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29 emner vises.
Jain, Jennifer P.; Sheira, Lila A.; Frongillo, Edward A.; Neilands, Torsten B.; Cohen, Mardge H.; Wilson, Tracey E.; Chandran, Aruna; Adimora, Adaora A.; Kassaye, Seble G.; Sheth, Anandi N.; Fischl, Margaret A.; Adedimeji, Adebola A.; Turan, Janet M.; Tien, Phyllis C.; Weiser, Sheri D.; Conroy, Amy A.
AIDS, 26.10.2022
Tilføjet 16.08.2022
Objective:
To test whether substance use mediates the associations between gender-based violence (GBV) and suboptimal adherence to antiretroviral therapy (ART), and GBV and poor engagement in care, among women living with HIV (WLHIV) in the United States (US).
Design:
We analyzed longitudinal data collected among 1717 WLHIV in the Women's Interagency HIV Study (WIHS).
Methods:
From 2013 to 2017, WLHIV completed semi-annual assessments on GBV, substance use, and HIV treatment and care. Adjusted multilevel logistic regression models were built to estimate the impact of GBV on; suboptimal (
Læs mere Tjek på PubMedNematadzira, Teacler G.; Murnane, Pamela M.; Odiase, Osamuedeme J.; Bacchetti, Peter; Okochi, Hideaki; Tallerico, Regina; Chanaiwa, Vongai M.; Vhembo, Tichaona; Mutambanengwe-Jacob, Mercy T.; Louie, Alexander; Chipato, Tsungai; Gandhi, Monica; Stranix-Chibanda, Lynda; for the IMPAACT PROMISE Study Team
Journal of Acquired Immune Deficiency Syndromes, 13.05.2022
Tilføjet 16.08.2022
Background:
We examined change in antiretroviral treatment (ART) adherence after breastfeeding (BF) cessation using hair tenofovir (TFV) concentrations as an objective metric of medication consumption.
Methods:
A subset of postpartum women in Zimbabwe randomized in IMPAACT PROMISE to take ART while BF and post BF cessation had hair TFV measured longitudinally. Using linear mixed effect models, we estimated differences in hair TFV levels following BF cessation, accounting for trends in levels over time regardless of BF status and change in slope following breastfeeding cessation. We also estimated the relative risk of viremia (>50 copies/mL) per doubling of hair TFV concentration.
Results:
Among 55 women (median age 26, IQR 24-29), hair TFV levels (n=305) were available for a median of 9 visits per woman between 3-29 months postpartum. Hair TFV levels ranged from undetected to 0.25 ng/mg (median 0.04 ng/mg). Controlling for trends since delivery (decline of 2.2% per month, 95%CI: -5.3-1.0), TFV levels averaged 24.4% higher (95%CI: -5.1-63.1;) post BF cessation than during BF, with no change in slope (0.0% per month, 95%CI: -3.8-3.9;). Postpartum, 42% of women were ever viremic. Higher TFV levels were strongly protective; relative risk of viremia per doubling of TFV was 0.52 (95%CI: 0.43-0.63; p<0.0001).
Conclusions:
Leveraging an objective metric of ART use, we observed modestly declining adherence across the postpartum period, but no additional decline associated with breastfeeding cessation. High viremia frequency and varying postpartum TFV levels observed highlight the importance of enhanced adherence support with viral load monitoring among postpartum women.
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedYoon, Hyunah; Hemmige, Vagish S.; Lee, Audrey; Conway-Pearson, Liam S.; Pirofski, Liise-anne; Felsen, Uriel R.
Journal of Acquired Immune Deficiency Syndromes, 13.05.2022
Tilføjet 16.08.2022
Background:
There is no established cryptococcal antigen (CrAg) screening guideline for people with HIV who are antiretroviral therapy-experienced but have poor virologic control. We assessed factors associated with CrAg screening and describe missed opportunities for earlier testing.
Setting:
Ambulatory clinics affiliated with Montefiore Medical Center, Bronx, N.Y.
Methods:
This was a retrospective chart review of CrAg screening among asymptomatic people with HIV with absolute CD4 count≤200cells/mm3 and HIV viral load (VL) >200copies/ml receiving HIV care from 2015 to 2020. We used Cox proportional hazards regression to identify predictors of screening, including longitudinal CD4 count and HIV VL as time-varying covariables. Among cases of diagnosed cryptococcosis, we assessed for opportunities for earlier diagnosis.
