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Mortality surveillance systems can have limitations, including reporting delays, incomplete reporting, missing data, and insufficient detail on important risk or sociodemographic factors that can impact the accuracy of estimates of current trends, disease severity, and related disparities across subpopulations. The Centers for Disease Control and Prevention used multiple data systems during the COVID-19 emergency response—line-level case‒death surveillance, aggregate death surveillance, and the National Vital Statistics System—to collectively provide more comprehensive and timely information on COVID-19‒associated mortality necessary for informed decisions. This article will review in detail the line-level, aggregate, and National Vital Statistics System surveillance systems and the purpose and use of each. This retrospective review of the hybrid surveillance systems strategy may serve as an example for adaptive informational approaches needed over the course of future public health emergencies. (Am J Public Health. 2024;114(10):1071–1080. https://doi.org/10.2105/AJPH.2024.307743) [ABSTRACT FROM AUTHOR]

Novel infectious pathogens can pose major challenges to global health and security. Tracking the geography, demographics, and suspected mode of transmission of these pathogens by using a standardized case definition [...]

Introduction: Modelling suggests that early diagnosis and immediate antiretroviral therapy (ART) among key populations would have a substantial impact in reducing HIV transmission and mortality in Vietnam. An implementation research project of 'test-and-treat' among people who inject drugs (PWID) was developed to inform effective roll-out of such interventions. Methods: 'Test-and-treat' was offered to PWID in two high burden provinces, Thai Nguyen and Thanh Hoa. The interventions comprised the offer of biannual HIV testing and immediate ART, irrespective of CD4 count. PWID were enrolled between April 2014 and July 2015 and followed up for 12 months, and retention, HIV viral load (VL) and risk behaviours were assessed. Retention in care of this prospective cohort was compared with the retention among men enrolled in care in the preceding period (April 2012 to March 2013) at the same clinics when ART was initiated at CD4 cell count [less than or equal to]350 cells/[mm.sup.3]. Results: In total, 287 HIV positive PWID started immediate ART. The majority (98%) were men; median age was 34; and median (interquartile range) CD4 count was 199 (50 to 402) cells/[mm.sup.3]. After 12 months, 238 participants (83%) were retained on ART, and 205 achieved viral suppression ( Keywords: antiretroviral therapy; people who inject drugs; Vietnam; viral suppression; retention; test-and-treat; risk behaviour, 1 | INTRODUCTION Vietnam's HIV epidemic has been concentrated in key populations, with injection drug use being the dominant mode of transmission, like in many Asian and Eastern European countries [...]

Objective To respond to the World Health Assembly call for dissemination of lessons learnt from countries that have begun implementing the International Health Regulations, 2005 revision; IHR (2005). Methods In November 2015, we conducted a systematic search of the following online databases and sources: PubMed[R], Embase[R], Global Health, Scopus, World Health Organization (WHO) Global Index Medicus, WHO Bulletin on IHR Implementation and the International Society for Disease Surveillance. We included identified studies and reports summarizing national experience in implementing any of the IHR (2005) core capacities or their components. We excluded studies that were theoretical or referred to IHR (1969). Qualitative systematic review methodology, including meta-ethnography, was used for qualitative synthesis. Findings We analysed 51 articles from 77 countries representing all WHO Regions. The meta-syntheses identified a total of 44 lessons learnt across the eight core capacities of IHR (2005). Major themes included the need to mobilize and sustain political commitment; to adapt global requirements based on local sociocultural, epidemiological, health system and economic contexts; and to conduct baseline and follow-up assessments to monitor the status of IHR (2005) implementation. Conclusion Although experiences of IHR (2005) implementation covered a wide global range, more documentation from Africa and Eastern Europe is needed. We did not find specific areas of weakness In monitoring IHR (2005); sustained monitoring of all core capacities is required to ensure effective systems. These lessons learnt could be adapted by countries In the process of meeting IHR (2005) requirements. Objetivo Responder a la convocatoria