Search

Background Home-based human immunodeficiency virus (HIV) testing and education has increased HIV test uptake and access to health services among men. We studied how a home-based antenatal intervention influenced male partner utilization of clinic-based HIV and sexually transmitted infection (STI) services, linkage to HIV care and medical circumcision. Methods We conducted a secondary analysis within a randomized controlled trial of pregnant women attending antenatal care in Kenya. Women and their male partners received either a home-based couple intervention or an invitation letter for clinic-based couple HIV testing. The home-based intervention included education on STI symptoms, STI and HIV treatment and male circumcision for HIV prevention. Male self-reported outcomes were compared using relative risks at 6 months postpartum. Results Among 525 women, we reached 487 (93%) of their male partners; 247 men in the intervention arm and 240 men in the control arm. Men who received the intervention were more likely to report an STI consultation (n = 47 vs. 16; relative risk, 1.59; 95% confidence interval, 1.33-1.89). Among 23 men with newly diagnosed HIV, linkage to HIV care was reported by 4 of 15 in the intervention (3 men had missing linkage data) and 3 of 5 men in the control arms (relative risk, 0.66; 95% confidence interval, 0.34-1.29). Although the intervention identified 3 times more men with new HIV infection, the study lacked power to find significant differences in linkage to HIV care. Few eligible men sought medical circumcision (4 of 72 intervention and 2 of 88 control). Conclusions Home-based couple education and testing increased STI consultations among male partners of pregnant women, but appeared insufficient to overcome the barriers involved in linkage to HIV care and medical circumcision.

