Search

Objectives: We aimed to assess the extent of integration of non‐communicable disease (NCD) assessment and management in HIV clinics across Europe. Methods: A structured electronic questionnaire with 41 multiple‐choice and rating‐scale questions assessing NCD assessment and management was sent to 88 HIV clinics across the WHO European Region during March–May 2023. One response per clinic was collected. Results: In all, 51 clinics from 34 countries with >100 000 people with HIV under regular follow‐up responded. Thirty‐seven clinics (72.6%) reported shared NCD care responsibility with the general practitioner. Systematic assessment for NCDs and integration of NCD management were common overall [median agreement 80%, interquartile range (IQR): 55–95%; and 70%, IQR: 50–88%, respectively] but were lowest in central eastern and eastern Europe. Chronic kidney disease (median agreement 96%, IQR: 85–100%) and metabolic disorders (90%, IQR: 75–100%) were regularly assessed, while mental health (72%, IQR: 63–85%) and pulmonary diseases (52%, IQR: 40–75%) were less systematically assessed. Some essential diagnostic tests such as glycated haemoglobin (HbA1c) for diabetes (n = 38/51, 74.5%), proteinuria for kidney disease (n = 30/51, 58.8%) and spirometry for lung disease (n = 11/51, 21.6%) were only employed by a proportion of clinics. The most frequent barriers for integrating NCD care were the lack of healthcare workers (n = 17/51, 33.3%) and lack of time during outpatient visits (n = 12/51, 23.5%). Conclusion: Most HIV clinics in Europe systematically assess and manage NCDs. People with HIV appear to be screened more frequently than the general population at the same age. There are, however, larger gaps among eastern European clinics in general and for clinics in all regions related to mental health, pulmonary diseases and the employment of some essential diagnostic tests. [ABSTRACT FROM AUTHOR]

Carbapenems are widely used for empiric treatment of healthcare-associated central nervous system (CNS) infections. We investigated the feasibility of a carbapenem-sparing strategy, utilising a third-generation cephalosporin (ceftriaxone or cefotaxime) (combined with vancomycin) for the empirical treatment of healthcare-associated CNS infections in Eastern Denmark. The departments of neurosurgery and neuro-intensive care at Copenhagen University Hospital Rigshospitalet. First, we analysed local microbiological data (1st January 2020–31st August 2022) to identify microorganisms non-susceptible to third-generation cephalosporin. Subsequently, we assessed all carbapenem prescriptions over a three-month period for their indication and justification. In total, 25,247 bacterial cultures were identified, of which 2,563 CNS-related, were included in the analysis. The positivity rate was 10.5% (n = 257/2439) for cerebrospinal-fluid samples and 75.8% (n = 95/124) for brain parenchyma. CNS samples from five individual patients revealed bacteria non-susceptible to third generation cephalosporins (Enterobacter spp. (n = 3), Pseudomonas spp. (n = 2), Klebsiella spp. (n = 2), Citrobacter freundii (n = 1)). All five patients had been hospitalised for ≥10days at the time-point of antibiotic therapy. Out of 11,626 sets of blood cultures, a total of 10 individual patients had Gram-negative blood-stream infections with resistance to ceftriaxone and piperacillin/tazobactam. 140 days-of-therapy (32%) with carbapenem in 18 patients (36%) were definitively or possibly indicated according to guidelines, none were indicated for healthcare-associated CNS-infections. An empiric treatment strategy relying on a third-generation cephalosporin appears suitable for healthcare-associated CNS infections at our tertiary hospital, serving a population of 2.6 million. However, in patients with prolonged hospitalization (≥10 days), immunosuppression, prior broad-spectrum antibiotic use, or history of resistant Gram-negative bacteria, empirical prescription of carbapenem may be needed. [ABSTRACT FROM AUTHOR]

