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Objective: In the present research work, we examined the dietary Moringa oleifera effect on gut health and growth traits in chickens. Materials and Methods: There were 280 chicks (day old) that were weighted and allotted uniformly in seven groupings, each containing eight replicates (n = 5). Birds were supplemented with M. oleifera leaf extract (MLE) and seed extract (MSE) for 35 days. Group I was the control (fed merely basal diets), while Group II received 0.8% MLE, Group III was given 0.8% MSE, Group IV was given 1.2% MLE, Group V was given 1.2% MSE, Group VI was given 0.8% MLE + 0.8% MSE, and Group VII was given 1.2% MLE + 1.2% MSE. At the end of the fifth week, two chickens were selected from each replica, and samples (small intestine and ileal ingesta) were collected. Results: The chicken diet with MLE and MSE supplements saw significant improvement (p < 0.05) in both feed conversion ratio (FCR) and body weight gain (BWG). In the small intestine (duodenal, jejunal, and ileal), dietary MLE and MSE supplements significantly increased (p < 0.05) the surface area of the villus and the ratio of their height/crypt depth in comparison to the control group. The MLE and MSE supplements significantly increased (p < 0.05) the total goblet cell counts in the small intestine. The Lactobacillus spp. count was significantly improved (p < 0.05) and reduced (p < 0.05) in Escherichia coli counts when the bird diet was supplemented with MLE (0.8%) and MSE (0.8%). Conclusion: Results indicated that M. oleifera leaf and seed extract diet improved the growth trait and gut health in chickens. [ABSTRACT FROM AUTHOR]

The paper explores empirically the nexus of environmental quality, measured by carbon dioxide (CO2) emissions, and human-health-capital formation, using covariates: real gross domestic product (GDP) per capita, inflation, and unemployment rate. This study uses a health expenditure approach and data from a panel of seven ASEAN countries from 1995 to 2020 within the health production function framework. The method of fully modified ordinary least squares (FMOLS) is implemented to estimate the long-run parameters and the Dumitrescu-Hurlin (Econ Model 29:1450–1460, 2012) test for the direction of causality. The empirical results reveal that high CO2 emissions raise health expenditure as do inflation and unemployment rate. While rising income makes higher healthcare costs affordable, this fact might persuade policymakers to adopt measures to cut CO2 to improve human-health-capital formation and thus to support long-run sustainable economic growth through healthy human capital formation. [ABSTRACT FROM AUTHOR]

Health status of the population is one of the significant indicators of social and economic well-being. Government of India has tried to ensure the highest possible health status of India's population and access to quality health care through a number of policy documents. Improved overall health status and socioeconomic pressures have resulted in changes in the demographic profile. The type of health-care service requirement has changed due to the rise of lifestyle-related diseases and communicable diseases. It is also crucially relevant that maternal and infant mortality continue to remain unacceptably high in several parts of the country. States like Kerala have performed well and "Kerala Model Health System" is often viewed as a rare combination of higher order human development and not so noticeable pattern of consistent exponential economic growth. However, the well-known "Kerala Model Health System" has been facing a crisis due to the demographic transition in Kerala and it is reflected in its patterns of morbidity and hospitalization. Bihar, on the other hand, has low longevity and performs poor in terms of medical and educational facilities, and it has the lowest rates of reported morbidity. At this context, this article tries to assess the socioeconomic determinants of morbidity and hospitalization in the states of Kerala and Bihar. [ABSTRACT FROM AUTHOR]

With unprecedented migration taking place in China, millions of children are profoundly affected. Using a sample of 916 children (aged 5-18) of migrants and the life course perspective, this article examines the impact of parental migration on children's health. Results show that migration has a complex impact on children's health. Although migrating to cities itself does not benefit children, poor housing conditions in cities have a negative impact on their health. The timing of parental migration is important, as preschoolers migrating with parents and teenagers left behind by parents have significantly worse health than others. Migration also has a gendered effect, as teenage boys benefit from migrating to cities but suffer from being left behind when compared to teenage girls. [ABSTRACT FROM AUTHOR]

Objectives: To identify and evaluate intervention studies (ie, experimental study in which the participants undergo some kind of intervention in order to evaluate its impact) that target mental and/or physical health outcomes in women who have experienced stillbirth and to provide specific recommendations for future research and intervention work. Methods: A librarian conducted an initial search using CINAHL, Cochrane Library, PsycInfo, PubMed, SocIndex, and Web of Knowledge in the spring of 2016. Reference mining provided further articles. Articles were eligible if they were: (1) published in English, (2) published in a peer-reviewed journal, (3) published in 1980 or later, (4) an intervention that evaluated (qualitative or quantitative methods) mental and/or physical health, and (5) included women who had experienced a stillbirth (in utero fetal death at ≥20 weeks of gestation). Results: The combined searches produced 2733 articles (including duplicates). After duplicate articles were removed (n = 928), the research team screened the titles, abstracts, and full texts (when necessary) for eligibility (n = 1805). Two articles were identified that met our eligibility criteria. Conclusion for Practice: There is a lack of intervention research in women with stillbirth. It is imperative to develop and implement interventions to improve both mental and physical health in this population, especially in the interconception period (ie, stillbirth aftercare). Future intervention research is needed to determine appropriate support and efficacious delivery of support interventions, feasibility and effectiveness of physical activity interventions and complementary approaches, appropriate timing and dose of interventions, and culturally sensitive interventions appropriate for racial/ethnic minority women with stillbirth. [ABSTRACT FROM AUTHOR]

Background: Adolescents face a range of health problems but many barriers block their access to health services, and in particular to sexual and reproductive health services. The objective of this study was to assess the health needs of adolescents in Ecuador and to draw lessons from the ways the country has responded to their need for differentiated care. Methods: We conducted a literature review and consulted key stakeholders. Results: Adolescents in Ecuador today have a wide range of health care needs, in particular related to sexual and reproductive health. A major concern is the high rates of adolescent pregnancy. A national programme was established in 2007 to offer differentiated health care for adolescents--an effort that featured specially trained staff, enclaved facilities, respect for adolescents' privacy and confidentiality, a friendly atmosphere, and a dedication to establishing trust. It resulted in rapid increases in visits by young persons both for preventive and curative services. In 2011, the government initiated a model for "integrated family and community health care" which led to a disruption of the central support for capacity building and follow-up of adolescent friendly services. Conclusion: The Ecuadorian experience has demonstrated the need for institutionalised differentiated care for adolescents who are facing a wide range of health issues. [ABSTRACT FROM AUTHOR]

Objective: Urban minority girls are at risk for summertime weight gain, and may also experience insufficient summertime sleep. Few studies have objectively measured sleep in this population or examined correlates, including physical activity (PA). This study is the first to objectively describe summertime sleep among urban minority girls.Methods: Data were collected at a community-based summer program that promoted PA (n = 60 girls, ages 10-14 years), at two time points: before beginning programming (T1; unstructured context) and during the final week of programming (T2; structured context).Results: At both time points, participants experienced shorter nighttime sleep than the recommended amount for girls their age. African American girls recorded significantly less sleep than Latina girls in the unstructured context. Findings also suggest that sleep schedules have an influential role in youths' abilities to obtain adequate sleep.Conclusion: Overall, summertime sleep is an understudied health behavior that may be important to consider among minority youth. [ABSTRACT FROM AUTHOR]

Objective: Examine average interindividual and temporal intraindividual associations between time of sleep onset (sleep onset), total sleep time (TST), and minutes in moderate-to-very-vigorous physical activity per hour (MVPA/h) among overweight/obese youth.Methods: Overweight/obese youth (n = 134; 7-12 years) wore an accelerometer for 16+ hr/day, 5-7 days, which provided daily objective estimates of MVPA/h, TST, and sleep onset.Results: Multilevel models revealed an intraindividual effect of TST, such that nights with longer TST preceded less MVPA/h during the midnight-to-midnight monitoring period; a significant random effect qualified this relationship. Average interindividual TST did not predict mean MVPA/h, whereas sleep onset significantly predicted mean MVPA/h.Conclusions: Later time of sleep onset (as opposed to TST) was the strongest predictor of group-level decreased physical activity. At the individual level, longer TST than usual predicted less MVPA/h than usual. Results suggest the need for more person-centered research and a greater focus on sleep timing among youth. [ABSTRACT FROM AUTHOR]

The article presents abstract on medical topics which include, "Subclinical Hyperthyroidism and Mortality," by Tinh-Hai Collet and colleagues, "Interpersonal Discrimination and Health Utility Scores Among Black and White Men and Women in the United States," Janel Hanmer and colleagues, and "Duration of the Risk of VTE in US Medical Patients," by Alpesh Amin and colleagues.

