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Objective. To develop a tool that measures levels of adherence to antiretroviral treatment (ART) in resource-poor settings, based on a combination of four methods for measuring adherence. Methods. Retrospective review of 500 medical records of people living with HIV, randomly selected from October 2017 to January 2020. Adherence to ART was measured by combining four measurement methods (coverage of prescribed ART, ART picked up at pharmacies, viral load, and self-reported adherence). Chi-squared tests were performed with p<0.05 for statistically significant differences and logistic binary regression to identify the probability of optimal and suboptimal adherence. Spearman tests were performed for correlation of categories, and Cronbach's alpha was used to measure the internal consistency of the tool. Results. We obtained 497 adherence scores. Of these, 307 (61.8%) users qualified as adherent, 141 (28.4%) as semi-adherent, and 49 (9.8%) as non-adherent. A higher probability of optimal adherence was found in groups aged 60 years and older (odds ratio [OR]: 1.6; CI95%: 0.8-3.5), with no difference between men and women (OR: 0.9; CI95%: 0.7-1.4). Spearman's test reported a relationship (r = 0.8) between viral load levels and final score, and Cronbach's alpha yielded modest internal consistency (α = 0.7). Conclusions. A tool was developed to measure adherence to ART in a resource-poor environment. The tool shows modest levels of internal consistency and a strong correlation between viral load and adherence. [ABSTRACT FROM AUTHOR]

The article describes the epidemiological and clinical features of visceral leishmaniasis (VL) cases presented to the three VL treatment centres in Somalia. Topics covered include paromomycin provided by the Drugs for Neglected Diseases initiative in 2015 to implement combination therapy as the first-line treatment, the use of place of residence as a proxy for place of infection, and sodium stilbogluconate as the drug most commonly used in single regimen treatment.

Objective. To determine and describe the prevalence and patterns of three recommended practices for infant and young child feeding—exclusive breastfeeding (EB), continued breastfeeding (CB), and achievement of minimum dietary diversity—in four regions in Haiti, and to identify the attitudes and beliefs that inform these practices and any other factors that may facilitate or impede their implementation. Methods. This study utilized a mixed-methods approach consisting of 1) a cross-sectional survey (n = 310) and 2) 12 focus group discussions among women ≥ 18 years old with children ≤ 2 years old. Multivariable logistic regression analyses were conducted to identify factors associated with 1) EB during the first six months of life, 2) CB for children ≥ 2 years old, and 3) receipt of a diverse variety of complementary foods. Qualitative data were recorded, transcribed verbatim, and analyzed for common themes. Data were collected in June and July 2013 in four departments in Haiti: Artibonite, Nippes, Ouest, and Sud-Est. Results. Prevalence of EB, CB, and achievement of minimum dietary diversity was 57.0%, 11.9%, and 21.2% respectively. EB was statistically significantly associated with infant's age when controlling for annual household income, location of most recent birth, or receipt of CB counseling (odds ratio (OR) = 0.67 (95% CI: 0.47-0.97)). CB was not statistically significantly associated with rural place of residence, receipt of CB counseling, parity, or infant's age. Meeting minimum dietary diversity was not significantly associated with parity, receipt of postnatal care, rural place of residence, location of most recent birth, receipt of infant and young child feeding counseling, or level of schooling. Beliefs surrounding the relationship between the mother's health and her diet on the quality of breast milk may prohibit EB and CB. Qualitative data revealed that dietary diversity may be low because 1) mothers often struggle to introduce complementary foods and 2) those that are traditionally introduced are not varied and primarily consist of grains and starches. Conclusions. Prevalence of the three recommended infant and young child feeding practices examined in this study is suboptimal, particularly CB and achievement of minimum dietary diversity. Future communication and programming efforts should address the misunderstandings and concerns identified through the qualitative methods used in this research. [ABSTRACT FROM AUTHOR]

Objective. To identify socio-demographic, behavioral, and health-related correlates of food preferences in Puerto Rico that will help determine Caribbean-region populations vulnerable to nutrition transition. Methods. Data from a cross-sectional study of a representative sample of 858 adults residing in the San Juan Metropolitan Area of Puerto Rico were analyzed. Multivariable ordinal logistic regressions were used to model the frequency of consumption of 1) fruits and vegetables, 2) tubers/starchy root vegetables, 3) fried foods, and 4) Western-style fast foods as a function of socio-demographic, behavioral, and health-related characteristics. Results. Higher frequency of consumption of fruits and vegetables was associated with being physically active and older and having a medium to high level of education, whereas intake of tubers was associated with being older, having a low income, not using government insurance, and having elevated levels of triglycerides. Frequency of consumption of fast food was associated with younger age, higher income, 12-15 years of formal education, and a higher body mass index (BMI), whereas frequency of consumption of fried food was associated with being younger and male, not being a smoker, and having elevated levels of fasting blood glucose. Conclusions. The results indicate a nutrition transition in Puerto Rico with health consequences for the Caribbean region. The characteristics of this nutrition transition seem to be determined by income, education, and age, but may also be dictated by access to various food groups. These results set the stage for needed investigation of environmental and individual-level factors that could shape patterns in food consumption. [ABSTRACT FROM AUTHOR]