Current farm systems rely on the use of Plant Protection Products (PPP) to secure high productivity and control threats to the quality of the crops. However, PPP use may have considerable impacts on human health and the environment. A study protocol is presented aiming to determine the occurrence and levels of PPP residues in plants (crops), animals (livestock), humans and other non-target species (ecosystem representatives) for exposure modelling and impact assessment. To achieve this, we designed a cross-sectional study to compare conventional and organic farm systems across Europe. Environmental and biological samples were/are being/will be collected during the 2021 growing season, at 10 case study sites in Europe covering a range of climate zones and crops. An additional study site in Argentina will inform the impact of PPP use on growing soybean which is an important European protein-source in animal feed. We will study the impact of PPP mixtures using an integrated risk assessment methodology. The fate of PPP in environmental media (soil, water and air) and in the homes of farmers will be monitored. This will be complemented by biomonitoring to estimate PPP uptake by humans and farm animals (cow, goat, sheep and chicken), and by collection of samples from non-target species (earthworms, fish, aquatic and terrestrial macroinvertebrates, bats, and farm cats). We will use data on PPP residues in environmental and biological matrices to estimate exposures by modelling. These exposure estimates together with health and toxicity data will be used to predict the impact of PPP use on environment, plant, animal and human health. The outcome of this study will then be integrated with socio-economic information leading to an overall assessment used to identify transition pathways towards more sustainable plant protection and inform decision makers, practitioners and other stakeholders regarding farming practices and land use policy. EEA Balcarce Fil: Silva, Vera. Wageningen University and Research. Soil Physics and Land Management Group; Países Bajos. Fil: Alaoui, Abdallah. University of Bern. Institute of Geography. Centre for Development and Environment; Suiza. Fil: Schlünssen, Vivi. Aarhus University. Department of Public Health; Dinamarca. National Research Centre for the Working Environment; Dinamarca. Fil: Vested, Anne. Aarhus University. Department of Public Health; Dinamarca. Fil: Graumans, Martien. Radboud Institute for Health Sciences; Países Bajos. Fil: Van Dael, Maurice. Radboud Institute for Health Sciences; Países Bajos. Fil: Trevisan, Marco. Università Cattolica del Sacro Cuore. Department for Sustainable Food Process; Italia. Fil: Suciu, Nicoleta. Università Cattolica del Sacro Cuore. Department for Sustainable Food Process; Italia. Fil: Mol, Hans. Wageningen University and Research. Wageningen Food Safety Research; Países Bajos. Fil: Beekmann, Karsten. Wageningen University and Research. Wageningen Food Safety Research; Países Bajos. Fil: Figueiredo, Daniel. Utrecht University. Institute for Risk Assessment Sciences; Países Bajos. Fil: Harkes, Paula. Wageningen University and Research. Soil Physics and Land Management Group; Países Bajos. Fil: Hofman, Jakub. Masaryk University. Faculty of Science. Research Centre for Toxic Compounds in the Environment; Republica Checa. Fil: Kandeler, Ellen. University of Hohenheim. Institute of Soil Science and Land Evaluation; Alemania. Fil: Abrantes, Nelson. University of Aveiro. Centre for Environmental and Marine Studies and Department of Environment and Planning; Portugal. Fil: Campos, Isabel. University of Aveiro. Centre for Environmental and Marine Studies and Department of Environment and Planning; Portugal. Fil: Martínez, María Ángeles. Centro de Investigaciones Energéticas, Medioambientales y Tecnológicas; España. Fil: Pereira, Joana Luísa. Centre for Environmental and Marine Studies and Department of Environment and Planning; Portugal. Fil: Goossens, Dirk. Wageningen University and Research. Soil Physics and Land Management Group. Países Bajos. KU Leuven Department of Earth and Environmental Sciences; Belgica. Fil: Gandrass, Juergen. Institute of Coastal Environmental Chemistry; Alemania. Fil: Debler, Freya. Institute of Coastal Environmental Chemistry; Alemania. Fil: Huerta Lwanga, Esperanza. Wageningen University and Research. Soil Physics and Land Management Group; Países Bajos. Fil: Jonker, Marlot. Dutch Mammal Society; Países Bajos. Fil: Van Langevelde, Frank. Wageningen University and Research. Wildlife Ecology and Conservation Group; Países Bajos. Fil: Sorensen, Martin. Aarhus University. Department of Animal Science; Dinamarca. Fil: Wells, Jerry. Wageningen University and Research. Host-Microbe Interactomics, Animal Sciences Group; Países Bajos. Fil: Boekhorst, Jos. Wageningen University and Research. Host-Microbe Interactomics, Animal Sciences Group; Países Bajos. Fil: Huss, Anke. Utrecht University. Institute for Risk Assessment Sciences; Países Bajos. Fil: Mandrioli, Daniele. Ramazzini Institute. Cesare Maltoni Cancer Research Center; Italia. Fil: Sgargi, Daria. Ramazzini Institute. Cesare Maltoni Cancer Research Center; Italia. Fil: Nathanail, Paul. Land Quality Management; Reino Unido. Fil: Nathanail, Judith. Land Quality Management; Reino Unido. Fil: Tamm, Lucius. Research Institute of Organic Agriculture; Suiza. Fil: Fantke, Peter. Technical University of Denmark. Department of Technology, Management and Economics; Dinamarca. Fil: Mark, Jennifer. Research Institute of Organic Agriculture; Suiza. Fil: Grovermann, Christian. Research Institute of Organic Agriculture; Suiza. Fil: Larsen, Ana Frelih. Ecologic Institute; Alemania. Fil: Herb, Irina. Ecologic Institute; Alemania. Fil: Chivers, Charlotte Anne. University of Gloucestershire. Countryside and Community Research Institute; Reino Unido. Fil: Mills, Jane. University of Gloucestershire. Countryside and Community Research Institute; Reino Unido. Fil: Alcon, Francisco. Universidad Politécnica de Cartagena; España. Fil: Contreras, Josefina. Universidad Politécnica de Cartagena; España. Fil: Baldi, Isabelle. Bordeaux University. INSERM U1219; Francia. Fil: Pasković, Igor. Institute of Agriculture and Tourism, Department of Agriculture and Nutrition; Croacia. Fil: Matjaz, Glavan. University of Ljubljana. Biotechnical Faculty; Eslovenia. Fil: Norgaard, Trine. Aarhus University. Department of Agroecology; Dinamarca. Fil: Aparicio, Virginia Carolina. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Balcarce; Argentina. Fil: Ritsema, Coen. Wageningen University and Research. Soil Physics and Land Management Group; Países Bajos. Fil: Geissen, Violette. University and Research. Soil Physics and Land Management Group; Países Bajos. Fil: Scheepers, Paul. Radboud Institute for Health Sciences; Países Bajos.