Results:
Screening CrAg was performed in 2.9% of 2,201 individuals meeting inclusion criteria. Compared to those not screened, those who were screened had a shorter duration of HIV infection (0.09 vs. 5.1 years; P=0.001) and lower absolute CD4 counts (12 vs. 24 cells/mm3; p<0.0001). In a multivariable model stratified by median HIV duration, CD410,000 (HR, 15.0; 95% CI, 4.16-54.0) and shorter duration of HIV infection (HR, 0.60; 95% CI, 0.42-0.86) were associated with screening for those with HIV
Læs mere Tjek på PubMedWeiss, Fabian; von Both, Ulrich; Rack-Hoch, Anita; Sollinger, Franz; Eberle, Josef; Mahner, Sven; Kaestner, Ralph; Alejandre, Irene Alba
Journal of Acquired Immune Deficiency Syndromes, 13.05.2022
Tilføjet 16.08.2022
Background:
Exclusive breastfeeding is recommended for women living with HIV (WLWH) in low-income - but not in high-income - countries, where milk substitutes are preferred. Some guidelines for high-income countries opted for a shared decision making process regarding breastfeeding in optimal scenarios with adherence to antiretroviral therapy (cART), suppressed maternal viral load (mVL) and clinical monitoring. While vertical transmission (VT) risk under cART is estimated below 1% in low-income settings, data from high-income countries is rare.
Methods:
We retrospectively analyzed all 181 live births from WLWH at the LMU Munich university hospital perinatal center in Germany between 01/2016 and 12/2020. We focused on VT, suppressed mVL and optimal scenario rates, breastfeeding frequency, cART regimens and infant prophylaxis. All women were counseled according to current guidelines, foremost recommending avoidance of breastfeeding.
Results:
In the 5-year cohort, no VT was observed. 151 WLWH (83.4%) decided not to breastfeed, even in optimal scenarios. 30 infants (16.6%) were nursed, out of which 25 were within an optimal scenario, while in 5 cases breastfeeding was performed with a detectable VL in pregnancy or the postpartum period. All WLWH were treated with cART at delivery, and 91.7% sustained suppressed mVL. Zidovudine infant prophylaxis was given between 2 and 8 weeks but not necessarily over the whole breastfeeding duration and was declined from 5 breastfeeding WLWH.
Conclusion:
While the cohort is too small to assess VT risk through breastfeeding with cART-suppressed mVL, breastfeeding might be an alternative even in high-income countries, but further studies are needed.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedChristine D. Palmer, Amy R. Rappaport, Matthew J. Davis, Meghan G. Hart, Ciaran D. Scallan, Sue-Jean Hong, Leonid Gitlin, Lauren D. Kraemer, Sonia Kounlavouth, Aaron Yang, Lindsey Smith, Desiree Schenk, Mojca Skoberne, Kiara Taquechel, Martina Marrali, Jason R. Jaroslavsky, Charmaine N. Nganje, Elizabeth Maloney, Rita Zhou, Daniel Navarro-Gomez, Adrienne C. Greene, Gijsbert Grotenbreg, Renee Greer, Wade Blair, Minh Duc Cao, Shawn Chan, Kyounghwa Bae, Alexander I. Spira, Sameek Roychowdhury, David P. Carbone, Brian S. Henick, Charles G. Drake, Benjamin J. Solomon, Daniel H. Ahn, Amit Mahipal, Steve B. Maron, Benny Johnson, Raphael Rousseau, Roman Yelensky, Chih-Yi Liao, Daniel V. T. Catenacci, Andrew Allen, Andrew R. Ferguson, Karin Jooss
Nature, 15.08.2022
Tilføjet 15.08.2022
Nature Medicine, Published online: 15 August 2022; doi:10.1038/s41591-022-01937-6An individualized, heterologous chimpanzee adenovirus (ChAd68) and self-amplifying mRNA-based neoantigen vaccine is safe and well tolerated in patients, warranting further studies to test its potential to rescue response to checkpoint blockade in tumors of low immune reactivity.
