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Kumar, R., Rao, D., Sharma, A., Phiri, J., Zimba, M., Phiri, M., Zyambo, R., Kalo, G. M., Chilembo, L., Kunda, P. M., Mulubwa, C., Ngosa, B., Mugwanya, K. K., Barrington, W. E., Herce, M. E., Musheke, M.
BMJ Open, 6.09.2024
Tilføjet 6.09.2024
IntroductionWomen engaging in sex work (WESW) have 21 times the risk of HIV acquisition compared with the general population. However, accessing HIV pre-exposure prophylaxis (PrEP) remains challenging, and PrEP initiation and persistence are low due to stigma and related psychosocial factors. The WiSSPr (Women in Sex work, Stigma and PrEP) study aims to (1) estimate the effect of multiple stigmas on PrEP initiation and persistence and (2) qualitatively explore the enablers and barriers to PrEP use for WESW in Lusaka, Zambia. Methods and analysisWiSSPr is a prospective observational cohort study grounded in community-based participatory research principles with a community advisory board (CAB) of key population (KP) civil society organi sations (KP-CSOs) and the Ministry of Health (MoH). We will administer a one-time psychosocial survey vetted by the CAB and follow 300 WESW in the electronic medical record for three months to measure PrEP initiation (#/% ever taking PrEP) and persistence (immediate discontinuation and a medication possession ratio). We will conduct in-depth interviews with a purposive sample of 18 women, including 12 WESW and 6 peer navigators who support routine HIV screening and PrEP delivery, in two community hubs serving KPs since October 2021. We seek to value KP communities as equal contributors to the knowledge production process by actively engaging KP-CSOs throughout the research process. Expected outcomes include quantitative measures of PrEP initiation and persistence among WESW, and qualitative insights into the enablers and barriers to PrEP use informed by participants’ lived experiences. Ethics and disseminationWiSSPr was approved by the Institutional Review Boards of the University of Zambia (#3650-2023) and University of North Carolina (#22-3147). Participants must give written informed consent. Findings will be disseminated to the CAB, who will determine how to relay them to the community and stakeholders.
Læs mere Tjek på PubMedConrad Keating
Lancet, 6.09.2024
Tilføjet 6.09.2024
This is a dangerous time for global health, not least given widespread vaccine disinformation across social media, with the aim of undermining societal trust in life-saving vaccines. Compounding this spread of fake propaganda and its potential to contribute to avoidable deaths are ongoing pandemic threats. In June, 2024, No Time to Gamble: Leaders Must Unite to Prevent Pandemics, a report by Helen Clark and Ellen Johnson Sirleaf, former Co-Chairs of the influential Independent Panel for Pandemic Preparedness and Response, highlighted two alarming developments: the transmission of highly pathogenic influenza A(H5N1) into mammals and the emergence of the more virulent clade 1b variant of mpox virus in DR Congo.
Læs mere Tjek på PubMedHexin Li, Negin Ashrafi, Chris Kang, Guanlan Zhao, Yubing Chen, Maryam Pishgar
PLoS One Infectious Diseases, 5.09.2024
Tilføjet 5.09.2024
by Hexin Li, Negin Ashrafi, Chris Kang, Guanlan Zhao, Yubing Chen, Maryam Pishgar Background Mechanical ventilation (MV) is vital for critically ill ICU patients but carries significant mortality risks. This study aims to develop a predictive model to estimate hospital mortality among MV patients, utilizing comprehensive health data to assist ICU physicians with early-stage alerts. Methods We developed a Machine Learning (ML) framework to predict hospital mortality in ICU patients receiving MV. Using the MIMIC-III database, we identified 25,202 eligible patients through ICD-9 codes. We employed backward elimination and the Lasso method, selecting 32 features based on clinical insights and literature. Data preprocessing included eliminating columns with over 90% missing data and using mean imputation for the remaining missing values. To address class imbalance, we used the Synthetic Minority Over-sampling Technique (SMOTE). We evaluated several ML models, including CatBoost, XGBoost, Decision Tree, Random Forest, Support Vector Machine (SVM), K-Nearest Neighbors (KNN), and Logistic Regression, using a 70/30 train-test split. The CatBoost model was chosen for its superior performance in terms of accuracy, precision, recall, F1-score, AUROC metrics, and calibration plots. Results The study involved a cohort of 25,202 patients on MV. The CatBoost model attained an AUROC of 0.862, an increase from an initial AUROC of 0.821, which was the best reported in the literature. It also demonstrated an accuracy of 0.789, an F1-score of 0.747, and better calibration, outperforming other models. These improvements are due to systematic feature selection and the robust gradient boosting architecture of CatBoost. Conclusion The preprocessing methodology significantly reduced the number of relevant features, simplifying computational processes, and identified critical features previously overlooked. Integrating these features and tuning the parameters, our model demonstrated strong generalization to unseen data. This highlights the potential of ML as a crucial tool in ICUs, enhancing resource allocation and providing more personalized interventions for MV patients.
Læs mere Tjek på PubMedBMC Infectious Diseases, 3.09.2024
Tilføjet 3.09.2024
Abstract Background Studying the characteristics of hospitalized Coronavirus Disease 2019 (COVID-19) patients is vital for understanding the disease and preparing for future outbreaks. The aim of this study was to analyze and describe the clinical profiles and factors associated with mortality among COVID-19 patients admitted to Jimma Medical Center COVID-19 Treatment Center (JMC CTC) in Ethiopia. Methods All confirmed COVID-19 patients admitted to JMC CTC between 17 April 2020 and 05 March 2022 were included in this study. Socio-demographic data, clinical information, and outcome variables were collected retrospectively from medical records and COVID-19 database at the hospital. Bivariable and multivariable analyses were performed to determine factors associated with COVID-19 severity and mortality. A P-value
Læs mere Tjek på PubMedIlhem Berrou, Laura Hobbs, Sue Jones, Sian Hughes, Hannah Bailey, Sally Quigg, Thomas Manning, Anne Morris
PLoS One Infectious Diseases, 29.08.2024
Tilføjet 29.08.2024
by Ilhem Berrou, Laura Hobbs, Sue Jones, Sian Hughes, Hannah Bailey, Sally Quigg, Thomas Manning, Anne Morris Background Vaccination remains one of the most successful public health interventions in preventing severe disease and death. The roll-out of Covid-19 vaccination programmes has helped protect billions of people around the world against Covid-19. Most of these programmes have been unprecedented in terms of scale and resources, and have been implemented at times of significant humanitarian crisis. This study aims to outline the lessons learnt from the implementation of a regional Covid-19 vaccination programme. These will help inform emergency preparedness and future crisis management. Methods This qualitative study sought to explore the key drivers to the successful implementation of the Covid-19 vaccination programme in a region in the Southwest of England, applying the Normalisation Process Theory lens (NPT) to examine multi-stakeholder perspectives. Data collection involved semi-structured interviews with 75 participants. Document analysis was also used to corroborate the findings emerging from the interviews. Inductive thematic analysis of the data was used to identify the key drivers for the successful implementation of the programme. The NPT lens was then applied to map the themes identified to the domains and constructs of the framework. Results Ten key drivers to the successful implementation of the Covid-19 vaccination programme locally were identified, including: the clarity and consistency of the programme’s goal; the diverse representation of stakeholders within the programme leadership team and the mechanisms created by this team to ensure psychological safety, autonomy, operational flexibility and staff empowerment; Communication and data specialists’ input, and collaboration with local communities to maximise the reach of the programme; and allocating funding to tackle health inequalities. Conclusions This study highlights the lessons learnt from the implementation of the Covid-19 vaccination programme at a local level, and the mechanisms that can be used in future crises to respond efficiently to the needs of individuals, communities and governments.
Læs mere Tjek på PubMedVineet DubeyNicola FarringtonNicholas HarperAdam JohnsonIona HornerAdam StevensonAnnie ParkesLewis HoareShampa DasWilliam Hope1Antimicrobial Pharmacodynamics and Therapeutics, University of Liverpool, Liverpool, United KingdomRyan K. Shields
Antimicrobial Agents And Chemotherapy, 27.08.2024
Tilføjet 27.08.2024
Vivian I. Avelino-Silva, Mars Stone, Sonia Bakkour, Clara Di Germanio, Michael Schmidt, Ashtyn L. Conway, David Wright, Eduard Grebe, Brian Custer, Steven H. Kleinman, Xutao Deng, Jairam R. Lingappa, Patricia Defechereux, Megha Mehrotra, Robert M. Grant, Sandhya Vasan, Shelley Facente, Nittaya Phanuphak, Carlo Sacdalan, Siriwat Akapirat, Mark de Souza, Michael P. Busch, Philip J. Norris, NHLBI Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P)
International Journal of Infectious Diseases, 25.08.2024
Tilføjet 25.08.2024
Highly accurate assays are currently available for HIV diagnosis, detecting nucleic acids, antigens, or HIV-specific antibodies (Abs). Typically, RNA becomes detectable in 10-14 days, p24 antigen (Ag) in 17-21 days, and Abs in 22-26 days following HIV acquisition [1,2]. However, currently available tests may undergo delays or fail to detect infections in a few circumstances. Exposure to antiretrovirals at or early after HIV acquisition can suppress viral replication, leading to diminished detectability of HIV RNA and p24, and an inconsistent antibody (Ab) response [3–7].
Læs mere Tjek på PubMedMaria Carolina Mesquita, Márcio Antônio Mendonça, Raquel Braz Assunção Botelho, Sandra Fernandes Arruda, Eliana dos Santos Leandro
PLoS One Infectious Diseases, 24.08.2024
Tilføjet 24.08.2024
by Maria Carolina Mesquita, Márcio Antônio Mendonça, Raquel Braz Assunção Botelho, Sandra Fernandes Arruda, Eliana dos Santos Leandro The demand for plant-based products has increased in recent years, due to several aspects related to health and environmental consciousness. This study aimed to produce and characterize a plant-based dairy alternative dessert based on araticum pulp and chickpea extract without added sugar and fat. Three formulations were prepared: Formulation 1 (F1): 20% araticum pulp + 80% chickpea extract; Formulation 2 (F2): 30% araticum pulp + 70% chickpea extract; and Formulation 3 (F3): 40% araticum pulp + 60% chickpea extract. All formulations’ chemical composition, sensorial characteristics, viscosity, total phenolic content, antioxidant activity, and microbiological stability were analyzed during 28 days of storage at 4°C and a relative humidity of 23%. Energetic value ranged from 64 to 71 kcal/100g, and carbohydrate content from 9.68 to 11.06, protein from 3.38 to 3.04, lipids from 1.41 to 1.60, ashes from 0.53 to 0.59 and crude fiber from 0.86 to 1.34 g/100g among the formulations. The increase in the proportion of araticum pulp in the formulations reduced moisture content by 1.2 to 2.1% (F1: 84.2, F2: 83.2, and F3: 82.4), protein content by 3 to 9% (F1: 3.3, F2: 3.2, and F3: 3.0), and pH value by 5.8 to 10.7% (F1: 5.50, F2: 5.18, and F3: 4.91), and increased the TSS by 1.1 to 1.3-fold (F1: 8.36, F2: 8.98, and F3: 10.63 º Brix), total phenolics content by 1.5 to 2.0-fold (F1: 4,677, F2: 6,943, and F3: 10,112 gallic acid μmol/L) and antioxidant activity by 1.8 to 2.8-fold (F1: 1,974, F2: 3,664, and F3: 5.523). During the 28 days of storage at 4°C, the formulations F1 and F2 showed better stability of phenolic compounds and antioxidant activity; however, the formulation F3 showed acceptable microbiological quality up to 28 days of storage, higher viscosity, 8 to 16-fold higher than the formulations F1 and F2, respectively (F1: 238.90, F2: 474.30, and F3:3,959.77 mPa.s), antioxidant capacity and better scores in sensory analysis. The present study showed that the plant-based dessert elaborated with araticum pulp and chickpea extract might be considered a potential dairy alternative product with high antioxidant activity, protein content, and a viscosity similar to yogurt; however, its sensory aspects need improvement.