de la Asamblea de la Organizacion Mundial de la Salud para difundir las lecciones aprendidas de los paises que han empezado a aplicar el Reglamento Sanitario Internacional, revision de 2005; RSI (2005). Metodos En noviembre de 2015, se realizo una busqueda sistematica de las siguientes fuentes y bases de datos en linea: PubMed[R], Embase[R], Global Health, Scopus, Global Index Medicus de la Organizacion Mundial de la Salud (OMS), el Boletin de la OMS sobre la implementacion del RSI y la Sociedad Internacional para la Vigilancia de Enfermedades. Se incluyeron estudios e informes identificados que resumen la experiencia nacional de la implementacion de cualquiera de las capacidades basicas del RSI (2005) o sus componentes. Se excluyeron los estudios teoricos o que hicieran referencia al RSI (1969). Se uso una metodologia cualitativa de revision sistematica, incluida la metaetnografia, para la sintesis cualitativa. Resultados Se analizaron 51 articulos de 77 paises que representan a todas las Regiones de la OMS. Las metasintesis identificaron un total de 44 lecciones aprendidas en las ocho capacidades basicas del RSI (2005). Los temas principales incluyeron la necesidad de movilizar y mantener el compromiso politico; de adaptar los requisitos globales en funcion de los contextos socioculturales, epidemiologicos, del sistema de salud y economicos locales; y de realizar evaluaciones iniciales y de seguimiento para supervisar el estado de la implementacion del RSI (2005). Conclusion Aunque las experiencias de la implementacion del RSI (2005) cubrieron un amplio rango global, hace falta mas documentacion de Africa y Europa del Este. No se hallaron areas especificas de debilidad en la supervision del RSI (2005). Es necesaria una supervision sostenida de todas las capacidades basicas para asegurar unos sistemas efectivos. Estas lecciones aprendidas podrian ser adaptadas por los paises en proceso de cumplir con los requisitos del RSI (2005). Objectif Repondre a la demande de l'Assemblee mondiale de la Sante de diffuser les lecons tirees par les pays qui ont commence a mettre en oeuvre le Reglement sanitaire international, tel que revise en 2005 --RSI (2005). Methodes En novembre 2015, nous avons effectue une recherche systematique dans les bases de donnees et sources en ligne suivantes: PubMed[R], Embase[R], Global Health, Scopus, l'Index Medicus mondial de l'Organisation mondiale de la Sante (OMS), le bulletin de l'OMS sur la mise en oeuvre du RSI et l'International Society for Disease Surveillance. Nous avons inclus des etudes et des rapports resumant une experience nationale de mise en oeuvre de l'une des principales capacites du RSI (2005) ou de ses composants. Nous avons exclu les etudes theoriques ou qui se referaient a l'edition du RSI de 1969. Nous avons utilise une methodologie qualitative de la revue systematique, et notamment une meta-ethnographie, pour realiser une synthese qualitative. Resultats Nous avons analyse 51 articles qui provenaient de 77 pays representant toutes les regions de l'OMS. Les meta-syntheses ont mis en evidence 44 lecons tirees des huit principales capacites du RSI (2005). Les themes centraux refletalent la necessite de susciter et maintenlr l'engagement politique; d'adapter les exigences mondiales en fonction du contexte socioculturel, epidemiologique, du systeme de sante et economique local; et de realiser des evaluations de reference et de suivi pour surveiller l'avancee de la mise en oeuvre du RSI (2005). Conclusion S'il est vrai que les experiences de mise en oeuvre du RSI (2005) ont couvert une vaste zone geographique, une plus ampie documentation provenant d'Afrique et d'Europe de l'Est est necessaire. Nous n'avons pas trouve de points faibles specifiques lors du suivi du RSI (2005); un suivi permanent de l'ensemble des principales capacites est indispensable pour garantir l'efficacite des systemes. Ces lecons tirees pourraient etre adaptees par les pays engages dans un processus de respect des exigences du RSI (2005)., Introduction While bi- and multilateral communication and collaboration are the foundation for global control of infectious disease epidemics, they are strengthened by the International Health Regulations (IHR). First introduced in [...]

Author(s): Amitabh B. Suthar *, Patrick K. Moonan, Heather L. Alexander Antimicrobial resistance (AMR) surveillance Drug resistance to microbes, including bacteria, viruses, fungi, and parasites, has reduced the treatment options [...]

Author(s): Amitabh B. Suthar 1,*, Till Bärnighausen 2,3,4 Antiretroviral therapy and population mortality Reducing mortality from HIV, tuberculosis, and malaria with effective medicines, preventing diseases with immunisations, and improving access [...]