Læs mere Tjek på PubMedSopio Chochua, Benjamin Metcalf, Zhongya Li, Saundra Mathis, Theresa Tran, Joy Rivers, Katherine E. Fleming-Dutra, Yuan Li, Lesley McGee, Bernard Beall aRespiratory Disease Branch, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Preventiongrid.416738.f, Atlanta, Georgia, USA bASRT Inc., Contractor to Respiratory Diseases Branch, Centers for Disease Control and Preventiongrid.416738.f, Atlanta, Georgia, USA
Antimicrobial Agents And Chemotherapy, 15.08.2022
Tilføjet 15.08.2022
Geberemichal Geberetsadik, Akane Inaizumi, Akihito Nishiyama, Takehiro Yamaguchi, Hiroshi Hamamoto, Suresh Panthee, Aki Tamaru, Manabu Hayatsu, Yusuke Mizutani, Shaban Amina Kaboso, Mariko Hakamata, Aleksandr Ilinov, Yuriko Ozeki, Yoshitaka Tateishi, Kazuhisa Sekimizu, Sohkichi Matsumoto aBacteriology, Niigata Universitygrid.412181.fgrid.260975.f School of Medicine, Niigata, Japan bDepartment of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan cInstitute of Medical Mycology, Teikyo University, Tokyo, Japan dDrug Discoveries by Silkworm Models, Faculty of Pharma-Science, Teikyo University, Tokyo, Japan eDepartment of Infectious Diseases, Osaka Prefectural Institute of Public Health, Osaka, Japan fDivision of Microscopic Anatomy, Niigata Universitygrid.412181.fgrid.260975.f Graduate School of Medical and Dental Sciences, Niigata, Japan gOffice of Institutional Research, Hokkaido University, Sapporo, Hokkaido, Japan hDepartment of Respiratory Medicine and Infectious Disease, Niigata Universitygrid.260975.fgrid.412181.fgrid.260975.f Graduate School of Medical and Dental Sciences, Niigata, Japan iDepartment of General Surgery, Krasnoyarsk State Medical University, Krasnoyarsk, Russia jDepartment of Biology, Natural and Computational Sciences Faculty, Assosa University, Assosa, Ethiopia kDepartment of Medical Pathogenesis and Immunology, College of Medicine, Texas A&M University, Bryan, Texas, USA lLaboratory of Tuberculosis, Institute of Tropical Disease, Universitas Airlangga, Surabaya, East Java, Indonesia
Antimicrobial Agents And Chemotherapy, 15.08.2022
Tilføjet 15.08.2022
Adam Valcek, Kristina Nesporova, Clémence Whiteway, Tim De Pooter, Wouter De Coster, Mojca Strazisar, Charles Van der Henst aMicrobial Resistance and Drug Discovery, VIB-VUB Center for Structural Biology, VIB, Flanders Institute for Biotechnology, Brussels, Belgium bStructural Biology Brussels, Vrije Universiteit Brusselgrid.8767.e (VUB), Brussels, Belgium cNeuromics Support Facility, VIB Center for Molecular Neurology, VIB, Antwerp, Belgium dDepartment of Biomedical Sciences, University of Antwerp, Antwerp, Belgium eApplied and Translational Neurogenomics Group, VIB Center for Molecular Neurology, VIB, Antwerp, Belgium fApplied and Translational Neurogenomics Group, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
Antimicrobial Agents And Chemotherapy, 15.08.2022
Tilføjet 15.08.2022
Wenye Wu, Siyuan He, Anqi Li, Qi Guo, Zhili Tan, Shicong Liu, Xinghai Wang, Zhemin Zhang, Bing Li, Haiqing Chu aDepartment of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China bSchool of Medicine, Tongji University, Shanghai, China cShanghai MicuRx Pharmaceutical Co., Ltd., Shanghai, China dShanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
Antimicrobial Agents And Chemotherapy, 15.08.2022
Tilføjet 15.08.2022
