Nyt fra tidsskrifterne

by Judit Sági, Csaba Lentner

The propensity to have children, which, according to the view accepted in the literature, is a good predictor of actual childbearing, is of particular importance in countries with low fertility rates and economic prosperity. In this paper, we report the results of a representative survey of 15,700 respondents in 2021 of university students in an emerging market economy in Central Europe, mapping their intentions to have children. The PLS-SEM data analysis method was used to test our hypotheses on the relationships between social, economic, and environmental variables of childbearing. Our results confirm the dominant role of socio-cultural inclusiveness in childbearing, over socio-economic and environmental-economic factors. The novelty of our research lies in the impact analysis of family policy incentives; however, our results are consistent with those documented in the literature, namely, the primacy of socio-cultural factors in the willingness of childbearing.

by Khoa Tran, Tuyet Nguyen, Yen Tran, Anh Nguyen, Khang Luu, Y. Nguyen

Raising environmental awareness and product development are two separate and costly investments that many small and medium-sized fashion businesses cannot afford to achieve sustainability. Therefore, there is a need to determine which factors exert a more significant impact on consumer loyalty and purchase intention toward eco-friendly fashions. Thus, this study employs a mixed-methods approach with thematic analysis and the SEM-PLS technique to research how Vietnamese Gen Z’s perceptions of product-service quality, environmental awareness, and pro-environmental behavior influence their purchase intention and loyalty toward eco-friendly fashion products. Most interviewees acknowledged that they primarily gained knowledge about eco-friendly fashion through social media platforms. The qualitative results further showed that their knowledge of and attitudes toward eco-friendly fashion practices were insufficient to convince young customers to afford eco-friendly fashion products. The SEM-PLS results of 313 participants show that while customers’ perceived behavioral control plays a more significant role in stimulating purchase intention, only product-service quality factors impact loyalty. Hence, this study suggests that businesses should prioritize improving service and product quality rather than funding green marketing when targeting Vietnamese Gen Z in case of financial constraints. Government should prioritize financial and technological support for fashion firms to develop high-quality eco-friendly fashion to ensure the product availability.

by Marta Marchlewska, Dagmara Szczepańska, Adam Karakula, Zuzanna Molenda, Marta Rogoza, Dominika Maison

Previous research found that conspiracy beliefs were usually activated when individuals faced different types of psychological threats and that they led mainly to maladaptive individual and societal outcomes. In this research, we assumed that potential harmfulness of conspiracy beliefs may depend on the context, and we focused on the link between food industry conspiracy beliefs and conscious food choices. We hypothesized that food industry conspiracy beliefs may allow for a constructive attempt to protect oneself against real or imagined enemies (i.e., food industry companies) by conscious food choices (e.g., paying attention to how much the food products are processed). We tested this hypothesis among Polish participants (Study 1; N = 608; cross-sectional and Study 2; N = 790; experimental). Study 1 confirmed that context-specific conspiracy beliefs (but not general notions of conspiracy) are associated with adaptive consumer behaviors. Study 2 showed that inducing feelings of threat related to the possibility of purchasing food contaminated by a harmful bacteria (vs. control condition) increased food industry conspiracy beliefs, which were further positively linked to conscious food choices. We discuss the role of threat and conspiracy beliefs in adaptive consumer behaviors related to food choices.

by Archana B. Patel, Carla M. Bann, Cherryl S. Kolhe, Adrien Lokangaka, Antoinette Tshefu, Melissa Bauserman, Lester Figueroa, Nancy F. Krebs, Fabian Esamai, Sherri Bucher, Sarah Saleem, Robert L. Goldenberg, Elwyn Chomba, Waldemar A. Carlo, Shivaprasad Goudar, Richard J. Derman, Marion Koso-Thomas, Elizabeth M. McClure, Patricia L. Hibberd