Læs mere Tjek på PubMedReitsema, Maarten; Wallinga, Jacco; van Sighem, Ard I; Bezemer, Daniela; van der Valk, Marc; van Aar, Fleur; Maria Heijne, Janneke Cornelia; Hoornenborg, Elske; Rozhnova, Ganna; van Benthem, Birgit; Xiridou, Maria
Journal of Acquired Immune Deficiency Syndromes, 23.08.2024
Tilføjet 23.08.2024
Background: In 2019, a five-year pre-exposure prophylaxis (PrEP) program started in the Netherlands, in which up to 8,500 men who have sex with men (MSM) can obtain PrEP and 3-monthly consultations with HIV/STI testing. Setting: We assessed the impact of the PrEP program on transmission of HIV and Neisseria gonorrhea (NG) among MSM in the Netherlands and examined prospective variations of the program after 2024. Methods: We used an agent-based model to estimate the effect of the PrEP program. For prospective PrEP programs from 2024, we varied the capacity (8,500; 12,000; 16,000 participants) and consultation frequency (3-monthly; 6-monthly; 70% 3-monthly and 30% 6-monthly) for t. Results: At a capacity of 8,500 participants and 3-monthly consultations, the PrEP program could lead to 3,140 (95%CrI 1,780 – 4,780) and 27,930 (95%CrI 14,560 – 46,280) averted HIV and NG infections; requiring 316,050 (95%CrI 314,120 – 317,580) consultations. At a capacity of 16,000 participants the programs with 3-monthly consultations and 6-monthly consultations could lead to comparable numbers of averted HIV (3,940 (95%CrI 2,420 – 5,460), and 3,900 (2,320 – 5,630) respectively) and NG infections (29,970 (95%CrI 15,490 – 50,350), and 29,960 (95%CrI 13,610 – 50,620) respectively), while requiring substantially different numbers of consultations: 589,330 (95%CrI 586,240 – 591,160) and 272,590 (95%CrI 271,770 – 273,290) respectively. Conclusion: Continuation of a PrEP program could lead to a substantial reduction in HIV and NG transmission. More infections could be averted if the number of participants is increased. In turn, the consultations frequency could be reduced without reducing the number of averted infections if capacity is increased. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedEgger, M., Sauermann, M., Loosli, T., Hossmann, S., Riedo, S., Beerenwinkel, N., Jaquet, A., Minga, A., Ross, J., Giandhari, J., Kouyos, R. D., Lessells, R.
BMJ Open, 23.08.2024
Tilføjet 23.08.2024
IntroductionHIV drug resistance poses a challenge to the United Nation’s goal of ending the HIV/AIDS epidemic. The integrase strand transfer inhibitor (InSTI) dolutegravir, which has a higher resistance barrier, was endorsed by the WHO in 2019 for first-line, second-line and third-line antiretroviral therapy (ART). This multiplicity of roles of dolutegravir in ART may facilitate the emergence of dolutegravir resistance. Methods and analysisNested within the International epidemiology Databases to Evaluate AIDS (IeDEA), DTG RESIST is a multicentre study of adults and adolescents living with HIV in sub-Saharan Africa, Asia, and South and Central America who experienced virological failure on dolutegravir-based ART. At the time of virological failure, whole blood will be collected and processed to prepare plasma or dried blood spots. Laboratories in Durban, Mexico City and Bangkok will perform genotyping. Analyses will focus on (1) individuals who experienced virological failure on dolutegravir and (2) those who started or switched to such a regimen and were at risk of virological failure. For population (1), the outcome will be any InSTI drug resistance mutations, and for population (2) virological failure is defined as a viral load >1000 copies/mL. Phenotypic testing will focus on non-B subtype viruses with major InSTI resistance mutations. Bayesian evolutionary models will explore and predict treatment failure genotypes. The study will have intermediate statistical power to detect differences in resistance mutation prevalence between major HIV-1 subtypes; ample power to identify risk factors for virological failure and limited power for analysing factors associated with individual InSTI drug resistance mutations. Ethics and disseminationThe research protocol was approved by the Biomedical Research Ethics Committee at the University of KwaZulu-Natal, South Africa and the Ethics Committee of the Canton of Bern, Switzerland. All sites participate in International epidemiology Databases to Evaluate AIDS and have obtained ethics approval from their local ethics committee to collect additional data. Trial registration number NCT06285110.
Læs mere Tjek på PubMedRachel SintesPaul McLellanGabriele NavelliCécilia LandmanSandrine DelageSandrine TruongNicolas BenechNathalie KapelAlicia Moreino SabaterAurélie SchnurigerCatherine EckertAlexandre BleibtreuAnne-Christine JolyHarry Sokol1Department of Pharmacy, Sorbonne Université, AP-HP, Saint-Antoine Hospital, Paris, France2Assistance Publique-Hopitaux de Paris (AP-HP) FMT Center, Paris, France3Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France4French Group for Fecal Microbiota Transplantation (GFTF), Paris, France5Department of Gastroenterology, Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint-Antoine Hospital, Paris, France6Department of Hepato-Gastroenterology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France7Functional Coprology Laboratory, APHP, Pitié Salpêtrière Hospital and Université Paris Cité, INSERM UMRS-1139, Centre d'Immunologie et des Maladies Infectieuses, (CIMI-PARIS), Inserm U1135, Sorbonne Université, Paris, France8Sorbonne Université, APHP, National Institute of Health and Medical Research, Center for Immunology and Infectious Diseases-Paris, Saint Antoine Hospital, Parasitology-Mycology, Paris, France9Sorbonne Université, AP-HP, Saint-Antoine Hospital, Virology, Paris, France10Sorbonne Université, AP-HP, Saint-Antoine Hospital, Bacteriology et Centre d'Immunologie et des Maladies Infectieuses, INSERM, U1135, Sorbonne Université, Paris, France11Department of Infectious Disease, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Paris, France12Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, FranceJared A. Silverman
Antimicrobial Agents And Chemotherapy, 22.08.2024
Tilføjet 22.08.2024
Paine, Emily Allen; Appenroth, Max; Scheim, Ayden; Goldrich, Madison; Giguere, Rebecca; Sandfort, Theodorus
Journal of Acquired Immune Deficiency Syndromes, 22.08.2024
Tilføjet 22.08.2024
Background: We assessed access to pre-exposure prophylaxis (PrEP) and interest in integration of PrEP with gender-affirmative care (GAC) in a global sample of transmasculine persons. Methods: Transmasculine persons (n=590) aged 18 and above from 57 countries completed a brief online survey 4/2022 to 7/2022 about sexual behavior, knowledge and interest in PrEP, current access to PrEP and GAC, and preferred context for accessing PrEP. Descriptive analyses were stratified by country income group. Results: Most participants (54.4%) lived near a health center offering care to trans people. 1.9% of respondents reported ever receiving a positive HIV test result. Among those who had not (n=579), over a third reported engaging in receptive sex in the past year (35.2%) or anticipated doing so in the next year (41.5%), 86.9% had never received information about HIV prevention specific to transmasculine people, and 76.3% had heard of PrEP. Among those who had heard of PrEP (n=440), only 18.9% had discussed or been offered it by a provider, and only 3.6% were currently taking it—yet 67.9% who had heard of it but were not using it would “definitely” (28.5%) or “maybe” (39.4%) be interested in taking it were it available for free. Out of these participants, the majority (60.5%) preferred the idea of accessing PrEP from the same clinic they received gender affirming care. Conclusion: Interventions are needed to improve PrEP access for transmasculine people globally. Clinics already providing gender-affirming care to trans people are acceptable clinical contexts to integrate such interventions. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedClinical Infectious Diseases, 20.08.2024
Tilføjet 20.08.2024
Abstract Background Little is known about the potential benefits or harms of statins on physical function among people with HIV (PWH).Methods REPRIEVE was a double-blind randomized controlled trial evaluating pitavastatin for primary prevention of major adverse cardiovascular events (MACE) in PWH. Time to complete ten chair rises, 4-meter gait speed, grip strength, and a modified short physical performance test were assessed annually for up to 5 years in the ancillary study PREPARE and analyzed using linear mixed models.Findings Of 602 PWH, 52% were randomized to pitavastatin and 48% to placebo. Median age was 51 years; 18% were female at birth; 2% transgender; 40% Black, and 18% Hispanic. Median PREPARE follow-up was 4.7 (4.3, 5.0) years. Muscle symptoms (grade ≥3 or treatment-limiting) occurred in 5% of both groups. There was no evidence of decline in chair rise rate in either treatment group, and no difference in the pitavastatin group compared to placebo (estimated difference -0.10 [95% CI: -0.30, 0.10] rises/min/year; p=0.31). Small declines over time were observed in other physical function tests in both treatment groups, with no apparent differences between groups.Interpretation We observed minimal declines in physical function over 5 years of follow-up among middle-aged PWH, with no differences among PWH randomized to pitavastatin compared to placebo. This finding, combined with low prevalence of myalgias, supports the long-term safety of statin therapy on physical function, when used for primary prevention of MACE among PWH.