Globally, dietary factors are responsible for about one in five deaths. In many low- and middle-income countries different forms of malnutrition (including obesity and undernutrition) can co-exist within the same population. This double burden of malnutrition is placing a disproportional strain on health systems, slowing progress towards universal health coverage (UHC). Poor nutrition also impedes the growth of local economies, ultimately affecting the global economy. In this article, we argue that comprehensive primary health care should be used as a platform to address the double burden of malnutrition. We use a conceptual framework based on human rights and the Astana Declaration on primary health care to examine existing recommendations and propose guidance on how policy-makers and providers of community-oriented primary health care can strengthen the role of nutrition within the UHC agenda. Specifically, we propose four thematic areas for action: (i) bridging narratives and strengthening links between the primary health care and the nutrition agenda with nutrition as a human rights issue; (ii) encouraging primary health-care providers to support local multisectoral action on nutrition; (iii) empowering communities and patients to address unhealthy diets; and (iv) ensuring the delivery of high-quality promotive, preventive, curative and rehabilitative nutrition interventions. For each theme we summarize the available strategies, policies and interventions that can be used by primary health-care providers and policy-makers to strengthen nutrition in primary health care and thus the UHC agenda. Environ un deces sur cinq dans le monde est du a des facteurs alimentaires. Dans de nombreux pays a faible et moyen revenu, differentes formes de malnutrition (y compris l'obesite et la denutrition) peuvent coexister au sein d'une merme population. Ce double fardeau de malnutrition exerce une pression demesuree sur les systemes de sante, ralentlssant la progression vers une couverture maladle unlverselle (CMU). Une mauvalse alimentation entra ve egalement la crolssance des economies locales, ce qui enfin de compteaffectel'economie mondiale. Dans cet article, nous estimons qu'll est imperatlf d'utillser une approche globale des soins de sante primaires commeplateforme pours'attaquer au double fardeau de la malnutrition. Nous avons employe un cadre conceptuel fonde sur les droits humainset la Declaration d'Astana sur les soins de sante primaires. D'une part pour examiner les recommandations existantes, et d'autre part pour fournir un eclairage sur la maniere dont les legislateurs et les prestataires de soins de sante primaires, implantes au niveau communautaire, peuvent renforcer le role de la nutrition dans le programme de CMU. Nous proposons plusexactementquatre champs d'action: (i) aligner les discours et consolider les liens entre les soins de sante primaires et le programme de nutrition, en integrant ce dernier dans la thematique des droits humains; (ii) encourager les prestataires de soins de sante primaires a soutenlr les Initiatives locales multisectorielles portant sur la nutrition; (iii) donner aux patients et aux collectivites le pouvoir de lutter contre l'alimentation desequilibree; et enfin, (iv) assurer la mise en ceuvre d'interventions de qualite pour la promotion, la prevention, le traitement et la rehabilitation en matiere de nutrition. Pour chaque champ d'action, nous resumons les strategies, politiques et interventions a la disposition des legislateurs et prestataires de soins de sante primaires pour renforcer le role de la nutrition dans les soins de sante primaires et, par consequent, le programme de CMU. Los factores alimentarios son responsables de aproximadamente una de cada cinco muertes en todo el mundo. Diferentes tipos de malnutricion (incluidas la obesidad y la desnutricion) pueden coexistir en la misma poblacion de muchos paises de ingresos bajos y medios. Esta doble carga de la malnutricion esta ejerciendo una presion desproporcionada sobre los sistemas sanitarios, lo que ralentiza los progresos hacia la cobertura sanitaria universal (CSU). Ademas, la mala nutricion dificulta el crecimiento de las economias locales, lo que en ultima instancia afecta a la economia global. En este articulo, se argumenta que la atencion primaria de salud integral se deberia utilizar como plataforma para abordar la doble carga de la malnutricion. Se utiliza un marco conceptual basado en los derechos humanos y en la Declaracion de Astana sobre la atencion primaria de salud para analizar las recomendaciones existentes y proponer directrices sobre como los responsables de formular las politicas y los proveedores de atencion primaria de salud orientada a la comunidad pueden fortalecer la funcion de la nutricion dentro del programa de la CSU. En concreto, se proponen cuatro areas tematicas de accion: (i) narrativas de vinculacion y fortalecimiento de los vinculos entre la atencion primaria de salud y el programa de nutricion en donde la nutricion sea una cuestion de derechos humanos; (ii) alentar a los proveedores de atencion primaria de salud a que apoyen la medida multisectorial local sobre la nutricion; (iii) potenciar a las comunidades y a los pacientes para tratar las dietas poco saludables; y (iv) garantizar la realizacion de intervenciones de nutricion de alta calidad de tipo promocional, preventivo, curativo y de rehabilitacion. Para cada tema se resumen las estrategias, politicas e intervenciones disponibles que los proveedores de atencion primaria de salud y los responsables de formular las politicas pueden utilizar para fortalecer la nutricion en la atencion primaria de salud y, por consiguiente, el programa de la CSU. [phrase omitted], Introduction About one in five deaths globally are attributable to poor diets, making dietary factors responsible for 11 million deaths annually, more than any other risk factors covered by the [...]