Background Globally, socioeconomic status (SES) is an important health determinant across a range of health conditions and diseases. However, measuring SES within low- and middle-income countries (LMICs) can be particularly challenging given the variation and diversity of LMIC populations. Objective The current study investigates whether maternal SES as assessed by the newly developed Global Network-SES Index is associated with pregnancy outcomes (stillbirths, perinatal mortality, and neonatal mortality) in six LMICs: Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan, and Zambia. Methods The analysis included data from 87,923 women enrolled in the Maternal and Newborn Health Registry of the NICHD-funded Global Network for Women’s and Children’s Health Research. Generalized estimating equations models were computed for each outcome by SES level (high, moderate, or low) and controlling for site, maternal age, parity, years of schooling, body mass index, and facility birth, including sampling cluster as a random effect. Results Women with low SES had significantly higher risks for stillbirth (p < 0.001), perinatal mortality (p = 0.001), and neonatal mortality (p = 0.005) than women with high SES. In addition, those with moderate SES had significantly higher risks of stillbirth (p = 0.003) and perinatal mortality (p = 0.008) in comparison to those with high SES. Conclusion The SES categories were associated with pregnancy outcomes, supporting the validity of the index as a non–income-based measure of SES for use in studies of pregnancy outcomes in LMICs.…

by Eggi Arguni, Fatwa Sari Tetra Dewi, Jajah Fachiroh, Dewi Kartikawati Paramita, Septi Kurnia Lestari, Bayu Satria Wiratama, Annisa Ryan Susilaningrum, Bara Kharisma, Yogi Hasna Meisyarah, Merlinda Permata Sari, Zakiya Ammalia Farahdilla, Siswanto Siswanto, Muhammad Farhan Sjaugi, Teguh Haryo Sasongko, Lutfan Lazuardi

The long-term antibody response to the novel SARS-CoV-2 in infected patients and their residential neighborhood remains unknown in Indonesia. This information will provide insights into the antibody kinetics over a relatively long period as well as transmission risk factors in the community. We aim to prospectively observe and determine the kinetics of the anti-SARS-CoV-2 antibody for 2 years after infection in relation to disease severity and to determine the risk and protective factors of SARS CoV-2 infections in the community. A cohort of RT-PCR confirmed SARS-CoV-2 patients (case) will be prospectively followed for 2 years and will be compared to a control population. The control group comprises SARS-CoV-2 non-infected people who live within a one-kilometer radius from the corresponding case (location matching). This study will recruit at least 165 patients and 495 controls. Demographics, community variables, behavioral characteristics, and relevant clinical data will be collected. Serum samples taken at various time points will be tested for IgM anti-Spike protein of SARS-CoV-2 and IgG anti-Spike RBD of SARS-CoV-2 by using Chemiluminescent Microparticle Immunoassay (CMIA) method. The Kaplan-Meier method will be used to calculate cumulative seroconversion rates, and their association with disease severity will be estimated by logistic regression. The risk and protective factors associated with the SARS-CoV-2 infection will be determined using conditional (matched) logistic regression and presented as an odds ratio and 95% confidence interval.

by Minori Uchimiya, Anthony G. Hay, Jeffrey LeBlanc

Sugarcane mill mud/filter cake is an activated sludge-like byproduct from the clarifier of a raw sugar production factory, where cane juice is heated to ≈90°C for 1–2 hr, after the removal of bagasse. Mill mud is enriched with organic carbon, nitrogen, and nutrient minerals; no prior report utilized 16S rRNA gene sequencing to characterize the microbial composition. Mill mud could be applied to agricultural fields as biofertilizer to replace or supplement chemical fertilizers, and as bio-stimulant to replenish microorganisms and organic carbon depleted by erosion and post-harvest field burning. However, mill mud has historically caused waste management challenges in the United States. This study reports on the chemical and microbial (16S rRNA) characteristics for mill muds of diverse origin and ages. Chemical signature (high phosphorus) distinguished mill mud from bagasse (high carbon to nitrogen (C/N) ratio) and soil (high pH) samples of diverse geographical/environmental origins. Bacterial alpha diversity of all sample types (mill mud, bagasse, and soil) was inversely correlated with C/N. Firmicutes dominated the microbial composition of fresh byproducts (mill mud and bagasse) as-produced within the operating factory. Upon aging and environmental exposure, the microbial community of the byproducts diversified to resemble that of soils, and became dominated by varying proportions of other phyla such as Acidobacteria, Chloroflexi, and Planctomyces. In summary, chemical properties allowed grouping of sample types (mill mud, bagasse, and soil-like), and microbial diversity analyses visualized aging caused by outdoor exposures including soil amendment and composting. Results suggest that a transient turnover of microbiome by amendments shifts towards more resilient population governed by the chemistry of bulk soil.