To meet the ambitious objectives of biodiversity and climate conventions, the international community requires clarity on how these objectives can be operationalized spatially and how multiple targets can be pursued concurrently. To support goal setting and the implementation of international strategies and action plans, spatial guidance is needed to identify which land areas have the potential to generate the greatest synergies between conserving biodiversity and nature’s contributions to people. Here we present results from a joint optimization that minimizes the number of threatened species, maximizes carbon retention and water quality regulation, and ranks terrestrial conservation priorities globally. We found that selecting the top-ranked 30% and 50% of terrestrial land area would conserve respectively 60.7% and 85.3% of the estimated total carbon stock and 66% and 89.8% of all clean water, in addition to meeting conservation targets for 57.9% and 79% of all species considered. Our data and prioritization further suggest that adequately conserving all species considered (vertebrates and plants) would require giving conservation attention to ~70% of the terrestrial land surface. If priority was given to biodiversity only, managing 30% of optimally located land area for conservation may be sufficient to meet conservation targets for 81.3% of the terrestrial plant and vertebrate species considered. Our results provide a global assessment of where land could be optimally managed for conservation. We discuss how such a spatial prioritization framework can support the implementation of the biodiversity and climate conventions.

Background Globally only 79% of adults living with HIV (human immunodeficiency virus) know their status and men in sub-Saharan Africa are considered a particularly hard-to-reach population for HIV testing. Home-based HIV couple testing during the antenatal period is a safe and effective method that has been used to test male partners of pregnant women. The goal of this qualitative study was to identify elements that made couple testing successful and describe important characteristics of this home-based intervention from couples’ perspectives. Methods Couples who received scheduled home-based couple testing during pregnancy in Kisumu, Kenya, were purposively sampled based on HIV status from January to May 2015. An interviewer administered all of the in-depth interviews and two coders were directly involved in the data analysis and reconciled codes several times in the process. Results Twenty-one couples were enrolled: 9 concordant HIV-negative couples, 8 HIV discordant couples, 3 HIV concordant HIV-positive couples, and 1 whose concordance status was unknown. Median age at the time of home-based couple testing was 24 and 28 years for women and men, respectively. Median relationship duration was 3 years and couples had a median of two pregnancies. The major themes that emerged were that home-based couple testing 1) removed the female burden of requesting couple testing, 2) overcame logistical barriers associated with clinic-based testing, 3) encouraged participants to overcome their fear of testing and disclosure, 4) provided privacy in the home, and 5) provided quality time with the health advisors. Importantly, some women appreciated individual testing at the clinic before couple testing and some couples preferred skilled, anonymous health advisors delivering the intervention rather than known community health workers. Conclusions The results of this qualitative study suggest that home-based couple testing during pregnancy overcame many of the barriers that limit men’s access to and uptake of clinic-based testing. It encouraged participants to overcome their fear of testing and disclosure through a setting that afforded privacy and quality time with skilled health advisors. These qualitative results may help design effective partner and couple HIV testing programs in the antenatal setting and alongside or within other assisted partner notification services. Trial Registration Clinicaltrials.gov registry: NCT01784783. Registered prospectively on June 15, 2012.

