effect on the risk of ischemic stroke, apixaban may be associated with a decreased risk of major bleeding compared with either dabigatran or rivaroxaban. This is a post-peer-review, pre-copyedit version of an article published in 'Drug Safety'.