Objective To determine whether integrating antiretroviral therapy (ART) into antenatal care (ANC) and maternal and child health (MCH) clinics could improve programmatic and patient outcomes. Methods The authors systematically searched PubMed, Embase, African Index Medicus and LiLACS for randomized controlled trials, prospective cohort studies, or retrospective cohort studies comparing outcomes in ANC or MCH clinics that had and had not integrated ART. The outcomes of interest were ART coverage, ART enrolment, ART retention, mortality and transmission of human immunodeficiency virus (HIV). Findings Four studies met the inclusion criteria. All were conducted in ANC clinics. Increased enrolment of pregnant women in ART was observed in ANC clinics that had integrated ART (relative risk, RR: 2.09; 95% confidence interval, CI; 1.78-2.46; [I.sup.2]: 15%). Increased ART coverage was also noted in such clinics (RR: 1.37; 95% CI: 1.05-1.79; [I.sup.2]: 83%). Sensitivity analyses revealed a trend for the national prevalence of HIV infection to explain the heterogeneity in the size of the effect of ART integration on ART coverage (P=0.13). Retention in ART was similar in ANC clinics with and without ART integration. Conclusion Although few data were available, ART integration in ANC clinics appears to lead to higher rates of ART enrolment and ART coverage. Rates of retention in ART remain similar to those observed in referral-based models. Objectif Determiner si l'integration de la therapie antiretrovirale (TAR) dans les etablissements de soins prenataux (ESP) et de sante maternelle et infantile (SMI) pourrait ameliorer les resultats du programme et la sante du patient. Methodes Les auteurs ont systematiquement recherche via PubMed, Embase, African Index Medicus et LILACS des essais controles randomises, des etudes de cohorte prospectives et des etudes de cohorte retrospectives comparant les resultats des cliniques ESP ou SMI ayant ou n'ayant pas integre la TAR. Les resultats pris en compte comprenaient la couverture, la participation et la retention de la TAR, ainsi que la mortalite et la transmission du virus d'immunodeficience humaine (VIH). Resultats Quatre etudes repondaient aux criteres d'inclusion. Toutes ont ete menees dans des cliniques ESP. Une participation accrue des femmes enceintes a la TAR a ete observee dans les cliniques ESP qui l'avaient integree (risque relatif, RR: 2,09; intervalle de confiance IC a 95%: 1,78 a 2,46; [I.sup.2]: 15%). Une couverture plus importante de la TAR a egalement ete notee dans ces cliniques (RR: 1,37; IC a 95%: 1,05 a 1,79; [I.sup.2]: 83%). Les analyses de sensibilite ont revele une tendance a la prevalence nationale de l'infection par le VIH pour expliquer l'heterogeneite de la taille de l'effet de l'integration de la TAR sur sa couverture (P = 0,13). La retention de la TAR etait similaire dans les cliniques ESP avec ou sans integration de la TAR. Conclusion Bien que peu de donnees aient ete disponibles, l'integration de la TAR dans les cliniques ESP semblait entrainer une augmentation des taux de participation et de couverture de la TAR. Les taux de retention de la TAR restent semblables a ceux qui sont observes dans les modeles de reference. Objetivo Determinar si la integraciin del tratamiento antirretroviral (TAR) en la atenciin prenatal (APN) y la salud materno-infantil (SMI) podria mejorar los resultados programaticos y del paciente. Metodos Partiendo de las bases de datos PubMed, Embase, Index Medicus de la Regiin de Africa y LiLACS, los autores realizaron busquedas sistematicas de ensayos controlados aleatorizados, estudios de cohortes prospectivos o estudios de cohortes retrospectivos en los que se compararon los resultados en clinicas de APN o SMI que habian y que no habian integrado elTAR. Los resultados de interes fueron la cobertura del TAR, la inclusiin en el TAR, la retenciin en el TAR, la mortalidad y la transmisiin del virus de la inmunodeficiencia humana (VIH). Resultados Cuatro estudios cumplieron los criterios de inclusiin. Todos ellos se realizaron en clinicas de APN. Se observi un aumento de la inclusiin de mujeres embarazadas en el TAR en aquellas clinicas de APN que se habian integrado el TAR (riesgo relativo, RR: 2,09, intervalo de confianza del 95%, IC; 1,78-2,46; [I.sup.2]: 15%). En estas clinicas tambien se observi un aumento de la cobertura del TAR (RR: 1,37; IC del 95%: 1,05-1,79; [I.sup.2]: 83%). Los analisis de sensibilidad revelaron una tendencia en la prevalencia nacional de la infecciin por el VIH para explicar la heterogeneidad en la magnitud del efecto de la integraciin del TAR sobre la cobertura del TAR (P=0,13). La retenciin en el TAR fue similar en las clinicas de APN con y sin integraciin del TAR. Conclusiin A pesar de la escasez de los datos disponibles, la integraciin del TAR en las clinicas de APN parece traducirse en mayores tasas de inclusiin en el TAR y de cobertura del TAR. Las tasas de retenciin en el TAR siguen siendo similares a las observadas en los modelos basados en derivaciones medicas., Introduction In 2009, 49% of pregnant women in low- and middle-income countries did not attend the minimum number of antenatal care (ANC) visits recommended by the World Health Organization (WHO) [...]