Læs mere Tjek på PubMedMelissa Vera, Helen Aketch, Caroline Omom, Felix Otieno, George Owiti, Joseph Sila, John Kinuthia, Kristin Beima-Sofie, Jillian Pintye, Valarie Kemunto, Eunita Akim, Grace John-Stewart, Pamela Kohler
PLoS One Infectious Diseases, 19.08.2024
Tilføjet 19.08.2024
by Melissa Vera, Helen Aketch, Caroline Omom, Felix Otieno, George Owiti, Joseph Sila, John Kinuthia, Kristin Beima-Sofie, Jillian Pintye, Valarie Kemunto, Eunita Akim, Grace John-Stewart, Pamela Kohler Pre-exposure prophylaxis (PrEP) is being scaled up to prevent HIV acquisition among adolescent girls and young women (AGYW) in Eastern and Southern Africa. In a prior study more than one-third of AGYW ‘mystery shoppers’ stated they would not return to care based on interactions with health providers. We examined the experiences of AGYW in this study to identify main barriers to effective PrEP services. Unannounced patient actors (USP/‘mystery shoppers’) posed as AGYWs seeking PrEP using standardized scenarios 8 months after providers had received training to improve PrEP services. We conducted targeted debriefings using open-ended questions to assess PrEP service provision and counseling quality with USPs immediately following their visit. Debriefings were audio-recorded and transcribed. Transcripts were analyzed using thematic analysis to explore why USPs reported either positive or negative encounters. We conducted 91 USP debriefings at 24 facilities and identified three primary influences on PrEP service experiences: 1) Privacy improved likelihood of continuing care, 2) respectful attitudes created a safe environment for USPs, and 3) patient-centered communication improved the experience and increased confidence for PrEP initiation among USPs. Privacy and provider attitudes were primary drivers that influenced decision-making around PrEP in USP debriefs. Access to privacy and improving provider attitudes is important for scale-up of PrEP to AGYW.
Læs mere Tjek på PubMedTamar Klaiman, Nsenga Farrell, Dorothy Sheu, Aerielle Belk, Jasmine Silvestri, Jannie Kim, Ryan Coffman, Joanna Hart
PLoS One Infectious Diseases, 19.08.2024
Tilføjet 19.08.2024
by Tamar Klaiman, Nsenga Farrell, Dorothy Sheu, Aerielle Belk, Jasmine Silvestri, Jannie Kim, Ryan Coffman, Joanna Hart The COVID-19 pandemic produced stress for people around the world. The perception that tobacco can be a coping tool for stress relief suggests that the conditions during the COVID-19 pandemic can provide insight into the relationship between stress and tobacco use patterns, particularly among those most at risk for severe COVID-19 disease. The goal was to identify the impacts of the COVID-19 pandemic on tobacco use and preparedness for smoking cessation among individuals who smoke and are older and medically underserved. We conducted in-depth interviews with 39 patients to learn about individuals’ smoking behavior during the COVID-19 pandemic. We used a modified grounded theory approach to code and analyze all qualitative data. We conducted thematic analysis to identify key factors associated with smoking behaviors during COVID-19. Our results indicated that increases in perceived stress and social isolation may have been associated with increased tobacco use during the COVID-19 pandemic. Pandemic-related social isolation contributed to increases in smoking, despite respondents being concerned about the severity of COVID-19. While many respondents felt that smoking relieved their stress from the pandemic, they appeared unaware of the stress-inducing properties of tobacco use. Our findings indicate that pandemic-related stress impacted smoking behavior among older, medically underserved smokers. Results may assist clinicians in addressing the role of tobacco use in response to highly stressful events. Smoking cessation strategies should consider the implications of stress on smoking behavior, including smoking relapse in response to highly stressful events–particularly for medically underserved populations.
Læs mere Tjek på PubMedBick, S., White, S., Hasund Thorseth, A., Friedrich, M. N. D., Gavin, I., Prasad Gautam, O., Dreibelbis, R.
BMJ Open, 18.08.2024
Tilføjet 18.08.2024
ObjectivesThis multicountry analysis aimed to assess the prevalence of key hygiene prevention behaviours and their determinants, associated with international non-governmental organisation (WaterAid) hygiene behaviour change programmes for COVID-19 prevention. The goal of this analysis is to inform future outbreak preparedness and pandemic response in low and middle-income countries. DesignCross-sectional study. SettingHouseholds in seven countries where WaterAid implemented a first-phase COVID-19 response programme in 2020 (Ethiopia, Ghana, Nepal, Nigeria, Rwanda, Tanzania and Zambia). Participants3033 adults (1469 men and 1564 women, alternately sampled from one household to the next to maintain gender balance) in specific programme areas (211 villages) surveyed between October and November 2020. Primary outcome measuresSelf-reported primary outcomes were: a composite measure of HWWS for prevention of respiratory infection/COVID-19 (total of 5 key moments); respondent increased HWWS behaviour after the COVID-19 pandemic; respondent always wears a mask in public spaces; respondent always practices physical distancing in public spaces. ResultsMost respondents (80%) reported increasing their handwashing behaviour after the pandemic, but practice of HWWS at COVID-19-specific prevention moments was low. Mask wearing (58%) and physical distancing (29%) varied substantially between countries. Determinants of key behaviours were identified, including age and socioeconomic status, perceived norms, self-regulation and the motive of protecting others. Incidence rate ratios or odds ratios and 95% CIs for a range of psychosocial determinants for each of the four primary outcomes are reported. ConclusionsThese findings highlight that leveraging behaviour-specific emotional drivers and norms, reducing common barriers and promoting targeted messages about specific behaviours and actions individuals can take to reduce risk are necessary to support large-scale behaviour change. Learning from the COVID-19 response to more effectively integrate novel behaviours into existing health promotion will be vital for disease prevention and outbreak resilience.
Læs mere Tjek på PubMedBhatt, R., Madsen, J., Castillo-Hernandez, T., Chant, K., Dehbi, H.-M., Marlow, N., Clark, H.
BMJ Open, 18.08.2024
Tilføjet 18.08.2024
IntroductionChronic respiratory morbidity from bronchopulmonary dysplasia (BPD) remains the most common complication of preterm birth and has consequences for later respiratory, cardiovascular and neurodevelopmental outcomes. The early phases of respiratory illness are characterised by rapid consumption of endogenous surfactant and slow replenishment. Exogenous surfactant is routinely administered to infants born before 28 weeks of gestation as prophylaxis. Endogenous surfactant includes four proteins, known as surfactant proteins (SPs) A, B, C and D. Current bovine-derived and porcine-derived surfactant preparations only contain SPs B and C. SP-D has a key role in lung immune homeostasis as part of the innate immune system. Laboratory studies using recombinant SP-D have demonstrated reduced inflammation, which may be a pathway to reducing the associated morbidity from BPD. RESPONSE uses a recombinant fragment of human SP D (rfhSP-D), in a phase I safety and dose-escalation trial as the first stage in determining its effect in humans. Methods and analysisThis is a single-centre, dose-escalation, phase I safety study aiming to recruit 24 infants born before 30 weeks gestation with respiratory distress syndrome. In addition to routine surfactant replacement therapy, participants will receive three doses of rfhSP-D via endotracheal route at either 1 mg/kg, 2 mg/kg or 4 mg/kg. The study uses a Bayesian continual reassessment method to make dose escalation decisions. Dose-limiting events (DLE) in this trial will be graded according to the published Neonatal Adverse Event Severity Score. The primary outcome of this study is to evaluate the safety profile of rfhSP-D across each dose level based on the profile of DLE to establish the recommended phase 2 dose (RP2D) of rfhSP-D. Ethics and disseminationThe RESPONSE study has received ethical approval from London-Brent NHS Research Health Authority ethics committee. Results from the study will be published in peer-reviewed journals and presented at national and international conferences. Trial registration numbersISRCTN17083028, NCT05898633. Protocol versionRESPONSE Protocol V.4.0 24th July 2024.
Læs mere Tjek på PubMedManjulika Das
Lancet Infectious Diseases, 17.08.2024
Tilføjet 17.08.2024
In their book The outbreak atlas, authors Rebecca Katz and Mackenzie S Moore, both affiliated to the Center for Global Health Science & Security, Washington DC, USA, sketch various aspects of disease outbreaks. They also portray fascinating case studies and visuals to help readers understand the complexity associated with outbreak preparedness and response.
Læs mere Tjek på PubMedHo, Ken; Hoesley, Craig; Anderson, Peter L.; Fernández-Romero, Jose A.; Friedland, Barbara A.; Kelly, Clifton W.; Jiao, Yuqing; Edick, Stacey; Brand, Rhonda; Kunjara Na Ayudhya, Ratiya Pamela; Zyhowski, Ashley; Hartman, Douglas J.; Reddy, Nipun B.; Al-Khouja, Amer; Piper, Jeanna; Bauermeister, Jose A.; Teleshova, Natalia; Melo, Claudia; Cornejal, Nadjet; Barnable, Patrick; Singh, Devika; Scheckter, Rachel; McClure, Tara; Hillier, Sharon L.; Hendrix, Craig W.; on behalf of the MTN-037 Study Team
Journal of Acquired Immune Deficiency Syndromes, 16.08.2024
Tilføjet 16.08.2024
Background. On demand, topical PrEP is desired by those preferring episodic, non-systemic PrEP. PC-1005 gel (MIV-150, zinc, and carrageenan) exhibits in vitro antiviral HIV-1, HPV, and HSV-2 activity, attractive for a multipurpose prevention technology (MPT) candidate. We evaluated the safety, pharmacokinetics, and antiviral effect of rectally-applied PC-1005. Methods. HIV-uninfected adults received a series of three rectal PC-1005 doses - 4, 16, and 32 mL separated by 2-week washout periods. Following each dose, plasma, rectal fluid and tissue, and vaginal fluid were collected over 48 h. Results. Thirteen adults enrolled; 12 completed all 3 doses. All 13 adverse events reported were Grade 1 or 2; five were judged study drug-related. Plasma MIV-150 peaked 1-2 h after dosing with a median peak concentrations range of 0.07-0.23 ng/mL and median half-life range of 4.9-7.4 hours across dose volumes; median concentrations were below assay quantitation limits (BLQ) 24 h after dosing. Rectal Tissue MIV-150 peaked 0.5-1 hours after dosing at 1.4 ng/g (ng/mL) (0.8, 1.9), 46.0 (30.7, 831.0), and 79.7 (11.9, 116.0), respectively, after each dose volume; median tissue concentrations were BLQ beyond 5 hours for all doses. All vaginal fluid samples were BLQ. Ex vivo antiviral assays showed 5 h of antiviral HPV and HSV effect, but no anti-HIV activity. Conclusions. MIV-150 rectal tissue concentrations were below the 100 ng/g target concentration and transient. Ex vivo assays demonstrated antiviral HSV and HPV effects, but not against HIV. PC-1005 requires a more potent antiviral and longer-lasting formulation for further consideration as an MPT candidate. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedPhu Dinh Vu, Thuong Thi Nguyen, Duyet Van Le
PLoS One Infectious Diseases, 15.08.2024
Tilføjet 15.08.2024
by Phu Dinh Vu, Thuong Thi Nguyen, Duyet Van Le Background Nursing professional is one of the most stressful jobs, particularly during the COVID-19 pandemic. When caring for COVID-19 patients, nurses face challenging conditions and limited resources, as well as the fear of infecting themselves and their families, putting them at risk for depression, anxiety, and insomnia. The purpose of this study was to determine the frequency, sources, and risk factors for occupational stress among clinical nurses caring for COVID-19 patients in a Vietnamese tertiary hospital. Methods A cross-sectional survey was conducted among all clinical nurses (184 nurses) at a tertiary hospital in Vietnam from March 15 to April 15, 2021. A questionnaire was used for collecting data. Data analysis was done by descriptive statistics, bivariate and multivariate logistic regressions. Risk factors were identified by adjusted odds ratio with 95% confidence interval and P values less than 0.05. Results The survey was completed by 89.7% (165/184) of clinical nurses. Most participants were female (85.5%) and ≤ 40 years old (97.6%). Overall, participants reported a medium stress level with an Extended Nursing Stress Scale (ENSS) mean score of 1.79 points, and 32.1% had occupational stress. Prevalence of occupational stress among participants caring for COVID-19 patients (34.0%) was not statistically significant difference with that among those who did not (29.4%). Nurses’ occupational stress in emergency and intensive care units (50.0%) was substantially higher than that in the other departments (11.7%). The most stressors for participants were difficulties connected to inadequate emotional preparedness, patients and families, and death and dying, with subscale mean scores of 1.97, 1.88, and 1.88 points, respectively. In multivariate analysis, working at an emergency and intensive care unit (OR 4.97), usually or more frequently feeling heavy duty for patients (OR 3.17), and income decrease (OR 3.03) were risk factors associated with occupational stress. Conclusion One-third of clinical nurses at a tertiary hospital experienced occupational stress, with highest rate occurred at emergency and intensive care units. Nurses’ working conditions at emergency and intensive care units should be essentially addressed to improve nurses’ occupational stress.