by Hailay Gebretnsae, Tsegay Hadgu, Brhane Gebrekidan Ayele, Alemnesh Abraha, Equbay Gebre-egziabher, Mulugeta Woldu, Tsegay Wellay, Gebregziabher Berihu Gebrekidan, Measho Gebreslassie Gebregziabher

Background Despite the emphasis placed on Community Based Tuberculosis Care (CBTC) implementation by Health Extension Workers (HEWs) within the National Tuberculosis Program (NTP) in Ethiopia, there is little evidence on contribution of HEWs on TB case notification. Therefore, this study aimed to describe the contribution of HEWs on TB case notification and its associated factors in Tigray region, Northern Ethiopia. Methods A concurrent mixed method (quantitative and qualitative) cross-sectional study design was conducted in three randomly selected districts in Tigray region, Northern Ethiopia. Quantitative data were collected using a pre-tested semi-structured questionnaire. Qualitative data were collected using Focused Group Discussions (FGDs) and Key Informant Interviews (KIIs) to further describe the community participation and presumptive TB identification and referral system. For the quantitative data, binary logistic regression analysis was done and all variables with P-value of < 0.25 in bivariate analysis were included in the multi-variable model to see predictors of HEWs contribution to TB notification. The qualitative data were thematically analyzed using Atlas.ti version 7. Results In this study, a total of 68 HEWs were included. From March 1, 2017 to February 28, 2018, a total of 427 TB cases notified in the study areas and one-third (34%) of them were notified by the HEWs referral. Provision of Community Based-Directly Observed Treatment Short course (CB–DOTS) (Adjusted Odds Ratio (AOR) = 3.63, 95% Confidence Interval (CI) = 1.18–11.19) and involvement of community volunteers on CBTC (AOR = 3.31, 95% CI = 1.10–10.09) were significantly associated with the contribution of HEWs on TB case notification. The qualitative findings indicated that high workload of HEWs, inaccessibility of TB diagnostic services at nearby health facilities, and transportation and investigation costs were identified as factors affecting for presumptive TB referral by HEWs. Conclusions Provision of CB-DOTS and involvement of community volunteers in CBTC activities should be strengthened to improve the HEWs contribution on TB case notification. Additionally, HEWs should be empowered and further interventions of TB diagnostic services at diagnostic health facilities are needed to improve presumptive TB referral by HEWs.…

Objectives

To evaluate the feasibility of the Zero TB Indicator Framework as a tool for assessing the quality of tuberculosis (TB) case-finding, treatment and prevention services in Mongolia.

Setting

Primary health centres, TB dispensaries, and surrounding communities in four districts of Mongolia.

Design

Three retrospective cross-sectional cohort studies, and two longitudinal studies each individually nested in one of the cohort studies.

Participants

15 947 community members from high TB-risk populations; 8518 patients screened for TB in primary health centres and referred to dispensaries; 857 patients with index TB and 2352 household contacts.

Primary and secondary outcome measures

14 indicators of the quality of TB care defined by the Zero TB Indicator Framework and organised into three care cascades, evaluating community-based active case-finding, passive case-finding in health facilities and TB screening and prevention among close contacts; individual and health-system predictors of these indicators.

Results

The cumulative proportions of participants receiving guideline-adherent care varied widely, from 96% for community-based active case-finding, to 79% for TB preventive therapy among household contacts, to only 67% for passive case-finding in primary health centres and TB dispensaries (range: 29%–80% across districts). The odds of patients completing active TB treatment decreased substantially with increasing age (aOR: 0.76 per decade, 95% CI: 0.71 to 0.83, p<0.001) and among men (aOR: 0.56, 95% CI: 0.36 to 0.88, p=0.013). Contacts of older index patients also had lower odds of initiating and completing of TB preventive therapy (aOR: 0.60 per decade, 95% CI: 0.38 to 0.93, p=0.022).