Objective To determine whether cotrimoxazole reduces mortality in adults receiving a ntiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection in low- and middle-income countries through a systematic review and meta-analysis. Methods PubMed and Embase were searched for randomized controlled trials and prospective and retrospective cohort studies that compared mortality or morbidity in HIV-infected individuals aged [greater than or equal to] 13 years on cotrimoxazole and ART and on ART alone. The NewcastleOttawa Quality Assessment Scale was used to assess selection, confounding and measurement bias. Publication bias was assessed using Egger's and Begg's tests. Sensitivity analysis was performed because the /-squared statistic indicated substantial heterogeneity in study results. A random-effects model was used for meta-analysis. Findings Nine studies were included. Begg and Egger P-values for the seven that reported the effect of cotrimoxazole on mortality were 0.29 and 0.49, respectively, suggesting no publication bias.The /-squared statistic was 93.2%, indicating high heterogeneity in study results. The sensitivity analysis showed that neither the follow-up duration nor the percentage of individuals with World Health Organization stage 3 or 4 HIV disease at baseline explained the heterogeneity. The summary estimate of the effect of cotrimoxazole on the incidence rate of death was 0.42 (95% confidence interval: 0.29-0.61). Since most studies followed participants for less than 1 year, it was not possible to determine whether cotrimoxazole can be stopped safely after ART-induced immune reconstitution. Conclusion Cotrimoxazole significantly increased survival in HIV-infected adults on ART. Further research is needed to determine the optimum duration of cotrimoxazole treatment in these patients. [TEXT NOT REPRODUCIBLE IN ASCII.] Effet du contrimoxazole sur la mortalite des adultes infectes par le VIH sous therapie antiretrovile: examine systematique et meta-analyse Objectif Determiner si le cotrimoxazole reduit la mortalite des adultes recevant une therapie antiretrovirale (TAR) contre l'infection par le virus de l'immunodeficience humaine (VIH) dans les pays a revenu faible et moyen, par un examen systematique et une meta-analyse. Methodes On a cherche dans PubMed et Embase des essais controles randomises et des etudes de cohorte prospectives et retrospectives comparant la mortalite ou la morbidite chez des individus ages de 13 ans et plus, infectes par le VIH, sous cotrimoxazole et TAR, et uniquement sous TAR. L'echelle d'evaluation de qualite Newcastle-Ottawa a ete utilisee pour evaluer les biais de selection, de confusion et de mesure. Le biais de publication a ete evalue a l'aide des tests d'Egger et de Begg. Une analyse de sensibilite a ete effectuee, car la statistique /-carre indiquait une heterogeneite importante des resultats de l'etude. Un modele a effets aleatoires a ete utilise pour la meta-analyse. Resultats Neuf etudes ont ete incluses. Les valeurs P de Begg et Egger pour les sept etudes rapportant l'effet du cotrimoxazole sur la mortalite etaient de 0,29 et de 0,49, respectivement, suggerant l'absence de biais de publication. La statistique /-carre etait de 93,2%, indiquant une forte heterogeneite des resultats de l'etude. Lanalyse de sensibilite a montre que ni la duree du suivi ni le pourcentage de personnes atteintes par le VIH au stade 3 et 4 de l'Organisation mondiale de la Sante, au moment de reference, n'expliquaient l'heterogeneite. L'estimation sommaire de l'effet du cotrimoxazole sur le taux d'incidence des deces etait de 0,42 (intervalle de confiance de 95%: 0,29-0,61). Comme la plupart des etudes avaient suivi les participants pendant moins d'un an, il netait pas possible de determiner si l'administration de cotrimoxazole pouvait etre interrompue en toute securite apres reconstitution immunitaire induite par le TAR. Conclusion Le cotrimoxazole augmentait significativement la survie des adultes infectes par le