Læs mere Tjek på PubMedArunima S., Alakesh Das, Prakash Jyoti Kalita, Rahul Ishwar Patil, Neha Pandey, Mamta Bhattacharjee, Bidyut Kumar Sharma, Debajit Das, Sumita Acharjee
PLoS One Infectious Diseases, 15.08.2024
Tilføjet 15.08.2024
by Arunima S., Alakesh Das, Prakash Jyoti Kalita, Rahul Ishwar Patil, Neha Pandey, Mamta Bhattacharjee, Bidyut Kumar Sharma, Debajit Das, Sumita Acharjee The recent advances in pigeon pea genomics, including high-quality whole genome and chloroplast genome sequence information helped develop improved varieties. However, a comprehensive Cajanus proteome, including the organelle proteome, is yet to be fully mapped. The spatial delineation of pigeon pea proteins at sub-cellular levels and inter-organelle communication could offer valuable insights into its defense mechanism against various stresses. However, the major bottleneck in the proteomic study is the lack of a suitable method of protein extraction and sample preparation compatible with two-dimensional gel electrophoresis (2D-PAGE), liquid chromatography-mass spectrometry (LCMS), or matrix-assisted laser desorption ionization-time of flight (MALDi-ToF). Our study introduces two efficient methods, one for isolating total proteins and another for organelle (chloroplast) proteins from various Cajanus spp. For total protein extraction, we have optimized a protocol using phenol in combination with a reducing agent (DTT) and protease inhibitor cocktail, also washing (6–7 times) with ice-cold acetone after overnight protein precipitation of total proteins. Our modified extraction method using phenol for total leaf protein yielded approximately 2-fold more proteins than the previously reported protocols from C. cajan (3.18 ± 0.11 mg/gm) and C. scarabaeoides (2.06 ± 0.08 mg/gm). We have also optimized a protocol for plastid protein extraction, which yielded 1.33 ± 0.25 mg/10 gm plastid proteins from C. cajan and 0.88 ± 0.19 mg/10 gm plastid proteins from C. scarabaeoides. The 2D-PAGE analysis revealed 678 ± 08 reproducible total protein spots from C. cajan and 597 ± 22 protein spots from C. scarabaeoides. Similarly, we found 566 ± 10 and 486 ± 14 reproducible chloroplast protein spots in C. cajan and C. scarabaeoides, respectively. We confirmed the plastid protein fractions through immunoblot analysis using antibodies against LHCb1/LHCⅡ type Ⅰ protein. We found both methods suitable for 2D-PAGE and mass spectrometry (MS). This is the first report on developing protocols for total and chloroplastic protein extraction of Cajanus spp. suitable for advanced proteomics research.
Læs mere Tjek på PubMedBMC Infectious Diseases, 15.08.2024
Tilføjet 15.08.2024
Abstract Background There is an increasing number of human immunodeficiency virus (HIV) reported cases among students in Southwest China. However, the data on HIV/sex-related knowledge, attitude toward sex, sexual behaviors, and correlates of pre-exposure prophylaxis (PrEP)-eligible behaviors among college students in this area is still limited. This study aimed to assess the prevalence of HIV/sex-related knowledge, sexual attitudes, sexual behaviors, and factors associated with PrEP-eligible behaviors among college students. Method An online survey from 2020 to 2021 based on a multistage stratified and cluster sampling method was conducted among college students in Southwest China, and a well-designed questionnaire collected data. Propensity score matching (PSM), logistic, and log-binomial regression were used to identify the determinants of PrEP-eligible behaviors. Result A total of 108,987 students participated in the survey, and 92,946 provided valid responses. 91.6% (85,145/92,946) had good HIV-related knowledge, while only 26.0% (24,137/92,946) reported awareness of sex-related knowledge. Furthermore, more than half of the participants (64.5%) held negative stances towards engaging in “one-night stand”, and 58.9% (617/1,047) reported PrEP-eligible behaviors. Log-binomial regression analysis indicated that unaware of HIV-related knowledge (aPR = 1.66, 95% CI:1.22–2.26, P = 0.001), not discussing about sex with their parent(s) (aPR = 1.16, 95% CI:1.01–1.33, P = 0.021), not receiving sex-related education in school(aPR = 1.24, 95% CI: 1.07–1.45, P = 0.005), not participating in HIV/AIDS prevention activities in the past year (aPR = 1.32, 95%CI:1.09–1.60, P = 0.004), experiencing forced sex (aPR = 2.08, 95% CI: 1.19–3.63, P = 0.010), and having the drug abuse (aPR = 22.21, 95% CI:5.59–88.31, P
Læs mere Tjek på PubMedSilva, Mayara ST.; Torres, Thiago S.; Coutinho, Carolina; Jalil, Emilia M.; Yanavich, Carolyn; Martins, Pedro S.; Bastos, Matheus O.; Mesquita, Maira B.; Echeverría-Guevara, Amanda; Nazer, Sandro; Peixoto, Eduardo M.; Terra, Marcela; Lovetro, Ana; Reges, Paula PS.; Meneguetti, Maria Roberta; Moreira, Ronaldo I.; Lessa, Flavia CS.; Hoagland, Brenda; Nunes, Estevão P.; Cardoso, Sandra Wagner; Veloso, Valdilea G.; Grinsztejn, Beatriz; the INI-Fiocruz Mpox Study Group
AIDS, 15.08.2024
Tilføjet 15.08.2024
Objective: To evaluate the prevalence and characteristics of concurrent bacterial sexually transmitted infections (bSTIs) among individuals with mpox. Design: Prospective cohort study of participants aged 18 years or older with confirmed mpox conducted in Rio de Janeiro, Brazil. This cross-sectional analysis include only participants who underwent bSTI testing at baseline between June 2022 and January 2024. Methods: Participants were offered testing for chlamydia/gonorrhea (NAAT, anorectal swabs) and syphilis (active diagnosis if VDRL ≥ 1/8). Baseline prevalence of bSTIs was calculated, and participant characteristics were described based on bSTI diagnosis (yes/no). Chi-squared/Fisher\'s tests were used for qualitative variables, and the Wilcoxon rank-sum test for quantitative variables. Results: Out of 634 enrolled participants, 538 (84.9%) were tested for STIs and included in this analysis, mostly cisgender men, aged 30–39 years with post-secondary education. Overall prevalence of concurrent bSTI was 37.3%, mainly syphilis, followed by chlamydia and gonorrhea. Half of the participants had HIV coinfection, and one-third were on PrEP. Concurrent bSTI diagnosis at the time of mpox assessment was associated with being aged 30–39 years, self-identifying as cisgender men, having HIV-positive status, reporting proctitis symptoms and reporting any STI in the past 12 months. Conclusions: Our data reveals a notable prevalence of concurrent STIs among participants with confirmed mpox at a prominent infectious diseases’ referral center in Rio de Janeiro, Brazil. These findings underscore the importance of integrating mpox into the differential diagnosis of anogenital manifestations and to promote combination prevention strategies within sexual health care services. Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedBassi, S., Bahl, D., Maity, H., Dringus, S., Rizvi, Z. A., Kumar, D., Raina, A., Arora, M.
BMJ Open, 13.08.2024
Tilføjet 13.08.2024
BackgroundThe COVID-19 pandemic strained India’s healthcare system and health workers unprecedentedly. PurposeThe extent of the contribution by peer educators (PEs) from India’s National Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram (RKSK) to COVID-19 response activities remains uncertain necessitating an imperative investigation. Within the overarching objective of the ‘i-Saathiya’ study (‘i’ signifies implementation science and Saathiya represents PEs in Madhya Pradesh), a key focus was to understand the role of PEs recruited under RKSK during COVID-19 in two Indian states, namely Madhya Pradesh and Maharashtra. The study states differ in sociodemographic characteristics and peer education implementation models. MethodsIn-depth interviews (IDIs) were conducted with stakeholders (n=110, Maharashtra: 57; Madhya Pradesh: 53) engaged in the implementation of RKSK’s peer education programme at state, district, block and village levels. Focus group discussions (FGDs) (n=16 adolescents, Maharashtra: 8; Madhya Pradesh: 8) were conducted with adolescents, part of the peer group of PEs (n=120 adolescents, Maharashtra: 66; Madhya Pradesh: 54). IDIs and FGDs were audio-recorded, translated, transcribed verbatim and analysed thematically. Adopting inductive and deductive approaches, a data-driven open coding framework was developed for thematic analysis. ResultsThe PE recruited under RKSK took a central role that extended beyond their predefined responsibilities within the RKSK. They provided crucial support to healthcare workers in curbing the spread of COVID-19. Their diverse contributions, including COVID-19 pandemic response support, addressing community and adolescent needs, role in COVID-19 vaccination efforts, navigating access to the health system and facilitating health workers in the implementation of various national health programmes and campaigns during COVID-19. ConclusionThe findings underscore the potential of PEs in bolstering the health system. Despite their unpreparedness for the context (COVID-19), PEs demonstrated tenacity and adaptability, extending their roles beyond their predefined responsibilities. Recognising PEs through awards and incentives, skill courses and additional grades, can enhance their visibility, sustaining impactful work within RKSK and beyond.
Læs mere Tjek på PubMedYuan, Y., Dube, C. E., Xu, S., Lim, E., Qu, S., McPhillips, E., Lapane, K. L.