Hashem A. KilaniI, Mo’ath F. Bataineh, Ali Al-Nawayseh, Khaled Atiyat, Omar Obeid, Maher M. Abu-Hilal, Taiysir Mansi, Maher Al-Kilani, Mahfoodha Al-Kitani, Majed El-Saleh, Ruba M. Jaber, Ahmad Sweidan, Mawaheb Himsi, Iyad Yousef, Faten Alzeer, Monther Nasrallah, Ayesha S. Al Dhaheri, Abdulsalam Al-Za’abi, Osama Allala, Laila Al-Kilani, Asma M. Alhasan, Mohamed Ghieda, Yasir Najah, Saad Alsheekhly, Ahmad Alhaifi, Raghda Shukri, Jamal Al Adwani, Mostafa Waly, Laila Kilani, Leen H. Kilani, Ahmad S. al Shareef, Areej Kilani
PLoS One Infectious Diseases, 15.08.2022
Tilføjet 15.08.2022
by Hashem A. KilaniI, Mo’ath F. Bataineh, Ali Al-Nawayseh, Khaled Atiyat, Omar Obeid, Maher M. Abu-Hilal, Taiysir Mansi, Maher Al-Kilani, Mahfoodha Al-Kitani, Majed El-Saleh, Ruba M. Jaber, Ahmad Sweidan, Mawaheb Himsi, Iyad Yousef, Faten Alzeer, Monther Nasrallah, Ayesha S. Al Dhaheri, Abdulsalam Al-Za’abi, Osama Allala, Laila Al-Kilani, Asma M. Alhasan, Mohamed Ghieda, Yasir Najah, Saad Alsheekhly, Ahmad Alhaifi, Raghda Shukri, Jamal Al Adwani, Mostafa Waly, Laila Kilani, Leen H. Kilani, Ahmad S. al Shareef, Areej Kilani
Læs mere Tjek på PubMedKaren Cortés-Sarabia, Armando Cruz-Rangel, Alejandro Flores-Alanis, Marcela Salazar-García, Samuel Jiménez-García, Griselda Rodríguez-Martínez, Juan Pablo Reyes-Grajeda, Rosa Isela Rodríguez-Téllez, Genaro Patiño-López, Israel Parra-Ortega, Oscar Del Moral-Hernández, Berenice Illades-Aguiar, Miguel Klünder-Klünder, Horacio Márquez-González, Adrián Chávez-López, Victor M. Luna-Pineda
PLoS One Infectious Diseases, 15.08.2022
Tilføjet 15.08.2022
by Karen Cortés-Sarabia, Armando Cruz-Rangel, Alejandro Flores-Alanis, Marcela Salazar-García, Samuel Jiménez-García, Griselda Rodríguez-Martínez, Juan Pablo Reyes-Grajeda, Rosa Isela Rodríguez-Téllez, Genaro Patiño-López, Israel Parra-Ortega, Oscar Del Moral-Hernández, Berenice Illades-Aguiar, Miguel Klünder-Klünder, Horacio Márquez-González, Adrián Chávez-López, Victor M. Luna-Pineda
Severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 infection in children and adolescents primarily causes mild or asymptomatic coronavirus disease 2019 (COVID-19), and severe illness is mainly associated with comorbidities. However, the worldwide prevalence of COVID-19 in this population is only 1%–2%. In Mexico, the prevalence of COVID-19 in children has increased to 10%. As serology-based studies are scarce, we analyzed the clinical features and serological response (SARS-CoV-2 structural proteins) of children and adolescents who visited the Hospital Infantil de México Federico Gómez (October 2020–March 2021). The majority were 9-year-old children without comorbidities who were treated as outpatients and had mild-to-moderate illness. Children aged 6–10 years and adolescents aged 11–15 years had the maximum number of symptoms, including those with obesity. Nevertheless, children with comorbidities such as immunosuppression, leukemia, and obesity exhibited the lowest antibody response, whereas those aged 1–5 years with heart disease had the highest levels of antibodies. The SARS-CoV-2 spike receptor-binding domain-localized peptides and M and E proteins had the best antibody response. In conclusion, Mexican children and adolescents with COVID-19 represent a heterogeneous population, and comorbidities play an important role in the antibody response against SARS-CoV-2 infection.
