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The ancient disease cholera remains a major public health threat in countries lacking safe drinking water, optimal sanitation, and preventive hygiene practices (1). In Haiti, which had not had a [...]

Introduction: Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) globalproject. Methods: Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if Results: A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from 7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts Conclusions: Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood. Keywords: adolescent; CD4; cohort studies; growth; HIV; perinatally acquired Additional information may be found under the Supporting Information tab of this article., 1 | INTRODUCTION In 2019, an estimated 1.7 million adolescents aged 10-19 years were living with HIV worldwide, with 90% of them in sub-Saharan Africa, and 8% in Asia and [...]

Background Same-day HIV testing and antiretroviral therapy (ART) initiation is being widely implemented. However, the optimal timing of ART among patients with tuberculosis (TB) symptoms is unknown. We hypothesized that same-day treatment (TB treatment for those diagnosed with TB; ART for those not diagnosed with TB) would be superior to standard care in this population. Methods and findings We conducted an open-label trial among adults with TB symptoms at initial HIV diagnosis at GHESKIO in Haiti; participants were recruited and randomized on the same day. Participants were randomized in a 1:1 ratio to same-day treatment (same-day TB testing with same-day TB treatment if TB diagnosed; same-day ART if TB not diagnosed) versus standard care (initiating TB treatment within 7 days and delaying ART to day 7 if TB not diagnosed). In both groups, ART was initiated 2 weeks after TB treatment. The primary outcome was retention in care with 48-week HIV-1 RNA Conclusions In patients with TB symptoms at HIV diagnosis, we found that same-day treatment was not associated with superior retention and viral suppression. In this study, a short delay in ART initiation did not appear to compromise outcomes. Trial registration This study is registered with ClinicalTrials.gov NCT03154320., Author(s): Nancy Dorvil 1, Vanessa R. Rivera 1, Cynthia Riviere 1, Richard Berman 2, Patrice Severe 1, Heejung Bang 3, Kerlyne Lavoile 1, Jessy G. Devieux 4, Mikerlyne Faustin 1, [...]

Background In 2018 the World Health Organization recommended a switch to an all oral bedaquiline-based second-line regimen for treatment of drug-resistant tuberculosis (DR-TB). How these new second-line regimens fare in comparison to first-line regimens for treatment of drug-sensitive tuberculosis (DS-TB) is not well known. Methods In this study, we contemporaneously enrolled subjects with DS-TB (n = 31) or DR-TB (n = 23) and assessed their response to therapy with first-line (rifampin, isoniazid, ethambutol, pyrazinamide) or second-line (bedaquiline, pyrazinamide, levofloxacin, linezolid, clofazimine) regimens, respectively. Results We found that the early bactericidal activity of first- and second-line regimens was similar during the first 2 weeks of therapy as determined by BACTEC MGIT, colony-forming units, and a liquid limiting dilution assay capable of detecting differentially detectable/culturable Mycobacterium tuberculosis. Furthermore, an identical percentage (77.8%) of subjects from the DS-TB and DR-TB cohorts converted to culture negative after 2 months of therapy. Conclusions Despite presenting with more advanced disease at time of treatment, subjects with DR-TB receiving an all oral bedaquiline-based second-line treatment regimen displayed a similar microbiological response to therapy as subjects with DS-TB receiving a first-line treatment regimen. [ABSTRACT FROM AUTHOR]

Background The World Health Organization recommends initiating same-day antiretroviral therapy (ART) while tuberculosis (TB) testing is under way for patients with non-meningitic symptoms at HIV diagnosis, though safety data are limited. C-reactive protein (CRP) testing may improve TB risk stratification in this population. Methods In this baseline analysis of 498 adults (>18 years) with TB symptoms at HIV diagnosis who were enrolled in a trial of rapid ART initiation in Haiti, we describe test characteristics of varying CRP thresholds in the diagnosis of TB. We also assessed predictors of high CRP as a continuous variable using generalized linear models. Results Eighty-seven (17.5%) participants were diagnosed with baseline TB. The median CRP was 33.0 mg/L (interquartile range: 5.1, 85.5) in those with TB, and 2.6 mg/L (interquartile range: 0.8, 11.7) in those without TB. As the CRP threshold increased from ≥1 mg/L to ≥10 mg/L, the positive predictive value for TB increased from 22.4% to 35.4% and negative predictive value decreased from 96.9% to 92.3%. With CRP thresholds varying from <1 to <10 mg/L, a range from 25.5% to 64.9% of the cohort would have been eligible for same-day ART and 0.8% to 5.0% would have untreated TB at ART initiation. Conclusions CRP concentrations can be used to improve TB risk stratification, facilitating same-day decisions about ART initiation. Depending on the CRP threshold, one-quarter to two-thirds of patients could be eligible for same-day ART, with a reduction of 3- to 20-fold in the proportion with untreated TB, compared with a strategy of same-day ART while awaiting TB test results. [ABSTRACT FROM AUTHOR]