BMJ Open, 13.08.2024
Tilføjet 13.08.2024
IntroductionAsian American caregivers supporting loved ones with dementia experience greater burden and more stress than other racial/ethnic groups, warranting the need for more culturally and linguistically appropriate formal support, such as in nursing homes. Transitioning loved ones into nursing homes with dementia care units is a complex process that can be impacted by a multitude of factors. Employing several established frameworks, including the socioecological model, this qualitative study will focus on the largest Asian American subgroup (people of Chinese descent) and explore the experience of family caregivers as they support the transition of their loved ones with dementia into nursing homes in the USA. Our focus will be on the nuanced influences of the Chinese language and culture and COVID-19-related social isolation and racial discrimination. Methods and analysisRecruitment will take place starting in January 2024. Current or former Chinese caregivers for Chinese loved ones with dementia, able to communicate in Mandarin Chinese or English, and currently residing in the USA will be eligible. Key informants with intimate understanding and experience with this population will also be included. Data will be collected through 2024 using semistructured, in-depth interviews with each participant. Depending on participants’ preferences, interviews will be conducted in either Mandarin Chinese or English and either in person, via Zoom or by phone. Interviews will be transcribed verbatim. Iterative thematic analysis will be employed. A coding structure will be developed based on interview questions and themes and patterns that are revealed through data immersion. Transcripts, prepared in their original language, will be dual-coded by bilingual researchers using NVivo 14. Consensus summaries of themes will be prepared. Relevant direct quotes for each thematic area will be identified (those in Chinese will be translated into English) and cited in reports and manuscripts. Ethics and disseminationThe study is approved by the UMass Chan Medical School Institutional Review Board (ID: STUDY00001376). Findings will be published in peer-review journals following the consolidated criteria for reporting qualitative research.
Læs mere Tjek på PubMedBMC Infectious Diseases, 10.08.2024
Tilføjet 10.08.2024
Abstract Background It is important to assess the relationship between specific HPV genotype or multiple infection and cervical cytology. The protection provided by the HPV vaccine is type-specific, and the epidemiology feature of coinfections needs to be investigated. The aim is to provide baseline information for developing HPV vaccination and management of HPV-positive populations in the region. Methods A total of 3649 HPV-positive women were collected from 25,572 women who underwent 15 HR-HPV genotypes and ThinPrep cytologic test (TCT) results. Logistic regression was used to determine the correlation between the risk of cytology abnormalities and specific HPV infection. We calculated odds ratios (ORs) to assess coinfection patterns for the common two-type HPV infections. chi-squared test was used to estimate the relationship between single or multiple HPV (divided into species groups) infection and cytology results. Results The results showed there was a positive correlation between HPV16 (OR = 4.742; 95% CI 3.063–7.342) and HPV33 (OR = 4.361; 95% CI 2.307–8.243) infection and HSIL positive. There was a positive correlation between HPV66 (OR = 2.445; 95% CI 1.579–3.787), HPV51 (OR = 1.651; 95% CI 1.086–2.510) and HPV58(OR = 1.661; 95% CI 1.166–2.366) infection and LSIL. Multiple HPV infections with α9 species (OR = 1.995; 95% CI 1.101–3.616) were associated with a higher risk of high-grade intraepithelial lesions (HSIL) compared with single HPV infection. There were positive correlations between HPV66 and HPV56 (α6) (OR = 3.321; 95% CI 2.329–4.735) and HPV39 and HPV68 (α7). (OR = 1.677; 95% CI 1.127–2.495). There were negative correlations between HPV52, 58, 16 and the other HPV gene subtypes. Conclusion HPV33 may be equally managed with HPV16. The management of multiple infections with α9 may be strengthened. The 9-valent vaccine may provide better protection for the population in Chongqing currently. The development of future vaccines against HPV51 and HPV66 may be considered in this region.
Læs mere Tjek på PubMedBMC Infectious Diseases, 9.08.2024
Tilføjet 9.08.2024
Abstract Background This study aimed to determine the prevalence and factors associated with susceptibility to hepatitis B virus (HBV) among cisgender men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP) in Northeastern Brazil. Methods This was a cross-sectional, analytical study conducted between September 2021 and June 2023. Participants underwent structured interviews to collect sociodemographic and clinical information, including hepatitis B vaccination history, HIV PrEP use and sexual health history. Blood samples were collected for hepatitis B serologic testing: HBV surface antigen (HBsAg), HBV surface antibody (anti-HBs), total and IgM HBV core antibody (anti-HBc). HBV susceptibility was defined as nonreactive results for all these serological markers. Results A total of 287 participants were enrolled into the study. The median age of the individuals was 31 years (interquartile range: 27; 36). HBV susceptibility was found in 58 out 286 individuals (20.3%; 95% CI: 15.9–25.2). Seventy-six percent of the participants reported completing the three-dose hepatitis B vaccine schedule. Susceptibility was significantly associated with a monthly income ≤ 5 minimum wages (PR: 2.02; 95% CI: 1.01–4.05), lack of complete hepatitis B vaccination schedule (PR: 4.52; 95% CI: 2.89–7.06), initiation of HIV PrEP (PR: 2.18; 95% CI: 1.21–3.94), duration of six months of HIV PrEP (PR: 2.16; 95% CI: 1.19–3.91), absence of tattoos (PR: 1.55; 95% CI: 1.00–2.40) and no history of sexually transmitted infections (PR: 1.65; 95% CI: 1.07–2.54). Conclusion Our findings highlight the significant burden of HBV susceptibility among MSM on HIV PrEP in Northeastern Brazil. Socioeconomic factors, vaccination status, PrEP use and sexual health behaviors play critical roles in determining susceptibility to HBV. Integrating hepatitis B screening and vaccination into PrEP services is critical for identifying and addressing HBV susceptibility among MSM. Interventions aimed at increasing vaccination coverage and promoting safer sexual practices are essential for mitigating the burden of HBV infection in this population.
Læs mere Tjek på PubMedZewdie, Kidist; Muwonge, Timothy; Ssebuliba, Timothy; Bambia, Felix; Badaru, Josephine; Nampewo, Olivia; Stein, Gabrielle; Mugwanya, Kenneth K.; Thomas, Katherine K.; Wyatt, Christina; Yin, Michael T.; Wang, Guohong; Gandhi, Monica; Mujugira, Andrew; Heffron, Renee
AIDS, 9.08.2024
Tilføjet 9.08.2024
Objectives: We evaluated a recently developed and validated point-of-care urine tenofovir (POC TFV) test to determine whether its use improves the accuracy of self-reported adherence to pre-exposure prophylaxis (PrEP) and sexual behavior. Design: We enrolled sexually active HIV-negative women ages 16–25 years in Kampala, Uganda. Methods: Women were followed quarterly for 24 months with HIV prevention counseling, PrEP dispensation, and adherence counseling. Midway through the study, the POC TFV test was introduced as part of routine study procedures. We examined changes in self-reported PrEP adherence, sexual behavior, and accuracy of self-reported PrEP adherence before and after the introduction of the POC TFV test. Results: A total of 146 women receiving PrEP refills had ≥1 visit with a POC TFV test administered before the study exit. At baseline, the median age was 19 years (interquartile range [IQR]: 18–21) and the majority (76%) reported having condomless sex within the last three months. Participants more frequently self-reported low PrEP adherence (OR: 2.96, 95% confidence interval [CI]: 1.89–4.67, p = 0.001) and condomless sex (OR: 1.47, 95% CI: 1.04–2.06, p = 0.03) during visits using the test compared to visits without the test. The accuracy of self-reported PrEP adherence (determined by concordance with TFV-diphosphate levels) was greater when the test was used (61% versus 24%, OR: 4.86, 95% CI: 2.85–8.30, p
Læs mere Tjek på PubMedSonia Muliyil
Nature, 8.08.2024
Tilføjet 8.08.2024
Malaria Journal, 6.08.2024
Tilføjet 6.08.2024
Abstract Background More than 95% of malaria transmission in Brazil occurs in the Legal Amazon Region, which in 2010 recorded around 333,429 cases reported in the Epidemiological Surveillance Information System-Malaria (Sivep_malaria), presenting an annual parasitic incidence (IPA) of 13.1 cases/1000 inhabitants. Methods This was a descriptive study that measured the community prevalence of Plasmodium infection and its relationship with land use in Três Fronteiras District, Colniza Municipality, Mato Grosso State. Data were collected during household visits in July 2011, with blood collection from finger pricks for the preparation of thick smear slides, and completion of a standardized case notification form. A georeferenced database was analysed, with land use evaluated as categorical variables. A kernel density map was built to show the density of cases and their location. Results Of the 621 respondents, 68(11%) had Plasmodium infection: 39 (57.4%) with Plasmodium vivax, 27(39.7%) with Plasmodium falciparum and two (2.9%) with mixed infections. Among infected individuals, 49 (72.1%) were men. Cases of malaria were distributed over the district, with greater occurrence of cases per household in open areas close to the mining company and artisanal mining sites. The was a greater density of cases located in the gold mining region. Conclusion Transmission of malaria in Três Fronteiras District has a heterogeneous distribution. Individuals residing in mining and timber extraction sites have increased occurrence of Plasmodium infection.
Læs mere Tjek på PubMedFarooq, S., Donnan, J. R., Lukewich, J., Mathews, M., Lee, T. A.
BMJ Open, 6.08.2024
Tilføjet 6.08.2024
ObjectivesTo explore the experiences and perspectives of community pharmacists regarding their roles during the closure stage (ie, March to May 2020) of the COVID-19 pandemic in Newfoundland and Labrador (NL), Canada. DesignThis qualitative case study included a document analysis and semistructured interviews with community pharmacists who provided direct patient care during the COVID-19 pandemic. The document analysis was used to develop a chronology that informed the interviews. Themes from qualitative interviews were developed through iterative cycles of data review and analysis using applied thematic analysis. Findings are presented specifically for the time period between March and May 2020, defined as the ‘Closure Stage’. SettingCommunity pharmacies in NL, Canada. Results12 community pharmacists participated in the interviews. Four themes were developed including (1) pharmacists’ leadership in continuity of care, (2) pharmacists as medication stewards, (3) pharmacists as a source of COVID-19 health information and (4) the impact of COVID-19 on pharmacists’ mental health and well-being. The first three themes described the key roles played by community pharmacists during the early days of the COVID-19 pandemic, including coordinating care, prescribing for common ailments, delivering medications and supplies, providing information on COVID-19 symptoms and their management, renewing chronic medications and protecting the medication supply. Unclear guidance on scope of practice, limited scope of practice, inadequate staffing and limited support from government bodies were identified as barriers to these roles. Facilitators included access to a delivery service, swift regulatory changes, reimbursement and support from colleagues and other healthcare professionals. The fourth theme is presented independently, emphasising the impact of working within the primary healthcare (PHC) system during the COVID-19 pandemic on pharmacists’ mental health and well-being. ConclusionPharmacists played a critical role in the delivery of PHC services during the closure stage of the COVID-19 pandemic. The findings of this research highlight the essential elements of a strong PHC pandemic preparedness plan that is inclusive of community pharmacists, including improved communication strategies, mental health support and access to resources.