Background Few men are tested for syphilis or human immunodeficiency virus (HIV) during their partner's pregnancy, a high-risk period for HIV and syphilis transmission. Offering home-based rapid testing of syphilis to couples during pregnancy can support prevention efforts to reduce transmission of sexually transmitted diseases and adverse pregnancy outcomes. Methods We assessed men's uptake of paired (separate tests, single blood draw) point-of-care syphilis and HIV tests within a randomized controlled trial of pregnant women who received clinic or home partner HIV testing. We evaluated acceptance of paired HIV-syphilis testing during pregnancy or at 6 months postpartum, and evaluated whether addition of syphilis testing affected the uptake of HIV testing among men. Results Of 601 women, we were unable to meet 101 male partners, and 180 tested before syphilis tests were available. Paired syphilis and HIV testing was offered at home to 80 men during pregnancy and to 230 men postpartum. For syphilis, 93% of men agreed to test during pregnancy and 98% agreed postpartum. For paired syphilis and HIV testing, 91% of men tested for both during pregnancy and 96% tested postpartum. Before syphilis test introduction, 96% of men accepted HIV testing, compared with 95% of men who accepted HIV testing when paired testing was offered. Conclusions Uptake of syphilis and HIV testing was high among male partners offered couple testing at home. Introducing syphilis testing did not adversely affect HIV testing among men. Point-of-care diagnostics outside facilities can increase testing of male partners who rarely accompany women to antenatal clinics.

Summary paragraphTo meet the ambitious objectives of biodiversity and climate conventions, countries and the international community require clarity on how these objectives can be operationalized spatially, and multiple targets be pursued concurrently1. To support governments and political conventions, spatial guidance is needed to identify which areas should be managed for conservation to generate the greatest synergies between biodiversity and nature’s contribution to people (NCP). Here we present results from a joint optimization that maximizes improvements in species conservation status, carbon retention and water provisioning and rank terrestrial conservation priorities globally. We found that, selecting the top-ranked 30% (respectively 50%) of areas would conserve 62.4% (86.8%) of the estimated total carbon stock and 67.8% (90.7%) of all clean water provisioning, in addition to improving the conservation status for 69.7% (83.8%) of all species considered. If priority was given to biodiversity only, managing 30% of optimally located land area for conservation may be sufficient to improve the conservation status of 86.3% of plant and vertebrate species on Earth. Our results provide a global baseline on where land could be managed for conservation. We discuss how such a spatial prioritisation framework can support the implementation of the biodiversity and climate conventions.

Supplemental Digital Content is Available in the Text., Introduction: Women in sub-Saharan Africa face a 2-fold higher risk of HIV acquisition during pregnancy and postpartum and the majority do not know the HIV status of their male partner. Home-based couple HIV testing for pregnant women can reduce HIV transmission to women and infants while increasing antiretroviral therapy (ART) coverage in men. However, the cost-effectiveness of this program has not been evaluated. Methods: We modeled the health and economic impact of implementing a home-based partner education and HIV testing (HOPE) intervention for pregnant women and their male partners in a region of Western Kenya (formally Nyanza Province). We used data from the HOPE randomized clinical trial conducted in Kisumu, Kenya, to parameterize a mathematical model of HIV transmission. We conducted an in-country microcosting of the HOPE intervention (payer perspective) to estimate program costs as well as a lower cost scenario of task-shifting to community health workers. Results: The incremental cost of adding the HOPE intervention to standard antenatal care was $31–37 and $14–16 USD per couple tested with program and task-shifting costs, respectively. At 60% coverage of male partners, HOPE was projected to avert 6987 HIV infections and 2603 deaths in Nyanza province over 10 years with an incremental cost-effectiveness ratio (ICER) of $886 and $615 per disability-adjusted life year averted for the program and task-shifting scenario, respectively. ICERs were robust to changes in intervention coverage, effectiveness, and ART initiation and dropout rates. Conclusions: The HOPE intervention can moderately decrease HIV-associated morbidity and mortality by increasing ART coverage in male partners of pregnant women. ICERs fall below Kenya's per capita gross domestic product ($1358) and are therefore considered cost-effective. Task-shifting to community health workers can increase intervention affordability and feasibility.