Conclusions

The Zero TB Framework provided a feasible and adaptable approach for using routine surveillance data to evaluate the quality of TB care and identify associated individual and health system factors. Future research should evaluate strategies for collecting process indicators more efficiently; gather qualitative data on explanations for low-quality care; and deploy quality improvement interventions.

…

Introduction

The COVID-19 pandemic has a significant spill-over effect on people with non-communicable diseases (NCDs) over the long term, beyond the direct effect of COVID-19 infection. Evaluating changes in health outcomes, health service use and costs can provide evidence to optimise care for people with NCDs during and after the pandemic, and to better prepare outbreak responses in the future.

Methods and analysis

This is a population-based cohort study using electronic health records of the Hong Kong Hospital Authority (HA) CMS, economic modelling and serial cross-sectional surveys on health service use. This study includes people aged ≥18 years who have a documented diagnosis of diabetes mellitus, hypertension, cardiovascular disease, cancer, chronic respiratory disease or chronic kidney disease with at least one attendance at the HA hospital or clinic between 1 January 2010 and 31 December 2019, and without COVID-19 infection. Changes in all-cause mortality, disease-specific outcomes, and health services use rates and costs will be assessed between pre-COVID-19 and-post-COVID-19 pandemic or during each wave using an interrupted time series analysis. The long-term health economic impact of healthcare disruptions during the COVID-19 pandemic will be studied using microsimulation modelling. Multivariable Cox proportional hazards regression and Poisson/negative binomial regression will be used to evaluate the effect of different modes of supplementary care on health outcomes.

Ethics and dissemination

The study was approved by the institutional review board of the University of Hong Kong, the HA Hong Kong West Cluster (reference number UW 21–297). The study findings will be disseminated through peer-reviewed publications and international conferences.

…

Antimicrobial Agents and Chemotherapy, Ahead of Print. …

Infection and Immunity, Ahead of Print. …

Abstract

Purpose

Infective endocarditis (IE) is a severe bacterial infection. As a measure of prevention, the administration of antibiotic prophylaxis (AP) prior to dental procedures was recommended in the past. However, between 2007 and 2009, guidelines for IE prophylaxis changed all around the word, limiting or supporting the complete cessation of AP. It remains unclear whether AP is effective or not against IE.

Methods

We conducted a systematic review whether the administration of AP in adults before any dental procedure, compared to the non-administration of such drugs, has an effect on the risk of developing IE. We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via OVID, and EMBASE. Two different authors filtered articles independently and data extraction was performed based on a pre-defined protocol.

Results

The only cohort study meeting our criteria included patients at high-risk of IE. Analysis of the extracted data showed a non-significant decrease in the risk of IE when high-risk patients take AP prior to invasive dental procedures (RR 0.39, p-value 0.11). We did not find other studies including patients at low or moderate risk of IE. Qualitative evaluation of the excluded articles reveals diversity of results and suggests that most of the state-of-the-art articles are underpowered.

Conclusions

Evidence to support or discourage the use of AP prior to dental procedures as a prevention for IE is very low. New high-quality studies are needed, even though such studies would require big settings and might not be immediately feasible.

…

Tropical Medicine &International Health, Accepted Article.

Tropical Medicine &International Health, Accepted Article.

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 (…

Background:

Feminizing hormonal therapy (FHT) and HIV potentially alter cardiovascular disease (CVD) risk in transgender women (TW).

Methods:

TW were enrolled in Los Angeles, CA and Houston, TX and frequency-matched to Multicenter AIDS Cohort Study cisgender men (CM) on age, race, substance use and abacavir use. Biomarkers of CVD risk and inflammation were assessed via ELISA. Wilcoxon rank sum and Fisher's exact tests compared TW and CM. Multivariable linear regression assessed factors associated with biomarker concentrations.