Problem In 2010, Haiti sustained a devastating earthquake that crippled the health-care infrastructure in the capital city, Port-au-Prince, and left 1.5 million people homeless. Subsequently, there was an Increase in reported tuberculosis in the affected population. Approach We conducted active tuberculosis case finding in a camp for internally displaced persons and a nearby slum. Community health workers screened for tuberculosis at the household level. People with persistent cough were referred to a physician. The National Tuberculosis Program continued its national tuberculosis reporting system. Local setting Even before the earthquake, Haiti had the highest tuberculosis incidence in the Americas. About half of the tuberculosis cases occur in the Port-au-Prince region. Relevant changes The number of reported tuberculosis cases in Haiti has increased after the earthquake, but data are too limited to determine if this is due to an increase in tuberculosis burden or to improved case detection. Compared to previous national estimates (230 per 100000 population), undiagnosed tuberculosis was threefold higher in a camp for internally displaced persons (693 per 100000) and fivefold higher in an urban slum (1165 per 100000). With funding from the World Health Organization (WHO), active case finding is now being done systematically in slums and camps. Lessons learnt Household-level screening for prolonged cough was effective in identifying patients with active tuberculosis in this study. Without accurate data, early detection of rising tuberculosis rates is challenging; data collection should be incorporated into pragmatic disease response programmes. Probleme En 2010, Haiti a ete frappe par un seisme devastateur qui a ebranle les infrastructures sanitaires de la capitale, Port-au-Prince, et laisse 1,5 millions de personnes sans abri. On a par la suite observe une augmentation des cas de tuberculose recenses dans la population concernee. Approche Nous avons mene une recherche active des cas de tuberculose dans un camp de personnes deplacees ainsi que dans un bidonville voisin. Les agents de sante communautaires ont recherche les cas de tuberculose dans les foyers. Les personnes qui presentaient une toux persistante ont ete orientees vers un medecin. Le systeme national de signalement des cas de tuberculose a ete maintenu, dans le cadre du programme national de lutte contre la tuberculose. Environnement local Deja avant le seisme, Haiti presentait la plus forte incidence de tuberculose d'Amerlque. Pres de la moitie des cas de tuberculose sont recenses dans la region de Port-au-Prince. Changements significatifs Le nombre de cas de tuberculose signales en Haiti a augmente depuis le seisme, mais les donnees limitees ne permettent pas de determiner si cela est du a une augmentation de la charge de la maladie ou a une amelioration du depistage. Compares aux precedentes estimations nationales (230 cas pour 100 000 personnes), les cas de tuberculose non diagnostiques etalent trois fois plus importants dans le camp de personnes deplacees (693 cas pour 100 000 personnes) et cinq fois plus dans le bidonville (1165 cas pour 100 000 personnes). Grace a un financement de reorganisation mondiale de la Sante, un depistage actifest desormais effectue systematiquement dans les camps et les bidonvilles. Lecons tirees Dans cette etude, la recherche d'une toux prolongee dans les foyers a permis d'identifier les patients atteints de tuberculose active. Sans donnees predses, il est difficile de detecter precocement une augmentation du taux de tuberculose; un travail de collecte de donnees devrait etre integre aux programmes pratiques de reponse aux maladies. Problema En 2010, Haiti sufrio un devastadorterremoto que movilizo a toda la infraestructura sanitaria para socorrer a la capital, Puerto Principe, y dejo a 1,5 millones de personas sin hogar. Ademas, se produjo un aumento de los casos de tuberculosis notificados entre la poblacion afectada. Enfoque Se llevaron a cabo detecciones de casos activos de tuberculosis en un campamento para personas desplazadas de la ciudad y en un barrio pobre cercano. Los agentes de salud comunitarios investigaron los casos de tuberculosis a nivel domestico. Las personas con tos persistente fueron derivadas a un medico. El programa nacional contra la tuberculosis continuo su sistema nacional de informes sobre la tuberculosis. Contexto local Incluso antes del terremoto, Haiti tenia el mayor numero de casos de tuberculosis de todo el continente americano. Alrededor de la mitad de los casos de tuberculosis se encontraba en la region de Puerto Principe. Cambios pertinentes El numero de casos registrados de tuberculosis en Haiti aumento tras el terremoto, aunque no existen los suficientes datos para determinar si este suceso se debe a un aumento de la carga de tuberculosis o a un mejor sistema de deteccion de casos. En comparacion con los calculos nacionales (230 de cada 100.000 personas), la tuberculosis sin diagnosticar era el triple en un campamento para personas desplazadas de la dudad (693 de cada 100.000 personas) y cinco veces mayor en el barrio pobre urbano (1.165 de cada 100.000 personas). Con fondos de la Organizacion Mundial de la Salud, actualmente se realiza una busqueda de casos activos de forma sistematica en barrios pobres y campamentos. Leccion aprendida La busqueda a nivel domestico de tos persistente resulto eficaz a la hora de identificar a pacientes con tuberculosis activa en este estudio. Sin datos precisos, la deteccion temprana de mayores tasas de tuberculosis supone todo un reto. Los datos recogidos se incorporaran a programas de respuesta pragmatica contra enfermedades., Introduction On January 12, 2010, Haiti sustained a devastating earthquake. Total damages are estimated at 7.8 billion United States dollars, more than 120% of the country's 2009 gross domestic product. [...]