Background: Biological changes underlying the sexual and reproductive maturation of school-age children are linked with various sexual and reproductive health and rights risks. SRHR risks are predictors of poor SRHR outcomes, such as poor knowledge of sexually transmitted diseases and early sexual initiation occurring predominantly among school-age children. The aim of this proposed review, therefore, is to identify educational interventions that have proven to be effective in promoting or supporting the sexual and reproductive health and rights of school-aged children in low- and middle-income countries. Methods: A systematic review of studies on the strategies promoting the SRHR of school-aged children shall be conducted. Electronic searches will be conducted from January 2000 onwards on the following databases: MEDLINE(R) ALL (Ovid), Embase (Ovid), CINAHL (EBSCOHost), APA PsycInfo (Ovid), ERIC (Ovid), Cochrane Central Register of Controlled Trials (Ovid), Education Source (EBSCOHost), Web of Science (Clarivate Analytics), SciELO Citation Index (Clarivate Analytics), Global Health (Ovid), and Sociological Abstract (Proquest). Studies eligible for inclusion will be randomized control trials (RCTs), non-randomized trials, quasi-experimental studies (e.g., pre-post tests), and observational studies (cross-sectional and cohort studies). Peer-reviewed studies published in English and/or French and involving school-aged children 5–10 years old will be included. The primary outcomes of interest will include knowledge, awareness, or attitudes about SRHR topics. The secondary outcomes of interest will include sexual and reproductive behaviors. Two reviewers will independently screen all citations, abstract data, and full-text articles, and the methodological quality of each study will be appraised using JBI critical appraisal tools. A narrative synthesis of extracted data will be conducted. Discussion: The systematic review will synthesize the evidence on existing educational interventions targeting SRHR outcomes of school-aged children in low- and middle-income countries. It will identify which interventions have proven to be effective, and which interventions have not proven to be effective in promoting or supporting their SRHR. Review findings will provide a useful reference for policy-makers, program developers, global health leaders, and decision makers who wish to support the SRHR of school-age children. Systematic review registration: The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO CRD42020173158). [ABSTRACT FROM AUTHOR]

Sexual violence against women is a human rights violation and public health concern, with serious Implications for women's physical and mental health. Reducing non-partner sexual violence, including rape, sexual assault and other forms of non- contact sexual abuse, is one of the main indicators of the sustainable development goals. World Health Organization estimates, based on available prevalence data from 137 countries between 2000 and 2018, showed that, globally, 6% of women aged 15-49 years reported experiencing sexual violence in their lifetime from someone other than an intimate partner, with prevalence rates varying across regions. However, the reporting, measurement and documentation of the global extent of non-partner sexual violence against women is methodologically challenging, resulting in a gross underestimation of its magnitude and impact. To prevent and respond to this issue, policy-makers must consider interventions on education, access to relevant health-care services, public awareness, and effective and comprehensive legislation. To better estimate the prevalence of both sexual violence overall and non-partner sexual violence, it is essential to continue to strengthen the measurement of non-partner sexual violence, including the types of acts asked about and the mode of interviewing. Further research is needed to understand the cumulative impact of different forms of sexual violence on the lives of women and girls, including sexual violence during childhood and its associated risk with further exposure. Funding is required for more research and implementation of interventions to prevent and reduce all forms of violence against women and girls, including sexual violence. Les violences sexuelles a l'egard des femmes constituent une violation des droits humains et un probleme de sante publique qui ont de graves repercussions sur la sante physique et mentale des femmes. La reduction des violences sexuelles qui ne sont pas le fait d'un(e) partenaire, y compris le viol, l'agression sexuelle et d'autres formes d'abus sexuels sans contact, est l'un des principaux indicateurs des objectifs de developpement durable. Selon les estimations de l'Organisation mondiale de la sante, qui se fonde sur les donnees de prevalence disponibles dans 137 pays entre 2000 et 2018, 6% des femmes agees de 15 a 49 ans dans le monde ont declare avoir subi des violences sexuelles au cours de leur vie de la part d'une personne autre qu'un(e) partenaire intime, les taux de prevalence variant d'une region a l'autre. Toutefois, la declaration, la mesure et la documentation de l'ampleur mondiale des violences sexuelles a l'egard des femmes qui n'impliquent pas de partenaire sont difficilement realisables sur le plan methodologique, ce qui entraine une sous-estimation flagrante de leur ampleur et de leur impact. Pour prevenir et pallier ce probleme, les decideurs politiques doivent envisager des interventions dans les domaines de l'education, de l'acces a des soins de sante appropries, de la sensibilisation du public et de l'adoption d'une legislation efficace et complete. Afin de mieux estimer la prevalence des violences sexuelles en general et des violences sexuelles qui ne sont pas le fait d'un(e) partenaire en particulier, il est essentiel de continuer a renforcer la mesure de ce dernier type de violences sexuelles, notamment en ce qui concerne les types d'actes sur lesquels portent les questions et le mode d'interrogation. Des recherches supplementaires s'imposent pour comprendre l'impact cumulatif des differentes formes de violences sexuelles sur la vie des femmes et des filles, y compris les violences sexuelles subies pendant l'enfance et les risques associes a une exposition ulterieure. La recherche sur les interventions visant a empecher et a reduire toutes les formes de violences a l'egard des femmes et des filles, y compris les violences sexuelles, et leur mise en oeuvre doivent etre davantage financees. La violencia sexual contra las mujeres es una violacion de los derechos humanos y un problema de salud publica, con graves consecuencias para la salud fisica y mental de las mujeres. Reducir la violencia sexual fuera de la pareja, incluidas las violaciones, las agresiones sexuales y otras formas de abuso sexual sin contacto, es uno de los principales indicadores de los Objetivos de Desarrollo Sostenible. Las estimaciones de la Organizacion Mundial de la Salud, basadas en los datos de prevalencia disponibles de 137 paises entre 2000 y 2018, mostraron que, a nivel mundial, el 6% de las mujeres de 15 a 49 anos informaron haber sufrido violencia sexual en su vida por parte de alguien que no era su pareja, con tasas de prevalencia que varian segun las regiones. Sin embargo, la presentacion de informes, la medicion y la documentacion del alcance mundial de la violencia sexual contra las mujeres fuera de la pareja es metodologicamente dificil, lo que resulta en una gran subestimacion de su magnitud e impacto. Para prevenir y responder a este problema, los responsables de formular las politicas deben considerar la posibilidad de intervenir en la educacion, el acceso a los servicios sanitarios pertinentes, la concienciacion publica y una legislacion eficaz y exhaustiva. Para estimar mejor la prevalencia tanto de la violencia sexual en general como de la violencia sexual fuera de la pareja, es esencial seguir reforzando la medicion de esta ultima, incluidos los tipos de actos sobre los que se pregunta y el modo de entrevista. Se requiere mas investigacion para comprender el impacto acumulativo de las diferentes formas de violencia sexual en la vida de las mujeres y las ninas, incluida la violencia sexual durante la infancia y su riesgo asociado con una mayor exposicion. Se requiere financiacion para investigar mas e implementar intervenciones que prevengan y reduzcan todas las formas de violencia contra mujeres y ninas, incluida la violencia sexual., Introduction Sexual violence against women is a human rights violation and public health concern worldwide. (1,2) Such violence can occur in many circumstances and settings: within the home, in public [...]