Results:

TW (HIV+ n = 75, HIV- n = 47) and CM (HIV+ n = 40, HIV- n = 40) had mean age 43-45 years; TW/CM were 90%/91% non-Hispanic Black, Hispanic, or Multi-racial, 26%/53% obese, and 34%/24% current smokers; 67% of TW were on FHT. Among PLWH, TW had higher median extracellular newly-identified receptor for advanced glycation end-products (EN-RAGE), lipoprotein-associated phospholipase A2 (LpPLA2), oxidized LDL (oxLDL), soluble TNF receptor type (sTNFR) I/II, interleukin (IL)-8 and plasminogen activator inhibitor (PAI)-1, but lower soluble CD14, von Willebrand factor (vWF) and endothelin (ET)-1 levels than CM. Findings were similar for participants without HIV (all p …

Objectives:

Hepatic steatosis is a leading cause of cirrhosis and hepatocellular carcinoma and is highly prevalent in persons with HIV (PWH). However, most studies of hepatic steatosis diagnosis in PWH have focused on those at high risk. We determined the accuracy of vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP) in detecting mild or greater hepatic steatosis as compared with the noninvasive gold standard magnetic resonance spectroscopy (MRS) in PWH.

Methods:

Among 149 participants with and without HIV, we evaluated test characteristics of CAP and calculated serum indices Hepatic Steatosis Index (HSI) and STEATO-ELSA in identifying 3T MRS-measured hepatic steatosis (defined as a liver fat fraction ≥5%).

Results:

Most participants were women and over half were African American. Median BMI was 27 kg/m2. Hepatic steatosis prevalence by MRS and CAP (cutoff 248 dB/m) was 36 and 47%, respectively. CAP had an AUROC of 0.82, and the at least 248 dB/m cutoff yielded a sensitivity, specificity, positive-predictive value, and negative-predictive value of 83, 72, 61, and 88%, respectively. These test characteristics were not statistically different from the optimal cutoff of at least 252 dB/m. Higher waist circumference, greater visceral adipose tissue, heavy alcohol use, and VCTE scans flagged as having the probe positioned too low were associated with CAP and MRS discordance. Serum indices of hepatic steatosis had slightly worse performance characteristics than CAP.

Conclusion:

CAP may be an effective alternative to MRS for noninvasive hepatic steatosis assessment in PWH. The commonly used CAP at least 248 dB/m to diagnose hepatic steatosis can be used in PWH.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Introduction:

Standard-of-care antiretroviral treatment (ART) monitoring in low- and middle-income countries consists of annual determination of HIV-RNA viral load (VL) with confirmatory VL testing in case of viral rebound. We evaluated an intensified monitoring strategy of three-monthly VL testing with additional drug exposure and drug resistance testing in case of viral rebound.

Methods:

We performed an open-label RCT at a rural South African healthcare clinic, enrolling adults already receiving or newly initiating first-line ART. During 96 weeks follow-up, intervention participants received three-monthly VL testing and sequential point-of-care drug exposure testing and DBS-based drug resistance testing in case of rebound >1000 copies/mL. Control participants received standard-of-care monitoring according to WHO-guidelines.

Results:

501 participants were included, of whom 416 (83.0%) were randomised at 24 weeks. 401 participants were available for intention-to-treat analysis. Viral rebound occurred in 9.0% (18/199) of intervention participants in 11.9% (24/202) of controls (p=0.385). Time to detection of rebound was 375 days [IQR: 348–515] in intervention participants and 360 days [IQR: 338–464] in controls (HR: 0.88 [95%confidenceinterval(CI):0.46–1.66]; p = 0.683). Duration of viral rebound was 87 days [IQR: 70–110] in intervention participants and 101 days [IQR: 78–213] in controls (p = 0.423). In the control arm, 3 patients with confirmed failure were switched to second-line ART. In the intervention arm, of 3 patients with confirmed failure, switch could initially be avoided in 2 cases.

Conclusions:

Three-monthly VL testing did not significantly reduce the duration of viraemia when compared to standard-of-care annual VL testing, providing randomised trial evidence in support of annual VL monitoring.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Objective:

To examine type 2 diabetes mellitus incidence and associated risk factors among people with HIV (PWH).