Læs mere Tjek på PubMedBMC Infectious Diseases, 6.08.2024
Tilføjet 6.08.2024
Abstract Background The GeneXpert MTB/RIF (Xpert) assay is a widely used technology for detecting Mycobacterium tuberculosis (MTB) in clinical samples. However, the study on the failure of the Xpert assay during routine implementation and its potential solutions is limited. Methods We retrospectively analyzed the records of unsuccessful tests in the Xpert and the GeneXpert MTB/RIF Ultra (Ultra) assays between April 2017 and April 2021 at the Shanghai Public Health Clinical Center. To further investigate the effect of prolonged preprocessing on clinical sputum, an additional 120 sputum samples were collected for Xpert testing after 15 min, 3 h, and 6 h preprocessing. The analysis was performed by SPSS version 19.0 software. Results A total of 11,314 test records were analyzed, of which 268 (2.37%) had unsuccessful test results. Among these, 221 (1.95%) were reported as “Error”, 43 (0.38%) as “Invalid”, and 4 (0.04%) as “No result”. The most common clinical specimen for Xpert tests was sputum, accounting for 114 (2.17%) unsuccessful tests. The failure rate of urine specimens was lower than that of sputum (OR = 0.12, 95% CI: 0.02–0.88, χ2 = 6.22, p = 0.021). In contrast, the failure rate of stool specimens was approximately twice as high as that of sputum (OR = 1.93, 95% CI: 1.09–3.40, χ2 = 5.35, p = 0.014). In the prolonged preprocessing experiment, 102 cases (85%) yielded consistent results in Xpert tests. Furthermore, 7 cases (5.83%) detected an increase in MTB load, 8 cases (6.67%) detected a decrease in MTB load, and 3 cases (2.5%) yielded incongruent results in MTB and rifampicin resistance detection. Conclusions The primary cause of unsuccessful tests in the Xpert assay was reported as “Error”. Despite varying failure rates depending on the samples, the Xpert assay can be applied to extrapulmonary samples. For paucibacillary specimens, retesting the remaining preprocessed mixture should be carefully considered.
Læs mere Tjek på PubMedEllerbroek, H., Schellekens, A. F. A., Kalkman, G. A., Visser, D. A., Kramers, C., Dahan, A., van den Heuvel, S. A. S., Bouvy, M. L., van Dorp, E. L. A.
BMJ Open, 4.08.2024
Tilføjet 4.08.2024
ObjectivesThe COVID-19 pandemic and related lockdown measures disrupted global healthcare provision, including opioid prescribing. In North America, opioid sales declined while opioid-related deaths increased. In Europe, the effect of the pandemic on prescribing is not yet known. Given the ongoing increase in opioid-related harm and mortality, it is crucial to analyse the impact of the COVID-19 crisis and lockdown measures on opioid prescribing. Therefore, the objective of this study was to characterise opioid prescribing in the Netherlands during the COVID-19 pandemic. DesignA nationwide register-based study characterising opioid prescribing using aggregated insurance reimbursement data. SettingDutch healthcare during the first 2 years of the COVID lockdown. ParticipantsThe whole Dutch population. Primary and secondary outcome measuresComparing the number of opioid prescriptions during the pandemic with a prepandemic period using a risk ratio (RR), with separate analysis on the prescription type (first-time or repeat prescription), patients’ sex, age and socioeconomic status. We also explored lockdown effects. ResultsDuring the first lockdown, the total number of new opioid prescriptions and prescriptions to young patients (briefly) decreased (RR 0.88, 95% CI 0.88 to 0.89 and RR 0.73, 95% CI 0.70 to 0.75, respectively), but the overall number of opioid prescriptions remained stable throughout the pandemic compared with prepandemic. Women, older patients and patients living in lower socioeconomic areas received more opioids per capita, but the pandemic did not amplify these differences. ConclusionsThe pandemic appears to have had a limited impact on opioid prescribing in the Netherlands. Yet, chronic use of opioids remains an important public health issue.
Læs mere Tjek på PubMedBMC Infectious Diseases, 2.08.2024
Tilføjet 2.08.2024
Abstract Background The GeneXpert MTB/RIF (Xpert) assay is a widely used technology for detecting Mycobacterium tuberculosis (MTB) in clinical samples. However, the study on the failure of the Xpert assay during routine implementation and its potential solutions is limited. Methods We retrospectively analyzed the records of unsuccessful tests in the Xpert and the GeneXpert MTB/RIF Ultra (Ultra) assays between April 2017 and April 2021 at the Shanghai Public Health Clinical Center. To further investigate the effect of prolonged preprocessing on clinical sputum, an additional 120 sputum samples were collected for Xpert testing after 15 min, 3 h, and 6 h preprocessing. The analysis was performed by SPSS version 19.0 software. Results A total of 11,314 test records were analyzed, of which 268 (2.37%) had unsuccessful test results. Among these, 221 (1.95%) were reported as “Error”, 43 (0.38%) as “Invalid”, and 4 (0.04%) as “No result”. The most common clinical specimen for Xpert tests was sputum, accounting for 114 (2.17%) unsuccessful tests. The failure rate of urine specimens was lower than that of sputum (OR = 0.12, 95% CI: 0.02–0.88, χ2 = 6.22, p = 0.021). In contrast, the failure rate of stool specimens was approximately twice as high as that of sputum (OR = 1.93, 95% CI: 1.09–3.40, χ2 = 5.35, p = 0.014). In the prolonged preprocessing experiment, 102 cases (85%) yielded consistent results in Xpert tests. Furthermore, 7 cases (5.83%) detected an increase in MTB load, 8 cases (6.67%) detected a decrease in MTB load, and 3 cases (2.5%) yielded incongruent results in MTB and rifampicin resistance detection. Conclusions The primary cause of unsuccessful tests in the Xpert assay was reported as “Error”. Despite varying failure rates depending on the samples, the Xpert assay can be applied to extrapulmonary samples. For paucibacillary specimens, retesting the remaining preprocessed mixture should be carefully considered.
Læs mere Tjek på PubMedLeong, Trudy D; Nel, Jeremy; Jamieson, Lise; Osih, Regina; Dawood, Halima; Subedar, Hasina; McCaul, Michael; Johnson, Leigh F; Cohen, Karen
Journal of Acquired Immune Deficiency Syndromes, 1.08.2024
Tilføjet 1.08.2024
Background: South Africa has a high HIV incidence and oral pre-exposure prophylaxis (PrEP) is available as public-sector standard of care. Access to alternative prevention methods for women may further reduce HIV acquisition. Setting: South African public-sector. Methods: We performed a systematic search for high-quality up-to-date guidelines recommending dapivirine ring as PrEP using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-Adolopment process. We appraised the systematic review and randomised controlled trial (RCT) evidence underpinning the selected guideline’s recommendations and conducted a cost-effectiveness analysis. The GRADE Evidence-to-Decision framework guided the adaptation of source guideline recommendations, according to our local context. Results: We identified the 2021 World Health Organization PrEP Guidelines, informed by two placebo-controlled RCTs, which were included in a contemporaneous systematic review. There were 23 fewer HIV acquisitions per 1000 clients with dapivirine ring versus placebo (95% confidence interval 10-34), with no increase in adverse events (moderate certainty evidence). We found no RCTs comparing dapivirine to oral PrEP, or amongst adolescent/pregnant/breastfeeding clients. Dapivirine is less cost-effective than oral PrEP at $14.59/ring, at the current price. Conclusion: The source guideline recommendation was adapted for the local context. Dapivirine ring appears to be less efficacious than oral PrEP, although comparative studies are lacking. Data in adolescents and pregnancy are also lacking, currently limiting the use of dapivirine as an alternative for women unable to take oral PrEP. At the current price, dapivirine is not cost-effective and unaffordable for inclusion in the South African Essential Medicines List. Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedInfection, 31.07.2024
Tilføjet 31.07.2024
Abstract Purpose Outpatient parenteral antimicrobial therapy (OPAT) offers several key advantages, including enhanced patient quality of life, reduced healthcare costs, and a potential reduction of nosocomial infections. It is acknowledged for its safety and effectiveness. This study provides the first systematic clinical data for Germany, where OPAT has not yet been widely adopted. The aim is to establish a foundational reference point for further research and integration of OPAT into the German healthcare system. Methods This prospective observational study descriptively analyses data obtained from a cohort of patients receiving OPAT. Both in- and outpatients from all medical specialties could be recruited. Patients administered the anti-infective medications themselves at home using elastomeric pumps. Results 77 patients received OPAT, with a median duration of 15 days and saving 1782 inpatient days. The most frequently treated entities were orthopaedic infections (n = 20, 26%), S. aureus bloodstream infection (n = 16, 21%) and infectious endocarditis (n = 11, 14%). The most frequently applied drugs were flucloxacillin (n = 18, 23%), penicillin G (n = 13, 17%) and ceftriaxone (n = 10; 13%). Only 5% of patients (n = 4) reported to have missed more than one outpatient dose (max. 3 per patient). Only one catheter-related adverse event required medical intervention, and there were no catheter-related infections. Conclusion The study demonstrates that OPAT can be safely conducted in Germany. In preparation for its broader implementation, crucial next steps include creating medical guidelines, fostering interdisciplinary and inter-sectoral communication, as well as creating financial and structural regulations that facilitate and encourage the adoption of OPAT. Trial registration number NCT04002453.
Læs mere Tjek på PubMedBMC Infectious Diseases, 30.07.2024
Tilføjet 30.07.2024
Abstract Background Dengue fever remains a significant public health challenge in tropical and subtropical regions, with its transmission dynamics being influenced by both environmental factors and human mobility. The Dominican Republic, a biodiversity hotspot in the Caribbean, has experienced recurrent dengue outbreaks, yet detailed understanding of the virus\'s transmission pathways and the impact of climatic factors remains limited. This study aims to elucidate the recent transmission dynamics of the dengue virus (DENV) in the Dominican Republic, utilizing a combination of genomic sequencing and epidemiological data analysis, alongside an examination of historical climate patterns. Methods We conducted a comprehensive study involving the genomic sequencing of DENV samples collected from patients across different regions of the Dominican Republic over a two-year period. Phylogenetic analyses were performed to identify the circulation of DENV lineages and to trace transmission pathways. Epidemiological data were integrated to analyze trends in dengue incidence and distribution. Additionally, we integrated historical climate data spanning several decades to assess trends in temperature and their potential impact on DENV transmission potential. Results Our results highlight a previously unknown north–south transmission pathway within the country, with the co-circulation of multiple virus lineages. Additionally, we examine the historical climate data, revealing long-term trends towards higher theoretical potential for dengue transmission due to rising temperatures. Conclusion This multidisciplinary study reveals intricate patterns of dengue virus transmission in the Dominican Republic, characterized by the co-circulation of multiple DENV lineages and a novel transmission pathway. The observed correlation between rising temperatures and increased dengue transmission potential emphasizes the need for integrated climate-informed strategies in dengue control efforts. Our findings offer critical insights for public health authorities in the Dominican Republic and similar settings, guiding resource allocation and the development of preparedness strategies to mitigate the impacts of climate change on dengue transmission.