Whooping cough is a highly contagious, acute, respiratory illness caused by Bordetella spp. bacteria, primarily B. pertussis and B. parapertussis, and may be associated with complications such as pneumonia (2,2). [...]

: Introduction: HIV pre‐exposure prophylaxis (PrEP) has been recommended and partly subsidized in Québec, Canada, since 2013. We evaluated the population‐level impact of PrEP on HIV transmission among men who have sex with men (MSM) in Montréal, Québec's largest city, over 2013–2021. Methods: We used an agent‐based mathematical model of sexual HIV transmission to estimate the fraction of HIV acquisitions averted by PrEP compared to a counterfactual scenario without PrEP. The model was calibrated to local MSM survey, surveillance, and cohort data and accounted for COVID‐19 pandemic impacts on sexual activity, HIV prevention, and care. PrEP was modelled from 2013 onwards, assuming 86% individual‐level effectiveness. The PrEP eligibility criteria were: any anal sex unprotected by condoms (past 6 months) and either multiple partnerships (past 6 months) or multiple uses of post‐exposure prophylaxis (lifetime). To assess potential optimization strategies, we modelled hypothetical scenarios prioritizing PrEP to MSM with high sexual activity (≥11 anal sex partners annually) or aged ⩽45 years, increasing coverage to levels achieved in Vancouver, Canada (where PrEP is free‐of‐charge), and improving retention. Results: Over 2013–2021, the estimated annual HIV incidence decreased from 0.4 (90% credible interval [CrI]: 0.3–0.6) to 0.2 (90% CrI: 0.1–0.2) per 100 person‐years. PrEP coverage among HIV‐negative MSM remained low until 2015 ( Conclusions: PrEP reduced population‐level HIV transmission among Montréal MSM. However, our study suggests missed prevention opportunities and adds support for public policies that reduce PrEP barriers, financial or otherwise, to MSM at risk of HIV acquisition., INTRODUCTION After over 20 years under study [1–3] and 10 years of availability [4], oral pre‐exposure prophylaxis (PrEP) has proven highly efficacious for preventing HIV acquisition across transmission routes. Rigorous [...]

: Introduction: Pre‐exposure prophylaxis (PrEP) delivery based on user needs can enhance PrEP access and impact. We examined whether telehealth for daily oral PrEP delivery could change the indicators of care related to prophylactic use in five Brazilian public HIV clinics (testing centres, outpatient clinics and infectious disease hospitals). Methods: Between July 2019 and December 2020, clients on PrEP for at least 6 months could transition to telehealth or stay with in‐person follow‐up. Clients were clinically monitored until June 2021. A desktop or mobile application was developed, comprising three asynchronous consultations and one annual in‐person consultation visit. Predictors influencing telehealth preference and care outcomes were examined. The analysis encompassed intent‐to‐treat (first choice) and adjustments for sexual practices, schooling, age, duration of PrEP use and PrEP status during the choice period. Results: Of 470 users, 52% chose telehealth, with the adjusted odds ratio (aOR) increasing over time for PrEP use (aOR for 25–months of use: 4.90; 95% CI: 1.32–18.25), having discontinued PrEP at the time of the choice (aOR: 2.91; 95% CI: 1.40–6.06) and having health insurance (aOR: 1.91; 95% CI: 1.24–2.94) and decreasing for those who reported higher‐risk behaviour (aOR for unprotected anal sex: 0.51; 95% CI: 0.29–0.88). After an average follow‐up period of 1.6 years (95% CI: 1.5–1.7), the risk of discontinuing PrEP (not having the medication for more than 90 days) was 34% lower with telehealth (adjusted hazard ratio: 0.66; 95% CI: 0.45–0.97). When adjusted by mixed linear regression, no differences in adherence (measured by mean medication possession rate) were found between in‐person and telehealth (p = 0.486) or at pre‐ and post‐telehealth follow‐ups (p = 0.245). Sexually transmitted infections increased between the pre‐follow‐up and post‐follow‐up choices and were not associated with in‐person or telehealth (p = 0.528). No HIV infections were observed. Conclusions: Our findings indicate that telehealth for PrEP delivery can enhance service rationalization and reinforce the prevention cascade. This approach reduces prophylaxis interruptions and is mainly preferred by individuals with lower demands for healthcare services., INTRODUCTION Although pre‐exposure prophylaxis (PrEP) is associated with a reduced HIV incidence [1–4], its low access [5] and inconsistent use over time [6] have compromised its population‐level effectiveness. Telehealth has [...]

Context.--Chordomas are uncommon malignant neoplasms with notochordal differentiation encountered by neuropathologists, bone/soft tissue pathologists, and general surgical pathologists. These lesions most commonly arise in the axial skeleton. Optimal therapy typically involves complete surgical resection, which is often technically difficult owing to the anatomic location, leading to a high rate of recurrence. Lesions have been generally resistant to radiation and chemotherapy; however, experimental studies involving targeted therapy and immunotherapy are currently underway. Objective.--To summarize the clinical and pathologic findings of the various types of chordoma (conventional chordoma, dedifferentiated chordoma, and poorly differentiated chordoma), the differential diagnosis, and recent advances in molecular pathogenesis and therapeutic modalities that are reliant on accurate diagnosis. Data Sources.--Literature review based on PubMed searches containing the term 'chordoma' that address novel targeted and immunomodulatory therapeutic modalities; ongoing clinical trials involved in treating chordoma with novel therapeutic modalities identified through the Chordoma Foundation and ClinicalTrials.gov; and the authors' practice experience combined with various authoritative texts concerning the subject. Conclusions.--Chordoma is a clinically and histologically unique malignant neoplasm, and numerous diagnostic considerations must be excluded to establish the correct diagnosis. Treatment options have largely been centered on surgical excision with marginal results; however, novel therapeutic options including targeted therapy and immunotherapy are promising means to improve prognosis. (Arch Pathol Lab Med. 2022;146:386-395; doi: 10.5858/arpa.2020-0258-RA), The history of notochordal lesions has its origin in 1846, when Virchow observed a small slimy excrescence on the surface of the clivus. He published these findings using the term [...]

Background Acute kidney injury (AKI) is common and it is associated with poor clinical outcomes in premature and low birth weight neonates. This systematic review and meta-analysis was performed to summarize the literature and evaluate the prevalence, risk factors, and mortality of premature and low birth weight neonates with AKI. Methods A systematic search in PubMed, Embase, and the Cochrane Library was performed. Studies on the prevalence, risk factors, diagnosis, and outcomes of acute kidney injury in preterm neonates and neonates with low birth weight were included and analyzed. Results Fifty articles of 10,744 patients were included in this study. The overall rate of AKI from the pooled results of all patients was 25% (95% CI 20-30%) with heterogeneity among studies (I.sup.2 = 97%; P < 0.01). Patients with AKI had significantly higher rate of mortality than patients without AKI (odds ratio (OR) = 7.13; 95% CI 5.91-8.60; P < 0.01). Conclusions AKI was prevalent and was associated with high mortality rate among preterm and low birth weight neonates. Graphical abstract, Author(s): Yang Wu [sup.1] , Haoran Wang [sup.2] , Jiao Pei [sup.3] , Xiaoping Jiang [sup.1] , Jun Tang [sup.4] Author Affiliations: (1) grid.13291.38, 0000 0001 0807 1581, Department of [...]