VIH sous traitement antiretroviral. Des recherches supplementaires sont necessaires pour definir la duree optimale du traitement par cotrimoxazole chez ces patients. [TEXT NOT REPRODUCIBLE IN ASCII.] Efecto de cotrimoxazol en la mortalidad de adultos por el VIH que reciben tratamiento antirretrovirico: examine sistematico y metaanalisis Objetivo Determinar si cotrimoxazol reduce la mortalidad en adultos que reciben tratamiento antirretrovirico (TAR) para el virus de la inmunodeficiencia humana (VlH) en paises de ingresos bajos y medios traves de un examen sistematico y un metaanalisis. Metodos Se realizo una busqueda en PubMed y Embase para evaluar los ensayos aleatorizados controlados y los estudios de cohortes prospectivos y retrospectivos en los que se comparaban la mortalidad o la morbilidad en personas infectadas por el VIH con edades [greater than or equal] 13 anos en trata miento con cotrimoxazol y TAR, y solo con TAR. Se utilizo la Escala de Evaluacion de la Calidad de Newcastle-Ottawa para evaluar el sesgo de seleccion, de confusion y de medicion. El sesgo de publicacion se evaluo mediante los tests de Egger y Begg. Se llevo a cabo un analisis de sensibilidad debido a que la estadistica/-cuadrado indico una heterogeneidad significativa en los resultados del estudio. El metanalisis siguio un modelo de efectos aleatorios. Resultados Se incluyeron nueve estudios. Los valores de P de Begg y Egger para los siete estudios que recogieron el efecto de cotrimoxazol sobre la mortalidad fueron de 0,29 y 0,49, respectivamente, lo que sugiere que no existe sesgo de publicacion. La estadistica /-cuadrado fue del 93,2%, lo que indica una alta heterogeneidad en los resultados de los estudios. El analisis de sensibilidad mostro que dicha heterogeneidad no se debe ni a la duracion de seguimiento ni al porcentaje de individuos con enfermedad por el VIH en los estadios 3 o 4 segun la Organizacion Mundial de la Salud al inicio del estudio. La estimacion global de los efectos del cotrimoxazol sobre la tasa de incidencia de la muerte fue de 0,42 (intervalo de confianza del 95%: 0,29-0,61). Dado que la mayoria de los estudios realizaron un seguimiento de los participantes durante menos de 1 ano, nofue posible determinar la posibilidad de suspender la administracion de cotrimoxazol sin peligro despues de la restauracion inmunitaria inducida por la TAR. Conclusion Cotrimoxazol aumento significativamente la supervivencia en adultos infectados por el VIH que recibieron TAR. Es preciso llevar a cabo investigaciones adicionales con el objetivo de determinar la duracion optima del tratamiento con cotrimoxazol en estos pacientes., Introduction In 2010, there were 1.8 million deaths among the 34 million people infected with the human immunodeficiency virus (HIV). (1) Of these deaths, 1.2 million occurred in the 22.9 [...]

Summary Points * New oral short-duration regimens using direct-acting antiviral medicines for hepatitis C virus (HCV) have the potential to facilitate treatment and improve outcomes. * Translating scientific advances into reduced disease burden requires well-designed programmes encompassing prevention, screening, treatment, and strategic information. * Engagement from countries, civil society, donors, and policymakers is needed to generate political commitment, mobilise resources, and reduce diagnostic and medicine costs for HCV. * Countries should estimate the resources required to implement planned HCV prevention, screening, and treatment strategies and their expected health, societal, and financial benefits to mobilise domestic and international funding. * Countries could integrate HCV prevention, screening, treatment, and strategic information into HIV/AIDS programmes for financial, infrastructural, and health workforce efficiencies., Introduction An estimated 130-150 million people live with hepatitis C virus (HCV) [1]. A significant number of people with HCV will progress to chronic disease, hepatocellular carcinoma, and death [2]. [...]