Læs mere Tjek på PubMedInfection, 30.07.2024
Tilføjet 30.07.2024
Abstract Purpose . While doxycycline shows promise as a preventative measure against certain STIs (post-exposure prophylaxis or PEP, and pre-exposure prophylaxis or PrEP), very few medical and scientific associations favor its community use. Nevertheless, sexual health organizations for gay, bisexual and other men who have sex with men (GBMSM) community have noticed an increase in requests of its use. Methods . The sexual health organization “Stop Sida” in Spain launched an anonymous snapshot survey to evaluate the current use of doxycycline as prevention strategy (both PEP and PrEP) in Spain through its social networks and its support groups in telegram. Results . 150 valid answers were obtained from different parts of Spain. 82 respondents (54,6% of total) had ever taken doxycycline, out of which 29 (35,4%) indicated the use as doxy-PEP and 7 (8,5%) as doxy-PrEP. The self-reported rate of STI diagnoses (mainly of syphilis and chlamydia) in the past 12 months was lower among those participants who reported having used doxy-PEP compared with those who did not report using doxy-PEP. The most common ways to obtain the doxycycline were telling a specialist that they have had a risky contact or by using leftover pills from a previous treatment. Conclusion The current study is the first study to describe the use of doxycycline as a preventive strategy among the GBMSM community in Spain, and the first designed, launched and analyzed entirely by an NGO dealing with sexual health for the GBMSM community. The results obtained are aligned with other studies in other parts of Europe, such as Germany.
Læs mere Tjek på PubMedInfection, 28.07.2024
Tilføjet 28.07.2024
Abstract Purpose . While doxycycline shows promise as a preventative measure against certain STIs (post-exposure prophylaxis or PEP, and pre-exposure prophylaxis or PrEP), very few medical and scientific associations favor its community use. Nevertheless, sexual health organizations for gay, bisexual and other men who have sex with men (GBMSM) community have noticed an increase in requests of its use. Methods . The sexual health organization “Stop Sida” in Spain launched an anonymous snapshot survey to evaluate the current use of doxycycline as prevention strategy (both PEP and PrEP) in Spain through its social networks and its support groups in telegram. Results . 150 valid answers were obtained from different parts of Spain. 82 respondents (54,6% of total) had ever taken doxycycline, out of which 29 (35,4%) indicated the use as doxy-PEP and 7 (8,5%) as doxy-PrEP. The self-reported rate of STI diagnoses (mainly of syphilis and chlamydia) in the past 12 months was lower among those participants who reported having used doxy-PEP compared with those who did not report using doxy-PEP. The most common ways to obtain the doxycycline were telling a specialist that they have had a risky contact or by using leftover pills from a previous treatment. Conclusion The current study is the first study to describe the use of doxycycline as a preventive strategy among the GBMSM community in Spain, and the first designed, launched and analyzed entirely by an NGO dealing with sexual health for the GBMSM community. The results obtained are aligned with other studies in other parts of Europe, such as Germany.
Læs mere Tjek på PubMedInfection, 28.07.2024
Tilføjet 28.07.2024
Abstract Purpose Doxycycline post-exposure prophylaxis (Doxy-PEP) reduces the likelihood of Chlamydia and early syphilis by approximately two-thirds. Currently, data on the frequency of Doxy-PEP use in men who have sex with men (MSM) are limited. This study aimed to assess knowledge, attitude towards, and frequency of Doxy-PEP use among MSM in Germany. Methods We conducted a national online survey in Germany from summer to fall 2023, recruiting MSM and transgender women. Participants were invited to complete the online survey through social media, online dating platforms, and print media advertisements with active recruitment and poster advertising in private practices, tertiary outpatient clinics, and MSM community events in Germany. Results In total, 438 participants completed the survey and were included in the analysis, and 285 (65.1%) were living with the human immunodeficiency virus (HIV) or taking HIV-pre-exposure prophylaxis (PrEP). Overall, 170 participants (38.8%) had heard of Doxy-PEP, and 275 (62.8%) would consider taking it, but only 32 (7.3%) reported having ever taken Doxy-PEP. The most common reason for a negative attitude towards Doxy-PEP were apprehension about insufficient detailed information, and concerns about antibiotic resistance. Doxy-PEP users were more likely to be on HIV-PrEP, had a higher self-reported risk of bacterial sexually transmitted infections (STIs), and often had a history of bacterial STIs. Conclusion The study demonstrated high awareness and strong interest in Doxy-PEP among MSM in Germany, most of whom were living with HIV or taking HIV-PrEP; however, the actual usage of Doxy-PEP remains low in the summer and fall of 2023.
Læs mere Tjek på PubMedFernemark, H., Hardstedt, M., Skagerström, J., Seing, I., Karlsson, E., Nilsen, P., Schildmeijer, K. G. I.
BMJ Open, 27.07.2024
Tilføjet 27.07.2024
ObjectiveTo explore how primary healthcare workers in Sweden experienced and perceived the long-term impact of the pandemic on their work. DesignThis is a descriptive qualitative study with individual semistructured interviews conducted 2 years after the onset of COVID-19. Data were analysed using an inductive thematic approach. SettingSwedish primary healthcare units in rural and urban locations. Participants29 healthcare providers (6 registered nurses, 7 assistant nurses, 8 physicians and 8 managers) in Swedish primary healthcare. ResultsData analysis yielded three overarching themes: (1) primary healthcare still affected by the pandemic; (2) primary healthcare changes made permanent; and (3) lessons learnt for handling future crises affecting primary healthcare. The participants experienced a high workload, even after the pandemic, and concluded that it would take years to catch up both mentally and workwise. Four lessons were learnt for future handling of crises that might affect primary healthcare: the importance of creating a cohesive primary healthcare management system to provide clarity regarding recommendations for how primary healthcare personnel should work, the need for management support at all levels, restricting and adapting the flow of information for primary healthcare and ascertaining the necessary resources if primary healthcare is to take on additional tasks. ConclusionTwo years after the onset of the COVID-19 pandemic, primary healthcare workers in Sweden experienced that their work was still affected by the pandemic. Our findings highlight the importance of ensuring sufficient recovery time and providing opportunities for reflection on the experiences of primary healthcare personnel. This also includes preparedness for managing the heavy workload and strained energy levels of healthcare workers in the aftermath of a crisis.
Læs mere Tjek på PubMedBMC Infectious Diseases, 26.07.2024
Tilføjet 26.07.2024
Abstract Background The causative agents of Acute Encephalitis Syndrome remain unknown in 68–75% of the cases. In Nepal, the cases are tested only for Japanese encephalitis, which constitutes only about 15% of the cases. However, there could be several organisms, including vaccine-preventable etiologies that cause acute encephalitis, when identified could direct public health efforts for prevention, including addressing gaps in vaccine coverage. Objectives This study employs metagenomic next-generation-sequencing in the investigation of underlying causative etiologies contributing to acute encephalitis syndrome in Nepal. Methods In this study, we investigated 90, Japanese-encephalitis-negative, banked cerebrospinal fluid samples that were collected as part of a national surveillance network in 2016 and 2017. Randomization was done to include three age groups (15-years). Only some metadata (age and gender) were available. The investigation was performed in two batches which included total nucleic-acid extraction, followed by individual library preparation (DNA and RNA) and sequencing on Illumina iSeq100. The genomic data were interpreted using Chan Zuckerberg-ID and confirmed with polymerase-chain-reaction. Results Human-alphaherpes-virus 2 and Enterovirus-B were seen in two samples. These hits were confirmed by qPCR and semi-nested PCR respectively. Most of the other samples were marred by low abundance of pathogen, possible freeze-thaw cycles, lack of process controls and associated clinical metadata. Conclusion From this study, two documented causative agents were revealed through metagenomic next-generation-sequencing. Insufficiency of clinical metadata, process controls, low pathogen abundance and absence of standard procedures to collect and store samples in nucleic-acid protectants could have impeded the study and incorporated ambiguity while correlating the identified hits to infection. Therefore, there is need of standardized procedures for sample collection, inclusion of process controls and clinical metadata. Despite challenging conditions, this study highlights the usefulness of mNGS to investigate diseases with unknown etiologies and guide development of adequate clinical-management-algorithms and outbreak investigations in Nepal.
Læs mere Tjek på PubMedPablo N Perez-Guzman, Stephen Longa Chanda, Albertus Schaap, Kwame Shanaube, Marc Baguelin, Sarah T Nyangu, Muzala Kapina Kanyanga, Patrick Walker, Helen Ayles, Roma Chilengi, Robert Verity, Katharina Hauck, Edward S Knock, Anne Cori
International Journal of Infectious Diseases, 26.07.2024
Tilføjet 26.07.2024
The World Health Organization\'s (WHO) Pandemic and Resilience for Emerging Threats (PRET) initiative calls for the formulation of preparedness plans and priority actions underpinned by learnings from the COVID-19 pandemic [1]. Yet, four years on from the emergence of SARS-CoV-2, the true burden of the pandemic and the impact of constraints to scale-up mitigation strategies in resource-limited settings remain poorly understood. Systematic issues with epidemiological surveillance data have been highlighted as a key challenge to undertake such retrospective assessments robustly [2].
Læs mere Tjek på PubMedBMC Infectious Diseases, 25.07.2024
Tilføjet 25.07.2024
Abstract Background The causative agents of Acute Encephalitis Syndrome remain unknown in 68–75% of the cases. In Nepal, the cases are tested only for Japanese encephalitis, which constitutes only about 15% of the cases. However, there could be several organisms, including vaccine-preventable etiologies that cause acute encephalitis, when identified could direct public health efforts for prevention, including addressing gaps in vaccine coverage. Objectives This study employs metagenomic next-generation-sequencing in the investigation of underlying causative etiologies contributing to acute encephalitis syndrome in Nepal. Methods In this study, we investigated 90, Japanese-encephalitis-negative, banked cerebrospinal fluid samples that were collected as part of a national surveillance network in 2016 and 2017. Randomization was done to include three age groups (15-years). Only some metadata (age and gender) were available. The investigation was performed in two batches which included total nucleic-acid extraction, followed by individual library preparation (DNA and RNA) and sequencing on Illumina iSeq100. The genomic data were interpreted using Chan Zuckerberg-ID and confirmed with polymerase-chain-reaction. Results Human-alphaherpes-virus 2 and Enterovirus-B were seen in two samples. These hits were confirmed by qPCR and semi-nested PCR respectively. Most of the other samples were marred by low abundance of pathogen, possible freeze-thaw cycles, lack of process controls and associated clinical metadata. Conclusion From this study, two documented causative agents were revealed through metagenomic next-generation-sequencing. Insufficiency of clinical metadata, process controls, low pathogen abundance and absence of standard procedures to collect and store samples in nucleic-acid protectants could have impeded the study and incorporated ambiguity while correlating the identified hits to infection. Therefore, there is need of standardized procedures for sample collection, inclusion of process controls and clinical metadata. Despite challenging conditions, this study highlights the usefulness of mNGS to investigate diseases with unknown etiologies and guide development of adequate clinical-management-algorithms and outbreak investigations in Nepal.