A randomized clinical trial in Haiti was conducted determine if early initiation of antiretroviral therapy, as compared with the standard timing for the initiation of therapy improves survival. Early initiation of antiretroviral therapy was observed to decrease the rates of death and incident tuberculosis hence access to antiretroviral therapy should be expanded to include all HIV-infected adults who have CD4+ T-cell counts of less than 350 per cubic millimeter, including those who live in areas with limited resources.

After an initial wave of coronavirus disease 2019 (COVID-19) in Haiti in summer 2020 (primarily lineage B.1), seropositivity for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) was ~40%. Variant P.1 (gamma) was introduced in February 2021, with an initially limited introduction followed by exponential local dissemination within this unvaccinated population with prior exposure to earlier SARS-CoV-2 lineages. [ABSTRACT FROM AUTHOR]

Objective To assess outcomes after antiretroviral therapy (ART) in adolescents and youth in Haiti, a country with a generalized epidemic of infection with HIV-1. Methods An assessment was made of survival, plasma HIV-1 ribonucleic acid (RNA) concentrations and HIV-1 drug resistance patterns after 12 months of ART in patients aged 13-25 years who presented to a clinic in Port-au-Prince, Haiti, with AIDS between 1 March 2003 and 31 December 2005. Participants received ART in accordance with WHO guidelines. Kaplan-Meier analysis was used to estimate survival probabilities and their 95% confidence intervals (Cl) for the period from ART initiation to death. Findings Of a total of 146 patients, 96 (66%) were female; the median CD4+ T-cell count at baseline was 129 cells/ml. By Kaplan-Meier analysis, 13% of the patients had died at 12 months, 17% at 24 months and 20% at 36 months. A plasma HIV-1 RNA concentration [greater than or equal to] 50 copies/ml was seen in 40 (51%) of 79 patients 12 months after treatment initiation and was associated. with poor ART adherence. Among 29 patients with > 1000 copies/ml at 12 months, resistance mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs) were detected in 23 cases (79%); to both NNRTIs and lamivudine in 21 (72%) cases; and to NNRTIs, lamivudine and other nucleoside reverse transcriptase inhibitors in 10 (35%) cases. One hundred and six participants (73%) reported sexual intercourse without condoms, and 35 of the 96 women (36%) were pregnant during follow-up. Conclusion Adolescents and youth with AIDS receiving ART are at risk of virologic failure and disease progression and can therefore transmit HIV-1 to sexual partners and infants. Strategies to target the special needs of this age group are urgently needed. Objectif Evaluer les issues du traitement antiretroviral (ART) chez des adolescents et des jeunes vivant en Haiti, pays victime d&apos;une epidemie generalisee de VIH-1. Methodes On a effectue une evaluation de la survie, du taux d&apos;acide ribonucleique (ARN) VIH-1 plasmatique et des schemas de pharmacoresistance du VIH-1 apres 12 mois de traitement ART chez des jeunes individus de 13 a 25 ans atteints de sida, accueillis dans un dispensaire de Port-au-Prince entre le ler mars 2003 et le 31 decembre 2005. Les sujets de l&apos;etude ont recu des antiretroviraux conformement aux recommandations de I&apos;OMS. On a utilise une analyse de Kaplan-Meier pour estimer les probabilites de survie et les intervalles de confiance a 95 % (IC) correspondants pour la periode allant du debut du traitement ART au deces des sujets. Resultats Sur les 146 malades, 96 (66 %) etaient des femmes ; la valeur mediane de reference pour la numeration des lymphocytes