Introduction: Male partner HIV testing has been recognized as an important component of prevention of mother-to-child HIV transmission. Scheduled home-based couple HIV testing may be an effective strategy to reach men. Methods: Women attending their first antenatal visit at Kisumu County Hospital in Kenya were randomized to home-based education and HIV testing within 2 weeks of enrollment (HOPE) or to written invitations for male partners to attend clinic (INVITE). Male partner HIV testing and maternal child health outcomes were compared at 6 months postpartum. Results: Of 1101 women screened, 620 were eligible and 601 were randomized to HOPE (n = 306) or INVITE (n = 295). At 6 months postpartum, male partners were more than twice as likely [relative risk (RR) = 2.10; 95% CI (CI): 1.81 to 2.42] to have been HIV tested in the HOPE arm [233 (87%)] compared with the INVITE arm [108 (39%)]. Couples in the HOPE arm [192 (77%)] were 3 times as likely (RR = 3.17; 95% CI: 2.53 to 3.98) to have been tested as a couple as the INVITE arm [62 (24%)] and women in the HOPE arm [217 (88%)] were also twice as likely (RR = 2.27; 95% CI: 1.93 to 2.67) to know their partner's HIV status as the INVITE arm [98 (39%)]. More serodiscordant couples were identified in the HOPE arm [33 (13%)] than in the INVITE arm [10 (4%)] (RR = 3.38; 95% CI: 1.70 to 6.71). Maternal child health outcomes of facility delivery, postpartum family planning, and exclusive breastfeeding did not vary by arm. Conclusions: Home-based HIV testing for pregnant couples resulted in higher uptake of male partner and couple testing, as well as higher rates of HIV status disclosure and identification of serodiscordant couples. However, the intervention did not result in higher uptake of maternal child health outcomes, because facility delivery and postpartum family planning were high in both arms, whereas exclusive breastfeeding was low. The HOPE intervention was successful at its primary aim to increase HIV testing and disclosure among pregnant couples and was able to find more serodiscordant couples compared with the invitation-only strategy. Trial Registration: Clinicaltrials.gov registry: NCT01784783.

Deregulated cathepsin proteolysis occurs across numerous cancers, but in vivo substrates mediating tumorigenesis remain ill-defined. Applying 8-plex iTRAQ terminal amine isotopic labeling of substrates (TAILS), a systems-level N-terminome degradomics approach, we identified cathepsin B, H, L, S, and Z in vivo substrates and cleavage sites with the use of six different cathepsin knockout genotypes in the Rip1-Tag2 mouse model of pancreatic neuroendocrine tumorigenesis. Among 1,935 proteins and 1,114 N termini identified by TAILS, stable proteolytic products were identified in wild-type tumors compared with one or more different cathepsin knockouts (17%–44% of 139 cleavages). This suggests a lack of compensation at the substrate level by other cathepsins. The majority of neo-N termini (56%–83%) for all cathepsins was consistent with protein degradation. We validated substrates, including the glycolytic enzyme pyruvate kinase M2 associated with the Warburg effect, the ER chaperone GRP78, and the oncoprotein prothymosin-alpha. Thus, the identification of cathepsin substrates in tumorigenesis improves the understanding of cathepsin functions in normal physiology and cancer. ISSN:2666-3864 ISSN:2211-1247

The World Health Organization’s (WHO) Strategic Framework for the Elimination of New HIV Infections among Children in Africa by 2015 identifies important synergies for the elimination of mother-to-child transmission of HIV and syphilis in terms of prevention interventions, implementation logistics and service delivery, monitoring and evaluation systems, and need for sustained political commitment. The WHO advocates the use of an integrated, rights-based dual approach with partnerships and collaboration to make the best use of available resources. Through a consultative approach, six countries in the African Region committed to dual elimination and developed and implemented action plans for this purpose. Where interest and commitment are high, this may also be possible and effective in other African countries.