Design:

A retrospective clinical cohort study of PWH at a Southeastern US academic HIV clinic between 2008 and 2018.

Methods:

PWH who attended at least two clinic visits were evaluated with demographic and clinical data extracted from the electronic medical record (EMR). Diabetes was defined as: (1) Hgb A1C ≥ 6.5% and/or 2 glucose results >200 mg/dl (at least 30 days apart), (2) diagnosis of diabetes in the EMR, or (3) exposure to diabetes medication. Time to diabetes incidence was computed from the entire clinic population for each year. Multivariable Cox proportional hazard regression models with time-dependent covariates were created to evaluate the independent association between covariates and time to incident diabetes.

Results:

Among 4113 PWH, we identified 252 incident cases of diabetes. Incidence increased from 1.04 incidents per 1000 PY in 2008, to 1.55 incidents per 1000 PY in 2018. Body mass index (Hazard Ratio [HR] 10.5 (6.2,17.7)), liver disease (HR1.9 (1.2,3.1)), steroid exposure (HR1.5 (1.1,1.9)), and use of Integrase Inhibitors (HR1.5 (1.1,2.0)) were associated with incident diabetes. Additional associated factors included lower CD4 cell counts, duration of HIV infection, exposure to non-statin lipid lowering therapy, and dyslipidemia.

Conclusions:

Rapidly increasing incident diabetes rates among PWH were associated with both traditional and HIV-related associated risk factors, particularly body weight, steroid exposure, and use of Integrase Inhibitors. Notably, several of the risk factors identified are modifiable and can be targeted for intervention.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

In pregnant women antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein cross the placenta and can be detected in cord-blood at the time of delivery. We measured SARS-CoV-2 full-length anti-spike IgG in blood samples collected from women living with HIV (WLWHIV) and without HIV when presenting for labour, and from paired cord-blood samples.

Anti-spike IgG was measured in maternal blood at delivery on the Luminex platform. Cord-blood samples from newborns of women in with detectable anti-spike IgG were analysed. The IgG geometric mean concentrations (GMCs) and the percentage of cord-blood samples with detectable anti-spike IgG were compared between WLWHIV and without HIV.

A total of 184 maternal and cord-blood pairs were analysed, including 47 WLWHIV and 137 without HIV. There was no difference in anti-spike GMCs between WLWHIV and without HIV (157 binding antibody units [BAU]/mL vs 187 BAU/mL; p = 0.17). Cord-blood samples from newborns of WLWHIV had lower GMCs compared with those without HIV (143 BAU/mL vs. 205 BAU/mL; p = 0.033). Cord-to-maternal blood antibody ratio was 1.0 and similar between the two HIV groups. In WLWHIV, those ≤30 years old had lower cord-to-maternal blood antibody ratio (0.75 vs. 1.10; p = 0.037) and their newborns had lower cord-blood GMCs (94 BAU/mL vs 194 BAU/mL; p = 0.04) compared to the older women.

Conclusions:

Independently of maternal HIV infection status there was efficient transplacental transfer of anti-spike antibodies. The GMCs in cord-blood from newborns of WLWHIV were lower than those in HIV-unexposed newborns.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Objective:

Non-governmental organisations (NGOs) in Ukraine have provided HIV testing, treatment, and condom distribution for men who have sex with men (MSM). HIV prevalence among MSM in Ukraine is 5.6%. We estimated the impact and cost-effectiveness of MSM-targeted NGO activities in Ukraine.

Design:

A mathematical model of HIV transmission among MSM was calibrated to data from Ukraine (2011–2018).

Methods:

The model, designed before the 2022 Russian invasion of Ukraine, evaluated the impact of 2018 status quo (SQ) coverage levels of 28% of MSM being NGO clients over 2016–2020 and 2021–2030 compared to no NGO activities over these time periods. Impact was measured in HIV incidence and infections averted. We compared the costs and disability adjusted life years [DALYs] for the SQ and a counterfactual scenario (no NGOs 2016–2020, but with NGOs thereafter) until 2030 to estimate the mean incremental cost-effectiveness ratio (ICER, cost per DALY averted).