Introduction: Antiretroviral-based pre-exposure prophylaxis (PrEP) is today an established, effective and safe method of HIV prevention used in multiple countries worldwide by a broad range of populations at risk of HIV infection. Biomedicalinno-vations are criticalin supporting the primary prevention of HIV; however, their potentialcan only be maximized if end-user challenges are recognized, described and used to develop next-generation models. Discussion: First-generation PrEP, a daily oralpill, is highly efficacious, discreet and affords users the ability to commence and conclude treatment rapidly. However, consistent daily adherence and persistence is challenging, especially among younger populations, due in part to side effects, the risk of stock-outs and a lack of pillstorage options. Second-generation PrEP, longer acting agents that require less frequent dosing, could overcome such challenges. Agents that have shown efficacy in clinical trials include a monthly vaginalring and PrEP injectables to be administered every 8 weeks, while products in development include 6 monthly injectables, oral therapy that uses monthly rather than daily pills, implants and the potentialfor long-acting passive immunization. Conclusions: Second-generation PrEP agents will have the potential to offer improved adherence and less frequent reminders once they have undergone further development and the delivery systems that will best support them have been established. In order to pursue globalUNAIDS targets of reducing new HIV infections to fewer than 500,000 annually by 2025, and to ensure that allpeople have access to prevention options that meet their specific prevention needs, both early and next-generation PrEP options are needed. Keywords: pre-exposure prophylaxis; long-acting PrEP; HIV prevention; oral PrEP; injectable PrEP; PrEP implants, 1 | INTRODUCTION We have known for more than a decade that antiretroviral-based pre-exposure prophylaxis (PrEP) provides robust protection against HIV infection in all populations and through allroutes of infection [...]

'When the history of AIDS and the global response is written, our most precious contribution may well be that, at a time of plague, we did not flee, we did [...]

Introduction: Randomized trials of new agents for HIV pre-exposure prophylaxis (PrEP) compare against emtricitabine and tenofovir disoproxil fumarate (F/TDF), without a placebo group. We used the well-characterized adherence-efficacy relationship for F/TDF to back-calculate the (non-PrEP) counterfactual background HIV incidence (bHIV) in a randomized trial of a nove PrEP agent and estimate comparative efficacy (to counterfactual bHIV). Methods: The DISCOVER trial (ClinicalTrials.gov: NCT02842086) randomized 5387 men who have sex with men (MSM) and transgender women who have sex with men and demonstrated non-inferiority of emtricitabine and tenofovir alafenamide (F/TAF) to F/TDF (HIV incidence rate ratio [IRR] 0.47, 95% CI: 0.19 to 1.15). Tenofovir diphosphate (TFV-DP) levels in dried blood spots (DBS) were assessed for all diagnosed with HIV and in a random 10% of the cohort. We used a Bayesian mode with a diffuse prior distribution, derived from established data relating tenofovir diphosphate levels to HIV prevention efficacy. This prior, combined with the F/TDF seroconversion rate and tenofovir diphosphate levels in DISCOVER, yielded Bayesian inferences on the counterfactual bHIV Results: There were six versus 11 postbaseline HIV infections (0.14 vs. 0.25/100 person-years [PY]) on F/TAF and F/TDF respectively. Of the 11 on F/TDF, 10 had low, none had medium and one had high tenofovir diphosphate levels; among HIV-negative controls, 5% of the person-time years had low, 9% had medium and 86% had high TFV-DP levels. A non-informative prior distribution for counterfactual bHIV, combined with the prior for TFV-DP level-efficacy relationship, yielded a posterior counterfactual bHIV of 3.4 infections/100 PY (0.80 Bayesian credible interval [CrI] 1.9 to 5.9), which suggests a median HIV efficacy of 96% (0.95 CrI [88% to 99%]) for F/TAF and 93% (0.95 CrI [87% to 96%]) for F/TDF compared to bHIV. Conclusions: Based on the established connection of drug concentrations to PrEP prevention efficacy, a Bayesian framework can be used to estimate a synthetic non-PrEP control group in randomized, active-controlled PrEP trials that include a F/TDF-comparator group. Keywords: counterfactual; PrEP; clinical trial design; tenofovir alafenamide; tenofovir disoproxil fumarate; Bayesian inference, 1 | INTRODUCTION HIV pre-exposure prophylaxis (PrEP) with oralemtricitabine and tenofovir disoproxil fumarate (F/TDF) is safe and highly effective for HIV prevention, when taken as directed in diverse at-risk populations [...]

Spatiotemporal analysis of high-resolution coronavirus disease (COVID-19) data can help health officials monitor disease spread and target interventions (1,2). Publicly available data have been used to detect COVID-19 spatiotemporal clusters [...]

Introduction: Given the synergistic relationship between HIV and sexually transmitted infections (STI), the integration of services has the potential to reduce the incidence of both HIV and STIs. We explored the extent to which STI testing has been offered within HIV pre-exposure prophylaxis (PrEP) programmes worldwide. Methods: We conducted a systematic review of PrEP programmes implementing STI testing services in nine databases. We approached PrEP implementers for additional unpublished data and implementation details. Descriptive statistics were used to present the characteristics of STI testing within PrEP programmes. Content analysis of the input from PrEP implementers was conducted to summarize the barriers to and facilitators of STI testing. Results: Of 9,161 citations, 91 studies conducted in 32 countries were included: 69% from high-income countries (HICs) and 64% from programmes targeting men who have sex with men (MSM) and transgender women (TGW) only. The majority of programmes (70%, 64/91) conducted STI testing before the initiation of PrEP. The most common STIs tested were gonorrhoea (86%, 78/91), chlamydia (84%, 76/91) and syphilis (84%, 76/91).The majority provided STI testing at three-month intervals (70%, 53/76, for syphilis; 70% 53/78, for chlamydia; 68%, 53/78, for gonorrhoea). Relative to low- and middle-income countries (LMICs), a higher proportion of PrEP programmes in HICs offered testing for gonorrhoea (92% vs. 71%, p < 0.05), chlamydia (92% vs. 64%, p < 0.01), syphilis (87% vs. 75%, p < 0.05), hepatitis A (18% vs. 4%, p < 0.05) and hepatitis C (43% vs. 21%, p < 0.05); offered testing for a higher number of STIs (mean 3.75 vs. 3.04, p < 0.05); and offered triple (throat, genital/urine and anorectal) anatomical site screening (54% vs. 18%, p < 0.001). Common implementation challenges included costs, access to STI diagnostics, programme logistics of integrating STI testing into PrEP delivery models and lack of capacity building for staff involved in PrEP provision. Conclusions: Significant gaps and challenges remain in the provision of STI testing services within HIV PrEP programmes. We recommend more active integration of STI testing and management into PrEP programmes, supported by standardized practice guidelines, staff capacity building training and adequate funding. This could lead to improved sexual health and HIV outcomes in key populations. Keywords: sexually transmitted infections; HIV; pre-exposure prophylaxis; sexual health; STI testing; systematic review, 1 | INTRODUCTION Pre-exposure prophylaxis (PrEP) is a safe and effective approach to prevent HIV infection when adherence is high [1-4]. PrEP was first approved for use as an HIV [...]