Introduction Few men are tested for syphilis or HIV during their partners’ pregnancy, a period of high HIV transmission risk and preventable adverse pregnancy outcomes. Offering home-based STI education and point-of-care (POC) testing of syphilis to couples can support HIV programs to reduce transmission of sexually transmitted infections and adverse pregnancy outcomes. Methods We assessed male partner uptake of paired POC syphilis and HIV tests within a randomised controlled trial (RCT) of 600 pregnant women and their male partners in Kenya. Married or cohabiting women were unaccompanied and attending a clinic-based first antenatal visit at recruitment. Participating men received a couple home-based visit with testing during pregnancy or at 6 months postpartum. We also evaluated whether the addition of syphilis testing has an effect on the uptake of HIV testing among men. Results From September 2013 to June 2014, male participation in home-based visits was 85% among women remaining enrolled (260 during pregnancy, 240 postpartum). Paired testing was offered to subsets of 80 and 230 men during pregnancy and postpartum. In both groups, test uptake was high: 1) For syphilis, 91% men agreed to test during pregnancy and 96% agreed postpartum; 2) For paired syphilis and HIV testing, 91% of men tested for both during pregnancy and 98% tested postpartum. Third, adding syphilis testing did not adversely affect home-based male partner HIV testing during pregnancy among 260 men, as HIV test uptake was 96% before (of 180), 95% after (of 80) syphilis test introduction, and remained 2-times greater than clinic-based HIV testing alone within the RCT (39%). Finally, men intended to seek clinic treatment if they received a positive test result during pregnancy and postpartum (94% and 95%, respectively). Conclusion Men were likely to accept both syphilis and HIV tests when offered at home without adversely affecting HIV testing approaches. POC diagnostics can work well outside facilities and increase testing of male partners who rarely accompany women to antenatal clinics.

Introduction Offering couples education and HIV rapid testing during pregnancy can increase testing of male partners, identify sero-discordant couples, and help link men to HIV care services. We aim to understand how a home-based antenatal couple HIV testing intervention affects male partner follow-up to clinic-based STI services during pregnancy. Methods We conducted a randomised controlled trial of un-accompanied pregnant women attending a first visit at Kisumu County Hospital from September 2013 to June 2014. Women and their partners received either home-based couple education with HIV and syphilis testing during pregnancy or an invitation letter to clinic-based couple HIV testing. Men’s self-reported health seeking outcomes during pregnancy were compared at 6 months postpartum. Results Among 601 enrolled women, we reached 247 and 240 men in the intervention and control arms, respectively (85% participation). Men who received the intervention were more likely to seek an STI consultation based on symptoms or a positive syphilis test [RR=1.59; 95%CI=1.33–1.89]. Postpartum, 39 (16%) intervention and 21 (9%) control men reported known HIV-positive status during pregnancy. Despite increased knowledge of HIV-positive status within the intervention group, men were less likely to link to HIV care services [RR=0.69; 95%CI=0.50–0.96], as 41% (16 of 39) of men were newly diagnosed with HIV. No differences were observed for uptake of male circumcision within the study period [RR=1.59; 95%CI=0.89–2.87] or attendance of subsequent clinic-based antenatal care with the female partner [RR=1.11; 95%CI=0.85–1.41]. Conclusion Home-based couple education and testing resulted in greater uptake of clinic-based STI consultation services among men. However, increased knowledge of HIV-status in the home did not lead to increased HIV care service uptake for men, potentially because there was a greater proportion of men with new HIV diagnoses in the intervention arm. This group of newly diagnosed men should be targeted with research to increase linkage and engagement to HIV care.

BACKGROUND: The sexually transmitted infection (STI) clinical encounter is an opportunity to identify current and prevent new HIV and STI infections. We examined knowledge, attitudes, and practices regarding STIs and HIV among public and private providers in a large province in South Africa with a high disease burden. METHODS: From November 2008 to March 2009, 611 doctors and nurses from 120 public and 52 private clinics serving patients with STIs in Gauteng Province completed an anonymous, self-administered survey. Responses were compared by clinic location, provider type, and level of training. RESULTS: Most respondents were nurses (91%) and female (89%), were from public clinics (91%), and had received formal STI training (67%). Most (88%) correctly identified all of the common STI syndromes (i.e., genital ulcer syndrome, urethral discharge syndrome, and vaginal discharge syndrome). However, almost none correctly identified the most common etiologies for all 3 of these syndromes (0.8%), or the recommended first or alternative treatment regimens for all syndromes (0.8%). Very few (6%) providers correctly answered the 14 basic STI knowledge questions. Providers reporting formal STI training were more likely to identify correctly all 3 STI syndromes (P = 0.034) as well as answer correctly all 14 general STI knowledge questions (P = 0.016) compared with those not reporting STI training. In addition, several providers reported negative attitudes about patients with STI that may have affected their ability to practice optimal STI management. CONCLUSIONS: Sexually transmitted infection general knowledge was suboptimal, particularly among providers without STI training. Provider training and brief refresher courses on specific aspects of diagnosis and management may benefit HIV/STI clinical care and prevention in Gauteng Province.