Læs mere Tjek på PubMedMukherjee, Vikramjit; Postelnicu, Radu; Parker, Chelsie; Rivers, Patrick S.; Anesi, George L.; Andrews, Adair; Ables, Erin; Morrell, Eric D.; Brett-Major, David M.; Broadhurst, M. Jana; Cobb, J. Perren; Irwin, Amy; Kratochvil, Christopher J.; Krolikowski, Kelsey; Kumar, Vishakha K.; Landsittel, Douglas P.; Lee, Richard A.; Liebler, Janice M.; Segal, Leopoldo N.; Sevransky, Jonathan E.; Srivastava, Avantika; Uyeki, Timothy M.; Wurfel, Mark M.; Wyles, David; Evans, Laura E.; Lutrick, Karen; Bhatraju, Pavan K.; on behalf of the Severe Acute Respiratory Infection-Preparedness (SARI-PREP) Study Group
Critical Care Explorations, 25.07.2024
Tilføjet 25.07.2024
IMPORTANCE: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has evolved through multiple phases in the United States, with significant differences in patient centered outcomes with improvements in hospital strain, medical countermeasures, and overall understanding of the disease. We describe how patient characteristics changed and care progressed over the various pandemic phases; we also emphasize the need for an ongoing clinical network to improve the understanding of known and novel respiratory viral diseases. OBJECTIVES: To describe how patient characteristics and care evolved across the various COVID-19 pandemic periods in those hospitalized with viral severe acute respiratory infection (SARI). DESIGN: Severe Acute Respiratory Infection-Preparedness (SARI-PREP) is a Centers for Disease Control and Prevention Foundation-funded, Society of Critical Care Medicine Discovery-housed, longitudinal multicenter cohort study of viral pneumonia. We defined SARI patients as those hospitalized with laboratory-confirmed respiratory viral infection and an acute syndrome of fever, cough, and radiographic infiltrates or hypoxemia. We collected patient-level data including demographic characteristics, comorbidities, acute physiologic measures, serum and respiratory specimens, therapeutics, and outcomes. Outcomes were described across four pandemic variant periods based on a SARS-CoV-2 sequenced subsample: pre-Delta, Delta, Omicron BA.1, and Omicron post-BA.1. SETTING: Multicenter cohort of adult patients admitted to an acute care ward or ICU from seven hospitals representing diverse geographic regions across the United States. PARTICIPANTS: Patients with SARI caused by infection with respiratory viruses. MAIN OUTCOMES AND RESULTS: Eight hundred seventy-four adult patients with SARI were enrolled at seven study hospitals between March 2020 and April 2023. Most patients (780, 89%) had SARS-CoV-2 infection. Across the COVID-19 cohort, median age was 60 years (interquartile range, 48.0–71.0 yr) and 66% were male. Almost half (430, 49%) of the study population belonged to underserved communities. Most patients (76.5%) were admitted to the ICU, 52.5% received mechanical ventilation, and observed hospital mortality was 25.5%. As the pandemic progressed, we observed decreases in ICU utilization (94% to 58%), hospital length of stay (median, 26.0 to 8.5 d), and hospital mortality (32% to 12%), while the number of comorbid conditions increased. CONCLUSIONS AND RELEVANCE: We describe increasing comorbidities but improved outcomes across pandemic variant periods, in the setting of multiple factors, including evolving care delivery, countermeasures, and viral variants. An understanding of patient-level factors may inform treatment options for subsequent variants and future novel pathogens.
Læs mere Tjek på PubMedInfection, 24.07.2024
Tilføjet 24.07.2024
Abstract Purpose Doxycycline post-exposure prophylaxis (Doxy-PEP) reduces the likelihood of Chlamydia and early syphilis by approximately two-thirds. Currently, data on the frequency of Doxy-PEP use in men who have sex with men (MSM) are limited. This study aimed to assess knowledge, attitude towards, and frequency of Doxy-PEP use among MSM in Germany. Methods We conducted a national online survey in Germany from summer to fall 2023, recruiting MSM and transgender women. Participants were invited to complete the online survey through social media, online dating platforms, and print media advertisements with active recruitment and poster advertising in private practices, tertiary outpatient clinics, and MSM community events in Germany. Results In total, 438 participants completed the survey and were included in the analysis, and 285 (65.1%) were living with the human immunodeficiency virus (HIV) or taking HIV-pre-exposure prophylaxis (PrEP). Overall, 170 participants (38.8%) had heard of Doxy-PEP, and 275 (62.8%) would consider taking it, but only 32 (7.3%) reported having ever taken Doxy-PEP. The most common reason for a negative attitude towards Doxy-PEP were apprehension about insufficient detailed information, and concerns about antibiotic resistance. Doxy-PEP users were more likely to be on HIV-PrEP, had a higher self-reported risk of bacterial sexually transmitted infections (STIs), and often had a history of bacterial STIs. Conclusion The study demonstrated high awareness and strong interest in Doxy-PEP among MSM in Germany, most of whom were living with HIV or taking HIV-PrEP; however, the actual usage of Doxy-PEP remains low in the summer and fall of 2023.
Læs mere Tjek på PubMedBMC Infectious Diseases, 21.07.2024
Tilføjet 21.07.2024
Abstract Background The ambitious goal to eliminate new pediatric HIV infections by 2030 requires accelerated prevention strategies in high-risk settings such as South Africa. One approach could be pre-exposure prophylaxis (PrEP) with broadly neutralizing anti-HIV-1 monoclonal antibodies (bNAbs). The aim of our study is to define the optimal dose(s), the ideal combination(s) of bNAbs in terms of potency and breadth, and timing of subcutaneous (SC) administration(s) to prevent breast milk transmission of HIV. Methods Two bNAbs, CAP256V2LS and VRC07-523LS, will be assessed in a sequential and randomized phase I, single-site, single-blind, dose-finding trial. We aim to investigate the 28-day safety and pharmacokinetics (PK) profile of incrementally higher doses of these bNAbs in breastfeeding HIV-1 exposed born without HIV neonates alongside standard of care antiretroviral (ARV) medication to prevent (infants) or treat (mothers) HIV infection. The trial design includes 3 steps and 7 arms (1, 2, 3, 4, 5, 6 and 6b) with 8 infants in each arm. The first step will evaluate the safety and PK profile of the bNAbs when given alone as a single subcutaneous (SC) administration at increasing mg/kg body weight doses within 96 h of birth: arms 1, 2 and 3 at doses of 5, 10, and 20 mg/kg of CAP256V2LS, respectively; arms 4 and 5 at doses of 20 and 30 mg/kg of VRC07-523LS, respectively. Step two will evaluate the safety and PK profile of a combination of the two bNAbs administered SC at fixed doses within 96 h of birth. Step three will evaluate the safety and PK profile of the two bNAbs administered SC in combination at fixed doses, after 3 months. Arms 1 and 6 will follow sequential recruitment, whereas randomization will occur sequentially between arms (a) 2 & 4 and (b) 3 & 5. Before each randomization, a safety pause will allow review of safety data of the preceding arms. Discussion The results of this trial will guide further studies on bNAbs to prevent breast milk transmission of HIV. Protocol version Version 4.0 dated 15 March 2024. Trial registration Pan African Clinical Trial Registry (PACTR): PACTR202205715278722, 21 April 2022; South African National Clinical Trial Registry (SANCTR): DOH-27–062022-6058.
Læs mere Tjek på PubMedInfection, 20.07.2024
Tilføjet 20.07.2024
Abstract Background WHO postulates the application of adaptive design features in the global clinical trial ecosystem. However, the adaptive platform trial (APT) methodology has not been widely adopted in clinical research on vaccines. Methods The VACCELERATE Consortium organized a two-day workshop to discuss the applicability of APT methodology in vaccine trials under non-pandemic as well as pandemic conditions. Core aspects of the discussions are summarized in this article. Results An “ever-warm” APT appears ideally suited to improve efficiency and speed of vaccine research. Continuous learning based on accumulating APT trial data allows for pre-planned adaptations during its course. Given the relative design complexity, alignment of all stakeholders at all stages of an APT is central. Vaccine trial modelling is crucial, both before and in a pandemic emergency. Various inferential paradigms are possible (frequentist, likelihood, or Bayesian). The focus in the interpandemic interval may be on research gaps left by industry trials. For activation in emergency, template Disease X protocols of syndromal design for pathogens yet unknown need to be stockpiled and updated regularly. Governance of a vaccine APT should be fully integrated into supranational pandemic response mechanisms. Discussion A broad range of adaptive features can be applied in platform trials on vaccines. Faster knowledge generation comes with increased complexity of trial design. Design complexity should not preclude simple execution at trial sites. Continuously generated evidence represents a return on investment that will garner societal support for sustainable funding. Adaptive design features will naturally find their way into platform trials on vaccines.
Læs mere Tjek på PubMedFrancisca Mutapi, Amadou Garba, Mark Woolhouse, Paul Kazyoba
Trends in Parasitology, 20.07.2024
Tilføjet 20.07.2024
Schistosomiasis is the second most important parasitic disease of public health importance in Africa, affecting over 50 million children aged
Læs mere Tjek på PubMedInfection, 18.07.2024
Tilføjet 18.07.2024
Abstract Background WHO postulates the application of adaptive design features in the global clinical trial ecosystem. However, the adaptive platform trial (APT) methodology has not been widely adopted in clinical research on vaccines. Methods The VACCELERATE Consortium organized a two-day workshop to discuss the applicability of APT methodology in vaccine trials under non-pandemic as well as pandemic conditions. Core aspects of the discussions are summarized in this article. Results An “ever-warm” APT appears ideally suited to improve efficiency and speed of vaccine research. Continuous learning based on accumulating APT trial data allows for pre-planned adaptations during its course. Given the relative design complexity, alignment of all stakeholders at all stages of an APT is central. Vaccine trial modelling is crucial, both before and in a pandemic emergency. Various inferential paradigms are possible (frequentist, likelihood, or Bayesian). The focus in the interpandemic interval may be on research gaps left by industry trials. For activation in emergency, template Disease X protocols of syndromal design for pathogens yet unknown need to be stockpiled and updated regularly. Governance of a vaccine APT should be fully integrated into supranational pandemic response mechanisms. Discussion A broad range of adaptive features can be applied in platform trials on vaccines. Faster knowledge generation comes with increased complexity of trial design. Design complexity should not preclude simple execution at trial sites. Continuously generated evidence represents a return on investment that will garner societal support for sustainable funding. Adaptive design features will naturally find their way into platform trials on vaccines.
Læs mere Tjek på PubMed