: Introduction: HIV pre‐exposure prophylaxis (PrEP) has been government subsidized in Australia since April 2018 and while uptake is high among men who have sex with men, rates of discontinuation are also high. The aims of this study were to examine the impact of discontinuation on overall PrEP usage, the proportion of PrEP users who discontinue and the predictors of discontinuation. Methods: We used linked de‐identified dispensing records of all government subsidized PrEP in Australia between April 2018 and September 2021: a whole‐of‐population data set. Defining discontinuation as 180 days or more without PrEP after the final dispensed supply, we calculated the number of people who discontinued at each 6‐month interval during the study period, the proportion who had discontinued 2 years after the first supply and, using Cox regression, predictors of discontinuation. Results: Of 49,164 people dispensed PrEP (98.5% male, median age 34 years), 40.3% (19,815) had discontinued by September 2021. Within 2 years of their first supply, 11,150 (37.7%) of 29,549 PrEP users had discontinued, including 10.0% after a single dispensed supply. Large variations were observed, particularly according to prescriber characteristics: discontinuation was higher among people prescribed PrEP by low caseload (≤10 patients) prescribers (61.2%) than by high caseload (>100 patients) prescribers (31.1%, p5%) prevalence (36.7%, p Conclusions: There are high rates of PrEP discontinuation in Australia and some populations are at increased risk of discontinuation. Strategies are needed to support persistence on PrEP and the re‐starting of PrEP during periods of risk., INTRODUCTION HIV pre‐exposure prophylaxis (PrEP) is highly effective in the prevention of HIV infection [1]. High coverage of PrEP interrupts transmission networks, particularly in settings with high uptake of effective [...]

Introduction: The human immunodeficiency virus 1 (HIV-1) pandemic is characterized by numerous distinct sub-epidemics (clusters) that continually fuel local transmission. The aims of this study were to identify active growing clusters, to understand which factors most influence the transmission dynamics, how these vary between different subtypes and how this information might contribute to effective public health responses. Methods: We used HIV-1 genomic sequence data linked to demographic factors that accounted for approximately 70% of all new HIV-1 notifications in New South Wales (NSW). We assessed differences in transmission cluster dynamics between subtype B and circulating recombinant form 01AE (CRF01AE). Separate phylogenetic trees were estimated using 2919 subtype B and 473 CRF01AE sequences sampled between 2004 and 2018 in combination with global sequence data and NSW-specific clades were classified as clusters, pairs or singletons. Significant differences in demographics between subtypes were assessed with Chi-Square statistics. Results: We identified 104 subtype B and 11 CRF01AE growing clusters containing a maximum of 29 and 11 sequences for subtype B and CRF01AE respectively. We observed a > 2-fold increase in the number of NSW-specific CRF01AE clades over time. Subtype B clusters were associated with individuals reporting men who have sex with men (MSM) as their transmission risk factor, being born in Australia, and being diagnosed during the early stage of infection (p < 0.01). CRF01AE infections clusters were associated with infections among individuals diagnosed during the early stage of infection (p < 0.05) and CRF01AE singletons were more likely to be from infections among individuals reporting heterosexual transmission (p < 0.05). We found six subtype B clusters with an above-average growth rate (>1.5 sequences / 6-months) and which consisted of a majority of infections among MSM. We also found four active growing CRF01AE clusters containing only infections among MSM. Finally, we found 47 subtype B and seven CRF01AE clusters that contained a large gap in time (>1 year) between infections and may be indicative of intermediate transmissions via undiagnosed individuals. Conclusions: The large number of active and growing clusters among MSM are the driving force of the ongoing epidemic in NSW for subtype B and CRF01AE. Keywords: HIV1; transmission cluster; subtype B and CRF01AE; demographic differences; early infections; public health, 1 | INTRODUCTION Australia is at the forefront of successful control of human immunodeficiency virus type 1 (HIV-1) transmission due to rapid and comprehensive public health responses from the beginning [...]

Introduction: Men who have sex with men (MSM) and transgender women (TGW) are at increased risk for acquiring HIV, but there are limited HIV incidence data for these key populations in Africa. Understanding HIV prevalence and incidence provides important context for designing HIV prevention strategies, including pre-exposure prophylaxis (PrEP) programmes. We describe HIV prevalence, awareness of HIV infection, HIV incidence and associated factors for a cohort of MSM and TGW in Cape Town and Port Elizabeth, South Africa. Methods: From 2015 to 2016, MSM and TGW in Cape Town and Port Elizabeth were enrolled and prospectively followed for 12 months, receiving a comprehensive package of HIV prevention services. HIV testing was conducted at baseline and at follow-up visits (targeted for three, six and twelve months). All HIV-negative PrEP-eligible participants were offered PrEP enrolment during the first four months of study participation. We determined HIV prevalence among participants at baseline, and incidence by repeat screening of initially HIV-negative participants with HIV tests at three, six and twelve months. Results: Among 292 participants enrolled, HIV prevalence was high (43%; 95% CI: 38 to 49) and awareness of HIV status was low (50%). The 167 HIV-negative participants who were followed prospectively for 144.7 person-years; nine incident HIV infections were documented. Overall annual incidence was 6.2% (CI: 2.8 to 11.8) and did not differ by city. Annual HIV incidence was significantly higher for younger (18 to 19 years) MSM and TGW (MSM: 21.8% (CI: 1.2 to 100); TGW: 31.0 (CI: 3.7, 111.2)). About half of participants started PrEP during the study; the annual incidence of HIV among 82 (49%) PrEP starters was 3.6% (CI: 0.4, 13.1) and among those who did not start PrEP was 7.8% (CI: 3.1, 16.1). Conclusions: HIV incidence was high among MSM and TGW in the context of receiving a comprehensive package of prevention interventions and offering of PrEP. PrEP uptake was high; the observed incidence of HIV in those who started PrEP was about half the incidence of HIV in those who did not. Future implementation-oriented studies should focus on decisions to start and continue PrEP for those at highest risk, including young MSM. Keywords: HIV; men who have sex with men; sexually transmitted infections; pre-exposure prophylaxis; HIV prevention; cohort studies, 1 | INTRODUCTION HIV disproportionally impacts men who have sex with men (MSM) globally, but data about the impact of HIV in MSM [1] and transgender women (TGW) [2] in [...]

Introduction: The clinical relevance of low-level viraemia (LLV) and virological outcomes among children living with HIV (CLHIV) remains controversial. This study aimed to determine the impact of LLV on virological failure (VF) among Asian CLHIV on first-line combination antiretroviral therapy (cART). Methods: CLHIV aged 14 days, or received treatment and care at sites with a pVL lower limit of detection >50 copies/mL were excluded. LLV was defined as a pVL 50 to 1000 copies/mL, and VF as a single pVL >1000 copies/mL. Baseline was the time of the second pVL < 50 copies/mL. Cox proportional hazards models were performed to assess the association between LLV and VF. Results: From January 2008 to September 2016, 508 CLHIV (55% female) were eligible for the study. At baseline, the median age was 9.6 (IQR: 7.0 to 12.3) years, cART duration was 1.4 (IQR: 1.3 to 1.8) years, 97% of CLHIV were on non-nucleoside reverse transcriptase inhibitor-based regimens, and the median CD4 was 25% (IQR: 20% to 30%). Over a median follow-up time of 6.0 (IQR: 3.1 to 8.9) years from baseline, 86 CLHIV (17%) had ever experienced LLV, of whom 32 (37%) had multiple LLV episodes. Female sex, living in Malaysia (compared to Cambodia), having family members other than biological parents/grandparents as a primary caregiver, and baseline CD4 < 25% increased risk of LLV. Overall, 115 children (23%) developed VF, corresponding to a rate of 4.0 (95%CI: 3.4 to 4.9) per 100 person-years of follow-up (PYFU). VF was greater among children who had ever experienced LLV compared with those who maintained virological suppression throughout the study period (8.9 vs. 3.3 per 100 PYFU; p < 0.001). In multivariable analyses, ever experiencing LLV was associated with increased risk of subsequent VF (adjusted hazard ratio: 3.01; 95%CI: 1.97 to 4.60). Conclusions: LLV increased the risk of subsequent VF among Asian CLHIV who had previously been suppressed on first-line cART. Adherence interventions and additional targeted pVL monitoring may be warranted among children with LLV to facilitate early detection of VF. Keywords: viraemia; viral blip; viral rebound; paediatric; treatment failure; Asia, 1 | INTRODUCTION HIV plasma viral load (pVL) is an important tool to monitor treatment response and assess medication adherence in people living with HIV. One of the primary aims [...]