CD4+ etait de 129 cellules/ml. L&apos;analyse de Kaplan-Meier a montre que 13 % des malades etaient decedes au bout de 12 mois, 17 % au bout de 24 mois et 20 % au bout de 36 mois. On a releve une concentration d&apos;ARN VIH-1 plasmatique [greater than or equal to] 50 copies/ml chez 40 malades sur 79 (51%), 12 mois apres le debut du traitement, en association avec une mauvaise observance therapeutique. Chez 29 malades presentant plus de 1000 copies/mi au bout de 12 mois, on a detecte des mutations de resistance aux inhibiteurs non-nucleosidiques de la transcriptase inverse (NNRTI) dans 23 cas (79 %) ; a la fois aux NNRTI et a la lamivudine dans 21 cas (72 %) ; et aux NNRTI, a la lamivudine et a des inhibiteurs nucleosidiques de la transcriptase inverse dans 10 cas (35 %). Cent six participants ont rapporte avoir eu des rapports sexuels non proteges et 35 des 96 femmes (36 %) etaient enceintes pendant le suivi. Conclusion Les adolescents et les jeunes atteints de sida qui recoivent un traitement ART courent un risque d&apos;echec virologique et de progression de la maladie et peuvent donc transmettre le VIH-1 a leurs partenaires sexuels et le cas echeant a leur enfant a natre. Il est urgent de disposer de strategies permettant de cibler les besoins specifiques de cette tranche d&apos;ages. Objetivo Evaluar los resultados dei tratamiento antirretroviral (TAR) en adolescentes y adultos jovenes en Haiti, pais que sufre una epidemia generalizada de infeccion por VIH-1. Metodos Se hizo una evaluacion de la supervivencia, las concentraciones plasmaticas de acido ribonucleico (ARN) de VIH-1 y el perfil de farmacorresistencia del VIH-1 a los 12 meses de iniciada la TAR en pacientes de 13 a 25 anos que acudieron a un consultorio de Puerto Principe, Haiti, con SIDA entre el 1 de marzo de 2003 y el 31 de diciembre de 2005. Los participantes recibieron TAR con arreglo a las directrices de la OMS. Se utilizo el metodo de Kaplan-Meier para estimar las probabilidades de supervivencia y sus intervalos de confianza (IC) dei 95% para el periodo transcurrido entre el inicio dei TAR y la defuncion. Resultados De un total de 146 pacientes, 96 (66%) eran mujeres; la mediana dei recuento de linfocitos T CD4+ al comienzo dei estudio fue de 129 celulas/ml. Segun el analisis de KaplanMeier, el 13% de los pacientes habian muerto a los 12 meses, el 17% a los 24 meses, y el 20% a los 36 meses. En 40 de 79 pacientes (51%) se detecto una concentracion plasmatica de ARN de VIH-1 [greater than or equal to] 50 copias/ml a los 12 meses de iniciado el tratamiento, asociada a un escaso cumplimiento dei TAR. Entre los 29 pacientes con mas de 1000 copias/ml a los 12 meses, se detectaron mutaciones de resistencia a los inhibidores no nucleosidos de la transcriptasa inversa (NNRTI) en 23 casos (79%); tanto a los NNRTI como a la lamivudina en 21 casos (72%); y a los NNRTI, la lamivudina y otros inhibidores nucleosidos de la transcriptasa inversa en 10 casos (35%). En total, 106 participantes (73%) declararon que habian mantenido relaciones sexuales sin preservativo, y 35 de las 96 mujeres (36%) se encontraban embarazadas durante el seguimiento. Conclusion Los adolescentes y adultos jovenes con SIDA sometidos a TAR presentan un riesgo especial de fracaso virologico y de progresion de la enfermedad y pueden por consiguiente transmitir el VIH-1 a su pareja y a los lactantes. Se requieren urgentemente estrategias que aborden las necesidades especiales de ese grupo de edad., Introduction AIDS is the leading cause of death in adolescents and youth aged 13-25 years in sub-Saharan Africa and Caribbean countries that have generalized epidemics of infection with HIV-1. (1-3) [...]