Objective. To examine whether a radio-education intervention (REI) is associated with improved maternal knowledge of pregnancy danger signs (PDS) in Nicaragua. Methods. This cross-sectional pilot study used pretests and posttests to evaluate whether an REI was associated with improved knowledge of PDS among 77 pregnant and postpartum women in Nicaragua. Results. The total number of PDS identified by study participants increased from 130 before the intervention to 200 after the intervention, an increase of 53.8% (Wilcoxon signed- rank test (z) = -4.18; P < 0.00001). The three PDS for which participant knowledge increased significantly after the intervention were 1) swelling of the face and hands, 2) convulsions, and 3) vaginal bleeding. Participants who 1) reported having a sister who had experienced a pregnancy complication, 2) lived in an urban setting, and 3) had more than a sixth-grade education were significantly more likely to score higher on posttests related to knowledge of PDS than those without those attributes (90.9% versus 56.9% [ Χ 2 (degrees of freedom) = 4.60 (1); P = 0.043; n = 76]; 75% versus 45.9% [ Χ 2 = 6.8 (1); P = 0.009; n = 77]; and 62.5% (12+ years education) versus 79.3% (6-12 years) versus 50.0% (0-6 years education) versus 25.0% (no education) [ Χ 2 = 8.11 (1); P = 0.044; n = 77] respectively). Conclusions. Exposure to the REI was associated with a significant increase in the ability to identify PDS. Further studies should establish whether this increase in knowledge of PDS is associated with increases in use of maternity care services and decreases in delays in seeking care. [ABSTRACT FROM AUTHOR]

Objective. Violence in post-conflict Guatemala has serious public health consequences for the population. The objective of this study was to assess the relationship between violence and social capital. Methods. Data from a cross-sectional victimization survey conducted in 2008-2010 in Guatemala were analyzed. Two-stage proportionate sampling was used in the survey. House - holds ( n = 1 300) were randomly sampled within a random sample of communities ( n = 118) in five administrative departments. The survey collected information on the six-month violence exposure of 6 335 individuals. Social capital was measured at the household level using the short version of the Adapted Social Capital Tool (SASCAT). The odds ratio for household violence exposure was estimated using multiple logistic regression. Community-level data from the latest national census were included as explanatory factors at the community level. Income, ethnicity, and social capital were included at the household level. Data were analyzed using SPSS 18.0. Results. In total, 2.7% of individuals and 11.7% of households had been exposed to violence within the past six months. The multivariate analysis showed that 1) structural social capital (in this case, the level of participation in social networks and civil society) was a risk factor for violence and 2) cognitive social capital (measured as trust, norms, and sense of belonging) was a protective factor for violence. Conclusions. The opposite direction of the association between violence and structural and cognitive social capital challenges the use of social capital as a unified concept. If this finding is corroborated by other studies, structural and cognitive social capital will have to be treated as two distinctly different concepts. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa remains a common cause of wound infections. Different studies have shown that the entrapment of plant-derived materials in liposomes could increase their antibacterial activity against Pseudomonas aeruginosa. The aim of this study was to prepare cyanidinum chloride-loaded liposomes and evaluate their in vitro and in vivo efficacy against a resistant strain of Pseudomonas aeruginosa ATCC 15692. Cyanidinum chloride-loaded liposomes were prepared by extrusion method. The minimum inhibitory concentrations of cyanidinum chloride in the free and liposomal forms against Pseudomonas aeruginosa ATCC 15692 were determined in vitro by broth dilution method. The in vitro killing rates for free and liposomal cyanidinum chloride were analyzed. Ultimately, the in vivo therapeutic efficacy of the prepared liposomes in mice skin infected by ATCC 15692 was investigated. The minimum inhibitory concentrations of the free and liposomal forms of cyanidinum chloride against ATCC 15692 were 1.5 x 10-3 and 7.7 x 10-4 M, respectively. In vivo treatment with the free and cyanidinum chloride-loaded liposomes resulted in almost 40 and 100% survival rates, respectively. Our results showed that cyanidinum chlorideloaded liposomes would be a good choice for the treatment of wound infection caused by Pseudomonas aeruginosa because of their high effectiveness. [ABSTRACT FROM AUTHOR]