Læs mere Tjek på PubMedZenawi Zeramariam Araia, Fitsum Kibreab, Abiel Abraham Kibrom, Amanuel Hadgu Mebrahtu, Michael Goitom Girmatsion, Yonatan Woldu Teklehiwet, Araia Berhane Mesfin
PLoS One Infectious Diseases, 15.08.2022
Tilføjet 15.08.2022
by Zenawi Zeramariam Araia, Fitsum Kibreab, Abiel Abraham Kibrom, Amanuel Hadgu Mebrahtu, Michael Goitom Girmatsion, Yonatan Woldu Teklehiwet, Araia Berhane Mesfin
Background Eritrea has achieved the global target (90%) for tuberculosis (TB) treatment success rate. Though, events of unsuccessful TB treatment outcomes (death, treatment failure, lost to follow up and not evaluated) could lead to further TB transmission and the development of resistant strains. Hence, factors related to these events should be explored and addressed. This study aims to fill the gap in evidence by identifying the determinants of unsuccessful TB treatment outcomes in Eritrea’s Northern Red Sea region. Methods A retrospective cohort study was conducted in Eritrea’s Northern Red Sea region. Data collected using a data extraction tool was analyzed using Stata version 13. Frequencies, proportions, median and standard deviations were used to describe the data. Furthermore, univariable and multivariable logistic regression analysis were performed to determine the risk factors for unsuccessful TB treatment outcomes. Crude odds ratio (COR) and adjusted odds ratio (AOR) with their 95% confidence interval (CI) presented and p-value < 0.05 was considered statistically significant. Results Among 1227 TB patients included in this study, 9.6% had unsuccessful TB treatment outcomes. In multivariable logistic regression analysis, TB cases 55–64 years old (AOR: 2.75[CI: 1.21–6.32], p = 0.016) and those ≥ 65 years old (AOR: 4.02[CI: 1.72–9.45], p = 0.001) had 2.7 and 4 times higher likelihood of unsuccessful TB treatment outcome respectively. In addition, HIV positive TB patients (AOR: 5.13[CI: 1.87–14.06], p = 0.002) were 5 times more likely to have unsuccessful TB treatment outcome. TB treatment in Ghindae Regional Referral Hospital (AOR: 5.01[2.61–9.61], p < 0.001), Massawa Hospital (AOR: 4.35[2.28–8.30], p< 0.001) and Nakfa Hospital (AOR: 2.53[1.15–5.53], p = 0.021) was associated with 5, 4 and 2.5 higher odds of unsuccessful TB treatment outcome respectively. Conclusion In this setting, old age, HIV co-infection and health facility were the independent predictors of unsuccessful TB treatment outcome.
Læs mere Tjek på PubMedAndargew Yohannes Ashamo, Abebaw Bekele, Adane Petrose, Tsegaye Gebreyes, Eyob Kebede Etissa, Amsalu Bekele, Deborah Haisch, Neil W. Schluger, Hanan Yusuf, Tewodros Haile, Negussie Deyessa, Dawit Kebede
PLoS One Infectious Diseases, 15.08.2022
Tilføjet 15.08.2022
by Andargew Yohannes Ashamo, Abebaw Bekele, Adane Petrose, Tsegaye Gebreyes, Eyob Kebede Etissa, Amsalu Bekele, Deborah Haisch, Neil W. Schluger, Hanan Yusuf, Tewodros Haile, Negussie Deyessa, Dawit Kebede
Background Various reports suggested that pre-existing medical illnesses, including hypertension and other demographic, clinical, and laboratory factors, could pose an increased risk of disease severity and mortality among COVID-19 patients. This study aimed to assess the relation of hypertension and other factors to the severity of COVID-19 pneumonia in patients discharged from Eka Kotebe Hospital in June-September, 2020. Methods This is a single-center case-control study of 265 adult patients discharged alive or dead, 75 with a course of severe COVID-19 for the cases arm and 190 with the non-severe disease for the control arm. Three age and sex-matched controls were selected randomly for each patient on the case arm. Chi-square, multivariable binary logistic regression, and odds ratio (OR) with a 95% confidence interval was used to assess the association between the various factors and the severity of the disease. A p-value of
Læs mere Tjek på PubMedWen Tian, Xingxiang Ren, Xu Gao, Yuanyuan Zhang, Zhihai Chen, Wei Zhang
Journal of Medical Virology, 15.08.2022
Tilføjet 15.08.2022
BMC Infectious Diseases, 15.08.2022
Tilføjet 15.08.2022
Abstract
Background
Significant immune escape by the Omicron variant, along with the emergence of widespread worry fatigue, have called into question the robustness of the previously observed relation between population mobility and COVID-19 incidence.