Introduction: In the Asia-Pacific, pre-exposure prophylaxis (PrEP) is a newly introduced public health intervention for minimizing HIV transmission, the coverage of which has remained limited. The best delivery models and strategies for broadening access of the vulnerable communities are not fully known. This review identified PrEP programmes reported in the Asia-Pacific, which were classified by delivery models and assessed with a healthcare accessibility framework. Methods: We performed a literature search on PubMed and Ovid MEDLINE using relevant search terms, manual searched grey literature by visiting relevant websites, examined reference lists and contacted authors for clarification of included PrEP programmes reported through July 2019. A structured table was used for data extraction and summarizing findings in accordance with the five constructs of approachability, acceptability, availability, affordability and appropriateness grounded in the conceptual framework of Healthcare Accessibility. Results and discussion: This literature search yielded a total of 1308 publications; 119 full texts and abstracts were screened, and 24 publications were included in the review. We identified 11 programmes implemented in seven cities/countries in the Asia-Pacific. A typology of four PrEP delivery models was delineated: (a) fee-based public service model; (b) fee-based community setting model; (c) free public service model; and (d) free community setting model. Overall, the free community setting model was most commonly adopted in the Asia-Pacific, with the strength to boost the capacity of facility and human resources, which enhanced 'approachability', 'availability' and 'acceptability.' The free public service model was characterized by components designed in improving 'approachability,' 'availability' and 'appropriateness,' with attention on equity in accessing PrEP. Among free-based models, long-term affordability both to the government and PrEP users would need to be maximized to increase accessibility. Alongside the need for raising awareness, supportive environments and ensuring timely access were means for enabling the development of a sustainable PrEP service. Conclusion: PrEP programmes could be classified by delivery models through the five constructs of healthcare accessibility. While the coverage of PrEP remains limited in the Asia-Pacific, an evaluation of these models could benchmark best practices, which would in turn allow effective models to be designed. Keywords: pre-exposure prophylaxis; HIV prevention; implementation; delivery model; accessibility; Asia-Pacific, 1 | INTRODUCTION Pre-exposure prophylaxis (PrEP) with coformulated tenofovir/emtricitabine is an intervention for HIV prevention, which could, with high adherence achieve an effectiveness of >90%, as evidenced in many clinical [...]

Introduction: Pre-exposure prophylaxis (PrEP) is highly effective, although PrEP adherence and persistence has been variable during real world implementation. Little is known about missed opportunities to enhance PrEP adherence among individuals who later HIV seroconverted after using PrEP. The goal of this analysis was to identify all HIV infections among individuals who had accessed PrEP in an integrated health system in San Francisco, and to identify potentially intervenable factors that could have prevented HIV infection through in-depth interviews with people who HIV seroconverted after using PrEP. Methods: We identified individuals who initiated PrEP in an integrated safety-net public health system and performed in-depth chart review to determine person-time on and after stopping PrEP over six years. We identified all PrEP seroconversions using the Centers for Disease Control and Prevention's Enhanced HIV/AIDS Reporting System and then calculated HIV incidence while using PrEP and during gaps in use. We then performed in-depth interviews with those who seroconverted. Results: Overall, 986 initiated PrEP across the San Francisco Department of Public Health from July 2012 to November 2018. Data were gathered from 895 person-years on PrEP and 953 after stopping PrEP. The HIV incidence was 7.5-fold higher after stopping PrEP compared to while on PrEP (95% CI 1 to 336). Of the eight individuals who HIV seroconverted; only one was taking PrEP at the time of seroconversion but was using on-demand PrEP inconsistently. All eight agreed to qualitative interviews. Major barriers to PrEP persistence included substance use, mental health and housing loss; difficulty accessing PrEP due to cost, insurance, and the cost and time of medical visits; difficulty weighing PrEP's benefit versus self-perceived risk; and entering a primary partnership. The individual who developed HIV using on-demand PrEP reported confusion about the dosing regimen and which sexual encounters required accompanying PrEP dosing. Conclusions: HIV incidence during gaps in PrEP use was nearly eight-fold higher than while on PrEP in this large cohort in San Francisco. Many individuals who stop PrEP remain at risk of HIV, and participants reported that proactive outreach could potentially have prevented HIV infections. Individuals using non-daily PrEP may require additional education and support in the United States. Keywords: PrEP; HIV seroconversion; Adherence; PrEP persistence; mixed methods; PrEP discontinuation, 1 | INTRODUCTION Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention strategy when taken during periods of HIV risk [1,2]. Although PrEP persistence (sustained PrEP use over time) was [...]

Keywords: Latin America; HIV epidemic; migration; HIV; PrEP in Latin America; ART; HIV testing, According to Joint United Nations Programme on HIV/AIDS (UNAIDS) data, 1,900,000 adults and children were living with HIV in Latin America and the Caribbean in 2018 [1], where overall prevalence [...]

Introduction: Until September 2019, pre-exposure prophylaxis (PrEP) with tenofovir disoproxil/emtricitabine for HIV prevention was not covered by health insurance plans in Germany, and was only available through private prescriptions with self-pay or through informal non-prescription sources. The objective of this study was to investigate the proportion of informal PrEP use among PrEP users and to identify factors of public health relevance that might be associated with informal PrEP use. Methods: We conducted a cross-sectional study recruiting PrEP users independent of their PrEP source. Clients from anonymous community testing checkpoints, users of three dating apps for men who have sex with men residing in Germany and users of a PrEP community website, were recruited to complete a short anonymous online survey. Participants were recruited between 24 July and 3 September 2018. The results were analysed using univariable and multivariable logistic regressions. Results: We recruited 2005 participants currently using PrEP. The median age was 38 years, and 80.3% of the participants identified themselves as male (missing: 19.1%). Overall, 71.6% obtained PrEP through medical services with a private prescription or a clinical trial, and 17.4% obtained PrEP through informal sources (missing: 11.0%). The most common informal sources were ordering online from another country (8.8%), travel abroad (3.6%), and friends (2.5%). Factors associated with informa PrEP use were on demand/intermittent dosing (adjusted OR: 3.5, 95% CI 2.5 to 5.0) and not receiving medical tests during PrEP use (adjusted OR: 3.2, 95% CI 2.0 to 5.2). In addition, informal PrEP users who did not take PrEP daily had a strongly increased risk of starting PrEP without prior medical tests (adjusted stratum-specific OR = 31.7, 95% CI 4.6 to 219.5). Conclusions: Informal PrEP use was associated with a higher risk of not getting tested before and during PrEP use, which could lead to HIV infections resistant to tenofovir and emtricitabine if people with undiagnosed HIV use PrEP. Health insurance plans that cover PrEP and the accompanying routine tests could ensure adequate medical supervision of PrEP users and reduce barriers to PrEP use. Our findings strongly support the implementation of PrEP programmes in countries with similar patterns of informal PrEP use. Keywords: PrEP; men who have sex with men; testing; informal PrEP; non-daily use; affordability, 1 | INTRODUCTION Pre-exposure prophylaxis (PrEP), with tenofovir disoproxil/emtricitabine, has been proven to be highly effective in preventing HIV infections in men who have sex with men (MSM) and other [...]