Objective. To compare distributions of human rights violations and disease risk; to juxtapose these patterns against demographic and structural environmental variables, and to formulate implications for structural interventions. Methods. Female sex workers who inject drugs were surveyed in Tijuana and Ciudad Juarez, Mexico. Structured interviews and testing for sexually transmitted infections (STIs) were conducted (October 2008 to October 2009). Frequencies of individual and environmental factors, including police abuse, risk of HIV infection, and protective behaviors, were compared between sites using univariate logistic regression. Results. Of 624 women, almost half reported police syringe confiscation despite syringes being legal; 55.6% reported extortion (past 6 months), with significantly higher proportions in Ciudad Juarez (P < 0.001). Reports of recent solicitation of sexual favors (28.5% in Tijuana, 36.5% in Ciudad Juarez, P = 0.04) and sexual abuse (15.7% in Tijuana, 18.3% in Ciudad Juarez) by police were commonplace. Prevalence of STIs was significantly lower in Tijuana than in Ciudad Juarez (64.2% and 83.4%, P < 0.001), paralleling the lower prevalence of sexual risk behaviors there. Ciudad Juarez respondents reported significantly higher median number of monthly clients (6.8 versus 1.5, P < 0.001) and lower median pay per sex act (US$ 10 versus US$ 20, P < 0.001) (in the past month). Relative to Tijuana, security deployment, especially the army's presence, was perceived to have increased more in Ciudad Juarez in the past year (72.1% versus 59.2%, P = 0.001). Conclusions. Collateral damage from police practices in the context of Mexico's drug conflict may affect public health in the Northern Border Region. Itinerant officers may facilitate disease spread beyond the region. The urgency for mounting structural interventions is discussed. [ABSTRACT FROM AUTHOR]

The aerial parts of the species Ageratina pichinchensis, popularly known as "axihuitl", have been empirically used in Mexico for wound-healing purposes. The evaluation of an extract from A. pichinchensis (in an in vivo model) demonstrated its capacity to reduce, in a significant manner, the time required for wound healing in rodent skin. This same extract showed (in vitro) a capacity of encouraging proliferation of normal human fetal lung fibroblasts (MRC-5). This study's objective was to evaluate, in a clinical trial, the effectiveness and tolerability of the topical administration of a product elaborated with the standardized extract from the aerial parts of A. pichinchensis in patients with chronic venous leg ulcers, and to compare the effect with a control group treated with 7% propylene glycol alginate. In this study, a total of 34 patients were included (50% in each group). Six patients of the control group withdrew from the treatment, three of these because of lack of recovery. In the experimental group, 2 participants withdrew from the study, but none of these due to treatment or clinical-evolution reasons. The A. pichinchensis extract showed therapeutic effectiveness in one hundred percent of the patients treated with it, while the control treatment achieved this condition in 81.8% of the control group patients. Ulcer size reduction resulted significantly higher (p < 0.010) in the group of patients administered the experimental treatment, which allows us to assure that the A. pichinchensis standardized extract is effective in the treatment of chronic venous leg ulcers and, compared with the 7% propylene glycol alginate formula, achieves a significant reduction of the time required for the ulcers to heal. [ABSTRACT FROM AUTHOR]

Objective. To assess human immunodeficiency virus (HIV) diversity and the prevalence of transmitted drug resistance (TDR) in Guatemala. Methods. One hundred forty-five antiretroviral treatment-naïve patients referred to the Roosevelt Hospital in Guatemala City were enrolled from October 2010 to March 2011. Plasma HIV pol sequences were obtained and TDR was assessed with the Stanford algorithm and the World Health Organization (WHO) TDR surveillance mutation list. Results. HIV subtype B was highly prevalent in Guatemala (96.6%, 140/145), and a 2.8% (4/145) prevalence of BF1 recombinants and 0.7% (1/145) prevalence of subtype C viruses were found. TDR prevalence for the study period was 8.3% (12/145) with the Stanford database algorithm (score > 15) and the WHO TDR surveillance mutation list. Most TDR cases were associated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) (83.3%, 10/12); a low prevalence of nucleoside reverse transcriptase inhibitors and protease inhibitors was observed in the cohort (< 1% for both families). Low selection of antiretroviral drug resistance mutations was found, except for NNRTI-associated mutations. Major NNRTI mutations such as K101E, K103N, and E138K showed higher frequencies than expected in ART-naïve populations. Higher literacy was associated with a greater risk of TDR (odds ratio 4.14, P = 0.0264). Conclusions. This study represents one of the first efforts to describe HIV diversity and TDR prevalence and trends in Guatemala. TDR prevalence in Guatemala was at the intermediate level. Most TDR cases were associated with NNRTIs. Further and continuous TDR surveillance is necessary to gain more in-depth knowledge about TDR spread and trends in Guatemala and to optimize treatment outcomes in the country. [ABSTRACT FROM AUTHOR]