The efficacy of antiretroviral therapy in the first 1004 consecutive patients with AIDS and without previous antiretroviral therapy who were treated beginning in March 2003 in Port-au-Prince, Haiti are studied. This report documents the feasibility of effective antiretroviral therapy in a large number of patients in an impoverished country.

The current study was conducted in Port au Prince, Haiti, to determine if information collected at HIV notification during voluntary counseling and testing (VCT) can predict patients' future adherence with risk reduction counseling and medical referral. Case histories describe HIV-infected patients with signs of depression during counseling who do not return for medical care, and women afraid of economic ruin and domestic violence who do not notify their sexual partners. Quantitative predictors of seeking medical care include: denial at the announcement of HIV test results (odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-0.6), belief that HIV can be transmitted by magic (OR 0.6, 95% CI 0.3-0.9), and having symptoms at the time of HIV testing (OR 1.9, 95% CI 1.6-2.3). Predictors of refusal to notify sexual partner of HIV status include: being poor (OR 1.8, 95% CI 1.1-2.5), female (OR 2.1, 95% CI 1.7-2.5), and belief that HIV can be transmitted by magic (OR 2.3, 95% CI 1.9-2.6) In conclusion, information collected during HIV counseling and testing can predict patients' future adherence with counseling and medical referral. Counselors can use information such as signs of severe depression, economic hardship, and denial of HIV disease to identify patients at risk for nonadherence and to provide them with specialized counseling and care.

There is a critical need to deliver empirically validated interventions to underserved populations. Haiti, the country most heavily affected by the AIDS epidemic in the Caribbean, accounts for approximately 50% of all cases in the region. Poverty, disparities in access to healthcare, and socio-political instability are among the reasons why the country has been ravaged by the disease. Ongoing projects in Haiti have shown that integrated prevention and care in resource poor settings are feasible and can be successful, as evidenced by a 50% drop in incidence among pregnant women since 1993. The AIDS prevention program has embarked on a comprehensive effort to culturally adapt a cognitive-behavioral stress management program for Haitian HIV+ individuals. The purpose of the program is to improve adherence to antiretroviral medication, reduce transmission to uninfected partners, and improve coping. This comprehensive approach is necessary to ensure the validity of the cross-cultural adaptation of this intervention. Key Words: Haiti, HIV, Cultural adaptation, CBSM, Adherence., Unlike North and Latin America, where the rates of HIV/AIDS have either been reduced or have leveled off, the Caribbean remains the only region in the Western Hemisphere with steadily [...]

Introduction: Long‐term survival of HIV patients after initiating highly active antiretroviral therapy (ART) has not been sufficiently described in Latin America and the Caribbean, as compared to other regions. The aim of this study was to describe the incidence of mortality, loss to follow‐up (LTFU) and associated risk factors for patients enrolled in the Caribbean, Central and South America Network (CCASAnet). Methods: We assessed time from ART initiation (baseline) to death or LTFU between 2000 and 2014 among ART‐naïve adults (≥18 years) from sites in seven countries included in CCASAnet: Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru. Kaplan‐Meier techniques were used to estimate the probability of mortality over time. Risk factors for death were assessed using Cox regression models stratified by site and adjusted for sex, baseline age, nadir pre‐ART CD4 count, calendar year of ART initiation, clinical AIDS at baseline and type of ART regimen. Results: A total of 16,996 ART initiators were followed for a median of 3.5 years (interquartile range (IQR): 1.6–6.2). The median age at ART initiation was 36 years (IQR: 30–44), subjects were predominantly male (63%), median CD4 count was 156 cells/µL (IQR: 60–251) and 26% of subjects had clinical AIDS prior to starting ART. Initial ART regimens were predominantly non‐nucleoside reverse transcriptase inhibitor based (86%). The cumulative incidence of LTFU five years after ART initiation was 18.2% (95% confidence interval (CI) 17.5–18.8%). A total of 1582 (9.3%) subjects died; the estimated probability of death one, three and five years after ART initiation was 5.4, 8.3 and 10.3%, respectively. The estimated five‐year mortality probability varied substantially across sites, from 3.5 to 14.0%. Risk factors for death were clinical AIDS at baseline (adjusted hazard ratio (HR)=1.65 (95% CI 1.47–1.87); p Conclusions: In this large, long‐term study of mortality among HIV‐positive adults initiating ART in Latin America and the Caribbean, overall estimates of mortality were heterogeneous, generally falling between those reported in high‐income countries and sub‐Saharan Africa., Introduction The HIV epidemic in Latin America and the Caribbean is unique but under‐studied. In 2013, the World Health Organization (WHO) estimated that 1.5 million (1.2–1.9 million) people were living [...]