Methods
We employed principal component analysis to construct a one-dimensional summary indicator of six Google mobility categories. We related this mobility indicator to case incidence among 111 of the most populous U.S. counties during the Omicron surge from December 2021 through February 2022.
Results
Reported COVID-19 incidence peaked earlier and declined more rapidly among those counties exhibiting more extensive decline in mobility between December 20 and January 3. Based upon a fixed-effects, longitudinal cohort model, we estimated that every 1% decline in mobility between December 20 and January 3 was associated with a 0.63% decline in peak incidence during the week ending January 17 (95% confidence interval, 0.40–0.86%). Based upon a cross-sectional analysis including mean household size and vaccination participation as covariates, we estimated that the same 1% decline in mobility was associated with a 0.36% decline in cumulative reported COVID-19 incidence from January 10 through February 28 (95% CI, 0.18–0.54%).
Conclusion
Omicron did not simply sweep through the U.S. population until it ran out of susceptible individuals to infect. To the contrary, a significant fraction managed to avoid infection by engaging in risk-mitigating behaviors. More broadly, the behavioral response to perceived risk should be viewed as an intrinsic component of the natural course of epidemics in humans.
Læs mere Tjek på PubMed
BMC Infectious Diseases, 15.08.2022
Tilføjet 15.08.2022
Abstract
Background
The literature on dolutegravir (DTG)-based HIV treatment has focused on assessing therapeutic efficacy particularly with regard to viral load suppression. However, little empirical attention has been devoted to understanding the effects of DTG on quality of life, in particular sexual health and functioning in PLHIV. This study focused on understanding patient experiences of sexual dysfunction, after transition to DTG-based regimens in Rwenzori region in Mid-Western Uganda.
Methods
We adopted a qualitative exploratory research design. Between August and September 2021, we conducted sixteen in-depth interviews and six focus group discussions (48 participants) with patients reporting ‘new’ sexual dysfunction after transition to DTG-based regimens at seven health facilities in mid-Western Uganda. Data were analyzed by thematic approach.
Results
Decreased libido was reported in both sexes of patients within weeks of transition to DTG-based regimens. Diminished interest in sex was more frequently reported among women while men complained of a marked reduction in the frequency of sex. Women reported loss of psycho-social attraction to their long-term male partners. Erectile dysfunction was common among men in this sample of patients. Patients described their experiences of sexual dysfunction as an affront to their socially-constructed gender identities. Patients described tolerating sexual adverse drug reactions (ADRs) as a necessary tradeoff for the extension in life granted through antiretroviral therapy. A number of women reported that they had separated from their spouses as a result of perceived drug-induced sexual dysfunction. Marital strife and conflict arising from frustration with sexual-partner dysfunction was frequently reported by participants in both sexes. Several participants indicated experiencing insecurity in their heterosexual relationships due to difficulties in sexual functioning.
Conclusion
Sexual dysfunction following transition to DTG-based regimens is common in both sexes of PLHIV, who indicated that they had no prior experience of difficulties in sexual health. Our findings demonstrate that sexual ADRs negatively impact self-esteem, overall quality of life and impair gender relations. DTG-related sexual health problems merit increased attention from HIV clinicians. Further research is warranted to assess the prevalence of DTG-associated sexual dysfunction in patients in Uganda.
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BMC Infectious Diseases, 15.08.2022
Tilføjet 15.08.2022
Abstract
Background
Because the clinical patterns and symptoms that persist after a COVID-19 infection are diverse, a diagnosis of post-acute COVID-19 syndrome (PACS) is difficult to implement. The current research project therefore aims to evaluate the feasibility and the practicability of a comprehensive, interdisciplinary, and cross-sectoral treatment program consisting of a low-threshold online screening and holistic assessment for PACS. Furthermore, it aims to evaluate digital interventions and the use of so-called personal guides that may help to facilitate the recovery of PACS.