Introduction: Pre-Exposure Prophylaxis (PrEP) is highly effective in reducing the risk for HIV infection among men who have sex with men (MSM) and may have an important impact in slowing down the HIV epidemic. Concerns remain however about low adherence, increased risk behaviour and reduced condom use when using PrEP. The aim of this study was to assess these factors prospectively among MSM using daily and event-driven PrEP in Belgium. Methods: An open-label prospective cohort study was conducted from October 2017 to May 2018 at the Institute of Tropica Medicine, in Antwerp, Belgium. At enrolment, MSM at high risk for HIV chose between daily or event-driven PrEP. They were allowed to switch regimens or stop taking PrEP at each of their tri-monthly visits. Data were collected on an electronic case report form, web-based diary and self-administered questionnaire. Screening for HIV and other Sexually Transmitted Infections (STIs) was also performed. Results: Two hundred MSM were followed up for a total duration of 318 person-years. At month 18, 75.4% of the participants were on daily and 24.6% were on event-driven PrEP. The mean proportion of covered sex acts by PrEP for the complete follow-up period was 91.5% for all participants, 96.5% for daily and 67.0% for event-driven PrEP use. The number of casua and anonymous sex partners was significantly higher for daily users, as compared with event-driven users, but did not change over time. In contrast, the mean proportion of condomless receptive anal intercourse with casual and anonymous partners increased significantly during follow-up, for both daily and event-driven use (p < 0.0001 for all 4 trends). No new HIV infection was diagnosed during follow-up. The incidence of bacterial STIs was 75.4 per 100 person-years (95% CI 63.8 to 89.1). We did not detect a significant change in N. gonorrhoeae/C. trachomatis incidence over time. The incidence of hepatitis C was 2.9 per 100 person-years. Conclusions: PrEP is an effective and well adopted HIV prevention tool for MSM in Belgium. Participants adapted daily and event-driven regimens to their own needs and were able to adapt their PrEP adherence to risk exposure. Keywords: PrEP; HIV prevention; MSM; Belgium; adherence; STI; event-driven, 1 | INTRODUCTION Pre-Exposure Prophylaxis (PrEP) using daily oral tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) is highly effective in reducing the risk for HIV infection among men who have sex [...]

Objective To generate estimates of the global prevalence and incidence of urogenital infection with chlamydia, gonorrhoea, trichomoniasis and syphilis in women and men, aged 15-49 years, in 2016. Methods For chlamydia, gonorrhoea and trichomoniasis, we systematically searched for studies conducted between 2009 and 2016 reporting prevalence. We also consulted regional experts. To generate estimates, we used Bayesian meta-analysis. For syphilis, we aggregated the national estimates generated by using Spectrum-STI. Findings For chlamydia, gonorrhoea and/or trichomoniasis, 130 studies were eligible. For syphilis, the Spectrum-STI database contained 978 data points for the same period. The 2016 global prevalence estimates in women were: chlamydia 3.8% (95% uncertainty interval, UI: 3.3-4.5); gonorrhoea 0.9% (95% UI: 0.7-1.1); trichomoniasis 5.3% (95% UI:4.0-7.2); and syphilis 0.5% (95% UI: 0.4-0.6). In men prevalence estimates were: chlamydia 2.7% (95% UI: 1.9-3.7); gonorrhoea 0.7% (95% UI: 0.5-1.1); trichomoniasis 0.6% (95% UI: 0.4- 0.9); and syphilis 0.5% (95% UI: 0.4-0.6). Total estimated incident cases were 376.4 million: 127.2 million (95% UI: 95.1-165.9 million) chlamydia cases; 86.9 million (95% UI: 58.6-123.4 million) gonorrhoea cases; 156.0 million (95% UI: 103.4-231.2 million) trichomoniasis cases; and 6.3 million (95% UI: 5.5-7.1 million) syphilis cases. Conclusion Global estimates of prevalence and incidence of these four curable sexually transmitted infections remain high. The study highlights the need to expand data collection efforts at country level and provides an initial baseline for monitoring progress of the World Health Organization global health sector strategy on sexually transmitted infections 2016-2021. Objectif Produire des estimations de la prevalence et de l'incidence mondiales des infections urogenitales dues a la chlamydiose, a la gonorrhee, a la trichomonase et a la syphilis chez les femmes et les hommes de 15 a 49 ans, en 2016. Methodes Pour la chlamydiose, la gonorrhee et la trichomonase, nous avons systematiquement recherche les etudes menees entre 2009 et 2016 qui s'interessaient a la prevalence. Nous avons egalement consulte des experts regionaux. Pour produire des estimations, nous avons eu recours a une meta-analyse bayesienne. Pour la syphilis, nous avons regroupe les estimations nationales obtenues a l'aide de Spectrum-STI. Resultats Pour la chlamydiose, la gonorrhee et/ou la trichomonase, 130 etudes etaient eligibles. Pour la syphilis, la base de donnees de Spectrum-STI contenait 978 points de donnees pour la periode consideree. Les estimations de la prevalence mondiale en 2016 chez les femmes etaient les suivantes: chlamydiose 3,8% (intervalle d'incertitude de 95%, II: 3,3-4,5); gonorrhee 0,9% (II 95%: 0,7-1,1); trichomonase 5,3% (II 95%: 4,0-7,2); et syphilis 0,5% (II 95%: 0,4-0,6). Chez les hommes, les estimations de la prevalence etaient les suivantes: chlamydiose 2,7% (II 95%: 1,9-3,7); gonorrhee 0,7% (II 95%: 0,5-1,1); trichomonase 0,6% (II 95%: 0,4-0,9); et syphilis 0,5% (II 95%: 0,4-0,6). Lincidence totale estimee etait de 376,4 millions de cas: 127,2 millions (II 95%: 95,1-165,9 millions) de cas de chlamydiose; 86,9 millions (II 95%: 58,6-123,4 millions) de cas de gonorrhee; 156,0 millions (II 95%: 103,4-231,2 millions) de cas de trichomonase; et 6,3 millions (II 95%: 5,5-7,1 millions) de cas de syphilis. Conclusion Les estimations mondiales de la prevalence et de l'incidence de ces quatre infections sexuellement transmissibles guerissables restent elevees. Cette etude souligne la necessite d'amplifier les efforts de collecte de donnees au niveau des pays et offre un point de reference pour suivre la progression de la Strategie mondiale du secteur de la sante contre les 1ST2016-2021 de l'Organisation mondiale de la Sante. Objetivo Generar estimaciones de la prevalencia y la incidencia mundiales de la infeccion urogenital por clamidia, gonorrea, tricomoniasis y sifilis en mujeres y hombres de 15 a 49 anos de edad en 2016. Metodos Para la clamidia, la gonorrea y la tricomoniasis, se realizaron busquedas sistematicas de estudios realizados entre 2009 y 2016 que registrasen la prevalencia. Tambien se consulto a expertos regionales. Para generar estimaciones, se utilizo el metanalisis bayesiano. Para la sifilis, se anadieron las estimaciones nacionales generadas por el uso de Spectrum-STI. Resultados Para la clamidia, la gonorrea y/o la tricomoniasis, hubo 130 estudios que cumplian los criterios. Para la sifilis, la base de datos Spectrum-STI contenia 978 puntos de datos para el mismo periodo. Las estimaciones de prevalencia mundial en mujeres en 2016 fueron: clamidia 3,8 % (intervalo de incertidumbre, II, del 95 %: 3,3-4,5); gonorrea 0,9 % (II del 95 %: 0,7-1,1); tricomoniasis 5,3 % (II del 95 %: 4,0-7,2); y sifilis 0,5 % (II del 95 %: 0,4-0,6). Las estimaciones de prevalencia en hombres fueron: clamidia 2,7 % (intervalo de incertidumbre, II, del 95 %: 1,9-3,7); gonorrea 0,7 % (II del 95 %: 0,5-1,1); tricomoniasis 0,6 % (II del 95 %: 0,4-0,9); y sifilis 0,5 % (II del 95 %: 0,4-0,6). El total estimado de casos incidentes fue de 376,4 millones: 127,2 millones (II del 95 %: 95,1-165,9 millones) de casos de clamidia; 86,9 millones (II del 95 %: 58,6-123,4 millones) de casos de gonorrea; 156,0 millones (II del 95 %: 103,4-231,2 millones) de casos de tricomoniasis; y 6,3 millones (II del 95 %: 5,5-7,1 millones) de casos de sifilis. Conclusion Las estimaciones mundiales de la prevalencia y la incidencia de estas cuatro enfermedades de transmision sexual curables siguen siendo elevadas. El estudio destaca la necesidad de ampliar los esfuerzos de recopilacion de datos a nivel nacional y proporciona una base inicial para el seguimiento de los progresos de la Estrategia Mundial del Sector de la Salud de la Organizacion Mundial de la Salud sobre las ETS entre 2016 y 2021. [phrase omitted], Introduction Sexually transmitted infections are among the most common communicable conditions and affect the health and lives of people worldwide. The World Health Organization (WHO) periodically generates estimates to gauge [...]