Background: People living with HIV (PLWH) are at increased risk of cardiovascular disease (CVD) and death, with greater burdens of both HIV and CVD in lower-middle income countries. Treating prehypertension in PLWH may reduce progression to hypertension, CVD risk and potentially mortality. However, no trial has evaluated earlier blood pressure treatment for PLWH. We propose a randomized controlled trial to assess the feasibility, benefits, and risks of initiating antihypertensive treatment among PLWH with prehypertension, comparing prehypertension treatment to standard of care following current WHO guidelines. Methods: A total of 250 adults 18–65 years and living with HIV (PLWH) with viral suppression in the past 12 months, who have prehypertension will be randomized to prehypertension treatment versus standard of care. Prehypertension is defined as having a systolic blood pressure (SBP) 120–139 mmHg or diastolic blood pressure (DBP) 80–89 mmHg. In the prehypertension treatment arm, participants will initiate amlodipine 5 mg daily immediately. In the standard of care arm, participants will initiate amlodipine only if they develop hypertension defined as SBP ≥ 140 mmHg or DBP ≥ 90 mmHg. The primary outcome is the difference in mean change of SBP from enrollment to 12 months. Secondary outcomes include feasibility, acceptability, adverse effects, HIV viral suppression, and medication adherence. Qualitative in-depth interviews with providers and participants will explore attitudes about initiating amlodipine, satisfaction, perceived CVD risk, and implementation challenges. Discussion: PLWH have a higher CVD risk and may benefit from a lower BP threshold for initiation of antihypertensive treatment. Trial registration: Clinicaltrials.gov registration number NCT04692467, registration date December 15, 2020, protocol ID 20–03021735. [ABSTRACT FROM AUTHOR]

Objectives: To assess the success of a human papillomavirus (HPV) vaccination program among adolescent girls aged 9–14 years in Haiti and to understand predictors of completion of a two-dose HPV vaccination series. Methods: Data collection was conducted during HPV vaccination campaigns in Port-au-Prince between August 2016 and April 2017. Descriptive statistics and logistic regression models were used to examine characteristics associated with vaccination series completion of school based and non-school based vaccination delivery modalities. Results: Of the 2,445 adolescent girls who participated in the awareness program, 1,994 participants (1,307 in non-school program, 687 in school program) received the first dose of the vaccine; 1,199 (92%) in the non-school program and 673 (98%) in the school program also received the second dose. Menarche (OR: 1.87; 95% CI, 1.11–3.14), if the participant was a prior patient at the GHESKIO clinics (OR: 2.17; 95% CI, 1.32–3.58), and participating in the school-based program (OR: 4.17; 95% CI, 2.14–8.12) were significantly associated with vaccination completion. Conclusions: Vaccination in school- and non-school-based settings was successful, suggesting that a nationwide HPV vaccination campaign using either approach would be successful using either approach. [ABSTRACT FROM AUTHOR]