Although trees have high economic, cultural and ecological value, increasing numbers of species are potentially at risk of extinction because of forest loss and degradation as a result of human activities, including overharvesting, fire and grazing. Emerging threats include climate change and its interaction with the spread of pests and diseases. The impact of such threats on the conservation status of trees is poorly understood. Here we highlight the need to conduct a comprehensive conservation assessment of the world's tree species, building on previous assessments undertaken for the IUCN Red List. We suggest that recent developments in plant systematics, online databases, remote sensing data and associated analytical tools offer an unprecedented opportunity to conduct such an assessment. We provide an overview of how a Global Tree Assessment could be achieved in practice, through participative, open-access approaches to data sharing and evaluation.

Author(s): Louie, Janice K; Hacker, Jill K; Gonzales, Ralph; Mark, Jennifer; Maselli, Judy H; Yagi, Shigeo; Drew, W Lawrence | Abstract: BackgroundWith use of polymerase chain reaction (PCR) and a centrifugation-enhanced viral culture method, we characterized the viruses causing acute respiratory infection in adults during an influenza season.MethodsDuring January-March 2002, nasopharyngeal wash specimens from previously healthy adults presenting with respiratory symptoms were evaluated for viral pathogens with centrifugation-enhanced viral culture and PCR.ResultsThe diagnoses in 266 cases included unspecified upper respiratory infection (in 142 [54%] of the cases), acute bronchitis (42 [16%]), sinusitis (23 [9%]), pharyngitis (22 [8%]), and pneumonia (17 [6%]). The use of a shell vial assay and PCR identified a pathogen in 103 (39%) of the patients, including influenza A or B in 54, picornavirus in 28 (including rhinovirus in 24), respiratory syncytial virus (RSV) in 12, human metapneumovirus in 4, human coronavirus OC43 in 2, adenovirus in 2, parainfluenza virus type 1 in 1, and coinfection with influenza and parainfluenza virus type 1 in 2.ConclusionOur findings demonstrate that, even during the influenza season, rhinovirus and RSV are prevalent and must be considered in the differential diagnosis of adult acute respiratory infection before prescribing antiviral medication. Human coronavirus and human metapneumovirus did not play a substantial role. PCR was an especially useful tool in the identification of influenza and other viral pathogens not easily detected by traditional testing methods.

Summary Objectives To determine prevalence, risk factors, and simple identification algorithms for HIV, hepatitis B, and hepatitis C co-infection; factors that may predispose for anti-tuberculosis therapy-induced hepatotoxicity. Methods We recruited 300 individuals at in-patient tuberculosis hospitals in three cities in Georgia, administered a behavioral questionnaire, and tested for antibody to HIV, hepatitis C (HCV), hepatitis B core antigen (anti-HBc), and the hepatitis B surface antigen (HBsAg). Results Of the individuals tested, 0.7% were HIV positive, 4.3% were HBsAg positive, 8.7% were anti-HBc positive, and 12.0% were HCV positive. In multivariable analysis, a history of blood transfusion, injection drug use, and prison were significant independent risk factors for HCV, while a history of blood transfusion, injection drug use, younger age at sexual debut, and a high number of sex partners were significant risk factors for HBV. Three-questionnaire item algorithms predicted HCV serostatus 74.1% of the time and HBV serostatus 85.2% of the time. Conclusions Treatment of tuberculosis patients in resource-limited countries with concurrent epidemics of HCV, HBV, and HIV may be associated with significant hepatotoxicity. Serologic screening of tuberculosis patients for HBV, HCV, and HIV or using behavioral algorithms to identify patients in need of intensive monitoring during anti-tuberculosis therapy may reduce this risk.