Objectives: In some eastern European countries, serious challenges exist to meet the HIV‐, tuberculosis (TB)‐ and hepatitis‐related target of the United Nations Sustainable Development Goals. Some of the highest incidence rates for HIV and the highest proportion of multi‐drug‐resistant (MDR) tuberculosis worldwide are found in the region. The purpose of this article is to review the challenges and important next steps to improve healthcare for people living with TB, HIV and hepatitis C (HCV) in eastern Europe. Methods: References for this narrative review were identified through systematic searches of PubMed using pre‐idientified key word for articles published in English from January 2000 to August 2020. After screening of titles and abstracts 37 articles were identified as relevant for this review. Thirty‐eight further articles and sources were identified through searches in the authors' personal files and in Google Scholar. Results: Up to 50% of HIV/MDR‐TB‐coinfected individuals in the region die within 2 years of treatment initiation. Antiretroviral therapy (ART) coverage for people living with HIV (PLHIV) and the proportion virological suppressed are far below the UNAIDS 90% targets. In theory, access to various diagnostic tests and treatment of drug‐resistant TB exists, but real‐life data point towards inadequate testing and treatment. New treatments could provide elimination of viral HCV in high‐risk populations but few countries have national programmes. Conclusion: Some eastern European countries face serious challenges to achieve the sustainable development goal‐related target of 3.3 by 2030, among others, to end the epidemics of AIDS and tuberculosis. Better integration of healthcare systems, standardization of health care, unrestricted substitution therapy for all people who inject drugs, widespread access to drug susceptibility testing, affordable medicines and a sufficiently sized, well‐trained health workforce could address some of those challenges. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is still a major challenge for global health, but in recent years there have been several important developments in treatment options. Shorter treatment regimens for latent TB, based on conventional drugs, offer better adherence and fewer side effects, while new and repurposed antibiotics have opened the door to more effective, shorter and less side effect-heavy treatments for drug susceptible TB and multidrug-resistant/extensively drug resistant TB as well as atypical mycobacterioses. This review investigates how these shorter and predominantly oral treatments, in the future, are expected to be used in combination with individualized precision medicine.

Background: Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH)., Methods: PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan-Meier estimates and Cox models., Findings: 480/740 patients (64.9%; 95% CI 61.3-68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. < 50 years, aOR = 2.51; 1.18-5.32; p = 0.016), injecting drug use (IDU) (vs. non-IDU aOR = 1.66; 1.21-2.29; p = 0.002), being ART naïve (aOR = 1.77; 1.24-2.54; p = 0.002), disseminated TB (vs. pulmonary TB, aOR = 1.56, 1.10-2.19, p = 0.012), and presenting with weight loss (vs. no weight loss, aOR = 1.63; 1.18-2.24; p = 0.003) were associated with delayed diagnosis. PLWH with a delayed diagnosis were at 36% increased risk of death (hazard ratio = 1.36; 1.04-1.77; p = 0.023, adjusted hazard ratio 1.27; 0.95-1.70; p = 0.103)., Conclusion: Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe., (© 2021. The Author(s).)