Objectives: Tuberculosis (TB) is the leading infectious cause of death in the world. Multi-drug resistant TB (MDR-TB) is a major public health problem as treatment is long, costly, and associated to poor outcomes. Here, we report epidemiological data on the prevalence of drug-resistant TB in Haiti. Methods: This cross-sectional prevalence study was conducted in five health centers across Haiti. Adult, microbiologically confirmed pulmonary TB patients were included. Molecular genotyping (rpoB gene sequencing and spoligotyping) and phenotypic drug susceptibility testing were used to characterize rifampin-resistant MTB isolates detected by Xpert MTB/RIF. Results: Between April 2016 and February 2018, 2,777 patients were diagnosed with pulmonary TB by Xpert MTB/RIF screening and positive MTB cultures. A total of 74 (2.7%) patients were infected by a drug-resistant (DR-TB) M. tuberculosis strain. Overall HIV prevalence was 14.1%. Patients with HIV infection were at a significantly higher risk for infection with DR-TB strains compared to pan-susceptible strains (28.4% vs. 13.7%, adjusted odds ratio 2.6, 95% confidence interval 1.5–4.4, P = 0.001). Among the detected DR-TB strains, T1 (29.3%), LAM9 (13.3%), and H3 (10.7%) were the most frequent clades. In comparison with previous spoligotypes studies with data collected in 2000–2002 and in 2008–2009 on both sensitive and resistant strains of TB in Haiti, we observed a significant increase in the prevalence of the drug-resistant MTB Spoligo-International-Types (SIT) 137 (X2 clade: 8.1% vs. 0.3% in 2000–02 and 0.9% in 2008–09, p<0.001), 5 (T1 clade: 6.8% vs 1.9 in 2000–02 and 1.7% in 2008–09, P = 0.034) and 455 (T1 clade: 5.4% vs 1.6% and 1.1%, P = 0.029). Newly detected spoligotypes (SIT 6, 7, 373, 909 and 1624) were also recorded. Conclusion: This study describes the genotypic and phenotypic characteristics of DR-TB strains circulating in Haiti from April 2016 to February 2018. Newly detected MTB clades harboring multi-drug resistance patterns among the Haitian population as well as the higher risk of MDR-TB infection in HIV-positive people highlights the epidemiological relevance of these surveillance data. The importance of detecting RIF-resistant patients, as proxy for MDR-TB in peripheral sites via molecular techniques, is particularly important to provide adequate patient case management, prevent the transmission of resistant strains in the community and to contribute to the surveillance of resistant strains. [ABSTRACT FROM AUTHOR]

While stigma associated with human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) is well recognized, there remains relatively limited intervention data on effective stigma reduction strategies. This systematic review was conducted to highlight the mechanisms through which sexual and HIV stigma is reduced in relation to HIV prevention and care engagement. Search of PubMed and Scopus resulted in 11 tested interventions to include in our preliminary model constructed from programme frameworks and recommendations. We refined the preliminary programme theory to identify whether, why, or how mitigation strategies produce observed outcomes. Our review showed that the interventions produced stigma reduction through three groups of mechanisms: (1) Self-acceptance, leadership, and motivational activation for behaviour change from intrapersonal strategies, such as education and mobile health strategies, which intervene on internalized and anticipated stigma; (2) socialization, knowledge sharing, and social empowerment from interpersonal strategies, such as peer support and training for care providers; and (3) community introspection, self-reflection, and humanistic activation from structural strategies such as community leaders' sensitization, which intervene on both anticipated and enacted stigma. Interventions mechanisms act complementarily and can be activated in different contexts in which MSM exposed to and infected with HIV are living. [ABSTRACT FROM AUTHOR]

Background Improving knowledge regarding Streptococcus pneumoniae distribution in pneumonia cases is important to better target preventive and curative measures. The objective was to describe S. pneumoniae serotypes in children with or without pneumonia Methods It was a case-control study carried out in 8 developing and emerging countries between 2010 and 2014. Cases were children aged <5 years admitted to the hospital for pneumonia. Controls were children admitted for surgery or routine outpatient care. Results In nasopharyngeal samples, S. pneumoniae were detected in 68.2% of the cases and 47.5% of the controls (P <.001). Nasopharyngeal carriage was associated with a higher risk of being a case in 6/8 study sites (adjusted odds ratio ranged from 0.71 [95% confidence interval [CI],.39–1.29; P =.26] in India [Pune/Vadu] to 11.86 [95% CI, 5.77–24.41; P <.001] in Mongolia). The 13-valent pneumococcal conjugate vaccine (PCV13) serotypes were more frequently detected in cases with nasopharyngeal carriage (67.1%) than in controls with nasopharyngeal carriage (54.6%), P <.001. Streptococcus pneumoniae was detected in blood by polymerase chain reaction in 8.3% of the cases. Of 34 cases with an S. pneumoniae serotype detected in blood, 27 (79%) had the same serotype in the nasopharyngeal sample. Conclusions The results confirm the assumption that the isolate carrying or causing disease in an individual is of the same serotype. Most serotypes independently associated with nasopharyngeal carriage or pneumonia are covered by PCV13, suggesting that increased PCV coverage would reduce the burden of S. pneumoniae –related pneumonia. [ABSTRACT FROM AUTHOR]