Methods
This German study consists of a low-threshold online screening for PACS where positively screened participants will be supported throughout by personal pilots. The personal pilots are aimed at empowering patients and helping them to navigate through the study and different treatment options. Patients will then be randomly assigned either to an intervention group (IG) or an active control group (ACG). The IG will receive a comprehensive assessment of physiological and psychological functioning to inform future treatment. The ACG does not receive the assessment but both groups will receive a treatment consisting of an individual digital treatment program (digital intervention platform and an intervention via a chatbot). This digital intervention is based on the needs identified during the assessment for participants in the IG. Compared to that, the ACG will receive a more common digital treatment program aiming to reduce PACS symptoms. Importantly, a third comparison group (CompG) will be recruited that does not receive any treatment. A propensity score matching will take place, ensuring comparability between the participants. Primary endpoints of the study are symptom reduction and return to work. Secondary outcomes comprise, for example, social participation and activities in daily life. Furthermore, the feasibility and applicability of the online screening tool, the holistic assessment, digital trainings, and personal pilots will be evaluated.
Discussion
This is one of the first large-scale studies to improve the diagnosis and the care of patients with PACS by means of empowerment. It is to be evaluated whether the methods utilized can be used for the German and international population.
Trial registration ClinicalTrials.gov Identifier: NCT05238415; date of registration: February 14, 2022
Læs mere Tjek på PubMed
Malaria Journal, 15.08.2022
Tilføjet 15.08.2022
Abstract
Background
Malaria rapid diagnostic tests (RDTs) have expanded diagnostic service to remote endemic communities in Ethiopia, where 70% of malaria services per annum are reliant on them. However, diagnostic strategies are threatened by Plasmodium falciparum parasites with deletions of the histidine-rich protein 2 and/or 3 (pfhrp2/3) genes. Studies have reported pfhrp2/3 gene deletion prevalence in Ethiopia that exceeds the WHO recommended threshold to switch to non-HRP2 targeted RDTs for detection of P. falciparum. Therefore, RDTs that target alternative antigens, such as P. falciparum lactate dehydrogenase (PfLDH) are increasingly in programmatic use.
Methods
Malaria suspected patients visiting health facilities of Amhara, Tigray, Gambella, and Oromia regions of Ethiopia were screened by community health workers using Carestart Pf/Pv (HRP2/Pv-LDH) and SD-Bioline Pf (HRP2 for Pf/LDH for Pf) RDTs. Dried blood spot (DBS) samples were collected from selected patients for molecular and serological analysis. The clinical data and RDT results were recorded on standard forms, entered into EpiInfo, and analysed using STATA. The Pf-LDH detecting RDT results were compared with real-time PCR and bead-based immunoassay to determine their diagnostic performance.
Results
The 13,172 (56% male and 44% female, median age of 19 years ranging from 1 to 99 year) study participants were enrolled and tested with PfHRP2 and PfLDH detection RDTs; 20.6% (95% CI: 19.6 to 21.6) were P. falciparum RDT positive. A subset of samples (n = 820) were previously tested using P. falciparum lactate dehydrogenase (pfldh) quantitative real-time PCR, and 456 of these further characterized using bead-based immunoassay. The proportion of samples positive for P. falciparum by the PfHRP2 Carestart and SD-Bioline RDTs were 66% (539/820) and 59% (481/820), respectively; 68% (561/820) were positive for the PfLDH band on the SD-Bioline RDT. The sensitivity and specificity of the PfLDH RDT band were 69% and 38%, respectively, versus pfldh qPCR; and 72% and 36%, respectively, versus PfLDH detection by immunoassay. Among samples with results for RDT, qPCR, and immunoassay, higher proportions of P. falciparum were recorded by pfldh qPCR (90%, 411/456) and PfLDH immunoassay (88%, 363/413) compared to the PfLDH band on the SD-Bioline RDT (74.6%, 340/456).
Conclusion and recommendation
Both PfHRP2 RDTs detected fewer P. falciparum cases than PfLDH, and fewer cases than qPCR or immunoassay. The poor sensitivity and specificity of the PfLDH RDT compared to qPCR and to immunoassay in this study raises concern. Continuous operator training and RDTs quality assurance programme to ensure quality diagnostic services are recommended.
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