Results:

Without NGO activity over 2016–2020, the HIV incidence in 2021 would have been 44% (95%CrI: 36%-59%) higher than with SQ levels of NGO activity, with 25% (21–30%) more incident infections occurring over 2016–2020. Continuing with SQ NGO coverage levels will decrease HIV incidence by 41% over 2021–2030, whereas it will increase by 79% (60–120%) with no NGOs over this period and 37% (30–51%) more HIV infections will occur. Compared to if NGO activities had ceased over 2016–2020 (but continued thereafter), the SQ scenario averts 14,918 DALYs over 2016–2030 with a mean ICER of US$600.15 per DALY averted.

Conclusions:

MSM-targeted NGOs in Ukraine have prevented considerable HIV infections and are highly cost-effective compared with a willingness-to-pay threshold of 50% of Ukraine's 2018 GDP (US$1,548).

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Objective:

Access to viral load measurements is constrained in resource-limited settings. A lateral flow urine tenofovir (TFV) rapid assay (UTRA) for patients whose regimens include TFV offers an affordable approach to frequent adherence monitoring.

Design:

We conducted a cross-sectional study of patients to assess the utility of UTRA to predict virologic failure, defined as a viral load greater than 400 copies/ml.

Methods:

We assessed urine TFV among 113 participants at increased risk of viral failure (who had previous viral failure on this regimen or had previously been ≥30 days out of care), comparing low genetic-barrier efavirenz (EFV) regimens (n = 60) to dolutegravir (DTG)-boosted or ritonavir-boosted protease inhibitor (PI/r)-based high genetic-barrier regimens (n = 53). Dried blood spots (DBS) for TFV-diphosphate and plasma for TFV concentrations were collected, with drug resistance assessed if viral failure present.

Results:

Among 113 participants, 17 of 53 received DTG or PI/r had viral failure at the cross-sectional visit, with 11 (64.7%) demonstrating an undetectable urine TFV; the negative-predictive value (NPV) of undetectable UTRA for viral failure was 85% (34/40); none of the 16 sequenced had dual class drug resistance. In those treated with EFV regimens the sensitivity was lower, as only 1 (4.8%) of 21 with viral failure had an undetectable UTRA (P …

Objective(s)

: Suppression of viral replication in patients on antiretroviral therapy (ART) is determined by plasma viral load (pVL) measurement. Whenever pVL reaches values below the limit of quantification, the qualitative parameter ’target detected’ or ’target not detected’ is available but often not reported to the clinician. We investigated whether qualitative pVL measurements can be used to estimate the viral reservoir size.

Design:

The study recruited 114 people with HIV (PWH) who are stable on ART between 2016 and 2018. The percentage of pVL measurements qualitatively reported as ’target detected’ (PTD) within a 2-year period was calculated.

Methods:

t-DNA and US-RNA were used to estimate viral reservoir size and were quantified on peripheral blood mononuclear cells (PBMCs) using droplet digital PCR.

Results:

A median of 6.5 pVL measurements over a 2-year period was evaluated for each participant to calculate PTD. A positive correlation was found between t-DNA and PTD (r = 0.24; P = 0.011) but not between US-RNA and PTD (r = 0.1; P = 0.3). A significantly lower PTD was observed in PWH with a small viral reservoir, as estimated by t-DNA less than 66 copies/106 PBMCs and US-RNA less than 10 copies/106 PBMCs, compared with PWH with a larger viral reservoir (P = 0.001). We also show that t-DNA is detectable whenever PTD is higher than 56% and that ART regimen does not affect PTD.

Conclusion:

Our study shows that PTD provides an efficient parameter to preselect participants with a small viral reservoir based on already available pVL data for future HIV cure trials.

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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.

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…

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.

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.

Antimicrobial Agents and Chemotherapy, Ahead of Print. …

Antimicrobial Agents and Chemotherapy, Ahead of Print. …

Antimicrobial Agents and Chemotherapy, Ahead of Print. …

Antimicrobial Agents and Chemotherapy, Ahead of Print. …

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.…

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…