Introduction: Recommendations on the optimal frequency of plasma viral load (pVL) monitoring in children living with HIV (CLWH) who are stable on combination antiretroviral therapy (cART) are inconsistent. This study aimed to determine the impact of annual versus semi-annual pVL monitoring on treatment outcomes in Asian CLWH. Methods: Data on children with perinatally acquired HIV aged 1.5 tests/patient/year. Treatment failure was defined as virologic failure (two consecutive pVL >1000 copies/mL), change of antiretroviral drug class, or death. Baseline was the date of the second consecutive pVL Results: During January 2008 to March 2015, there were 1220 eligible children from 10 sites that performed at least annua pVL monitoring, 1042 (85%) and 178 (15%) were from sites performing annual (n = 6) and semi-annual pVL monitoring (n = 4) respectively. Pre-cART, 675 children (55%) had World Health Organization clinical stage 3 or 4, the median nadir CD4 percentage was 9%, and the median pVL was 5.2 [log.sub.10] copies/mL. At baseline, the median age was 9.2 years, 64% were on nevirapine-based regimens, the median cART duration was 1.6 years, and the median CD4 percentage was 26%. Over the follow-up period, 258 (25%) CLWH with annual and 40 (23%) with semi-annual pVL monitoring developed treatment failure, corresponding to incidence rates of 5.4 (95% CI: 4.8 to 6.1) and 4.3 (95% CI: 3.1 to 5.8) per 100 patient-years of follow-up respectively (p = 0.27). In multivariable analyses, the frequency of pVL monitoring was not associated with treatment failure (adjusted hazard ratio: 1.12; 95% CI: 0.80 to 1.59). Conclusions: Annual compared to semi-annual pVL monitoring was not associated with an increased risk of treatment failure in our cohort of virally suppressed children with perinatally acquired HIV on first-line NNRTI-based cART. Keywords: antiretroviral treatment; viral load; monitoring; paediatric; treatment failure; Asia, 1 INTRODUCTION In 2017, there were an estimated 1.8 million children younger than 15 years of age living with HIV (CLWH) worldwide, of whom 110,000 were in the Asia-Pacific region [...]

Introduction: Discontinuations of HIV preexposure prophylaxis (PrEP) by at-risk individuals could decrease the effectiveness of PrEP Our objective was to characterize patterns of, reasons for, and clinical outcomes associated with PrEP discontinuations in primary care. Methods: We conducted medical chart reviews for patients prescribed PrEP during 2011 to 2014 at a Boston community health centre specializing in healthcare for sexual and gender minorities. Patients were followed through 2015. We characterized patients' sociodemographics, relationship status, behavioural health conditions, patterns of and reasons for PrEP discontinuations, and HIV seroconversions. Cox proportional hazards models were used to assess patient factors associated with PrEP discontinuations. Results: Of the 663 patients prescribed PrEP, the median age was 33 years, 96% were men who have sex with men (MSM) and 73% were non-Hispanic white; 40% were in committed relationships and 15% had HIV-infected partners. Patients either used PrEP continuously (60%), had 1 or more discontinuations (36%), or did not initiate PrEP (4%). Discontinuations were most often due to a decrease in HIV risk perception (33%), non-adherence to care plans (16%), or insurance barriers (12%). Of the 7 (1.1%) PrEP patients diagnosed with HIV, 1 was HIV-infected at baseline, 2 seroconverted while using PrEP, and 4 seroconverted after discontinuations. In a multivariable model adjusted for race/ethnicity, relationship status, substance use disorders, and insurance status, those who were less than 30 years old (aHR 2.0, 95% CI 1.4 to 2.9 for ages 18 to 24, aHR 2.2, 95% CI 1.6 to 3.1 for ages 25 to 29, vs. ages 30 to 39 years), who identified as transgender women (aHR 2.0, 95% CI 1.2 to 3.4, vs. cisgender men), and who had mental health disorders (aHR 1.2, 95% CI 1.1 to 1.4 for each additional disorder) were more likely to have discontinuations. Conclusions: Discontinuations of PrEP use among this American sample of predominately MSM were common, particularly among patients who were younger, identified as transgender women, or had behavioural health issues. As HIV seroconversions occurred after discontinuations of PrEP, strategies to prevent inappropriate discontinuations are needed. Keywords: HIV; PrEP; primary care; discontinuations; adherence; community health center; men who have sex with men, 1 | INTRODUCTION As there are nearly 40,000 new HIV infections each year in the US [1], there is a need to implement and optimize effective HIV-prevention strategies. Randomized-controlled studies [...]

Introduction: A significant body of research exists on the impact of the social determinants of health (SDoHs) on diabetes care and general health outcomes. However, less is known about health care practitioners' (HCPs') perspectives and experiences regarding the impact of the SDoHs on their patients with Type I and Type 2 diabetes mellitus and how this affects the prevention and treatment of hypoglycemia. Method: A descriptive qualitative study, derived from the InHypo-DM (Canada) research program. A purposive sampling technique was used to recruit participants residing in southwestern Ontario, Canada, for a 30- to 45-min semistructured interview. Individual and team analysis of interviews was conducted to identify overarching and subthemes. Twenty HCP participants, including endocrinologists, family physicians, and allied health care practitioners, were recruited. Seven were Certified Diabetes Educators. Results: Participants articulated 2 overarching components of the SDoHs: patients' socioeconomic issues and psychosocial issues. They highlighted two socioeconomic issues: occupation type and poverty. Participants also emphasized 3 areas pertaining to patients' psychosocial issues: stage in the life cycle (e.g., elderly), social isolation, and mental health. Discussion: This study emphasizes the need for conducting detailed and comprehensive social histories during clinical diabetes assessments, as well as the necessity of adequate clinical time and resources for HCPs and patients to address these issues in the context of hypoglycemia management.Keywords: hypoglycemia, diabetes mellitus, social determinants of health, health care practitioners, qualitative research, Evidence suggests that traditional approaches to glycemic management that focus solely on blood glucose targets are insufficient at reducing rates of hypoglycemia (Goodall & Halford, 1991; Peyrot et al., 2005). [...]