Background: Effective national and global HIV responses require a significant expansion of HIV testing and counselling (HTC) to expand access to prevention and care. Facility-based HTC, while essential, is unlikely to meet national and global targets on its own. This article systematically reviews the evidence for community-based HTC. Methods and Findings: PubMed was searched on 4 March 2013, clinical trial registries were searched on 3 September 2012, and Embase and the World Health Organization Global Index Medicus were searched on 10 April 2012 for studies including community-based HTC (i.e., HTC outside of health facilities). Randomised controlled trials, and observational studies were eligible if they included a community-based testing approach and reported one or more of the following outcomes: uptake, proportion receiving their first HIV test, CD4 value at diagnosis, linkage to care, HIV positivity rate, HTC coverage, HIV incidence, or cost per person tested (outcomes are defined fully in the text). The following community-based HTC approaches were reviewed: (1) door-to-door testing (systematically offering HTC to homes in a catchment area), (2) mobile testing for the general population (offering HTC via a mobile HTC service), (3) index testing (offering HTC to household members of people with HIV and persons who may have been exposed to HIV), (4) mobile testing for men who have sex with men, (5) mobile testing for people who inject drugs, (6) mobile testing for female sex workers, (7) mobile testing for adolescents, (8) self-testing, (9) workplace HTC, (10) church-based HTC, and (11) school-based HTC. The Newcastle- Ottawa Quality Assessment Scale and the Cochrane Collaboration's 'risk of bias' tool were used to assess the risk of bias in studies with a comparator arm included in pooled estimates. 117 studies, including 864,651 participants completing HTC, met the inclusion criteria. The percentage of people offered community-based HTC who accepted HTC was as follows: index testing, 88% of 12,052 participants; self-testing, 87% of 1,839 participants; mobile testing, 87% of 79,475 participants; door-to-door testing, 80% of 555,267 participants; workplace testing, 67% of 62,406 participants; and school-based testing, 62% of 2,593 participants. Mobile HTC uptake among key populations (men who have sex with men, people who inject drugs, female sex workers, and adolescents) ranged from 9% to 100% (among 41,110 participants across studies), with heterogeneity related to how testing was offered. Community- based approaches increased HTC uptake (relative risk [RR] 10.65, 95% confidence interval [CI] 6.27-18.08), the proportion of first-time testers (RR 1.23, 95% CI 1.06-1.42), and the proportion of participants with CD4 counts above 350 cells/ml (RR 1.42, 95% CI 1.16-1.74), and obtained a lower positivity rate (RR 0.59, 95% CI 0.37-0.96), relative to facility-based approaches. 80% (95% CI 75%-85%) of 5,832 community-based HTC participants obtained a CD4 measurement following HIV diagnosis, and 73% (95% CI 61%-85%) of 527 community-based HTC participants initiated antiretroviral therapy following a CD4 measurement indicating eligibility. The data on linking participants without HIV to prevention services were limited. In low- and middle-income countries, the cost per person tested ranged from US$2-US$126. At the population level, community-based HTC increased HTC coverage (RR 7.07, 95% CI 3.52-14.22) and reduced HIV incidence (RR 0.86, 95% CI 0.73-1.02), although the incidence reduction lacked statistical significance. No studies reported any harm arising as a result of having been tested. Conclusions: Community-based HTC achieved high rates of HTC uptake, reached people with high CD4 counts, and linked people to care. It also obtained a lower HIV positivity rate relative to facility-based approaches. Further research is needed to further improve acceptability of community-based HTC for key populations. HIV programmes should offer community-based HTC linked to prevention and care, in addition to facility-based HTC, to support increased access to HIV prevention, care, and treatment. Review Registration: International Prospective Register of Systematic Reviews CRD42012002554 Please see later in the article for the Editors' Summary., Introduction HIV is a leading cause of morbidity and mortality globally [1]. Despite considerable progress in controlling the epidemic, there were approximately 2.2 million new HIV infections, 1.7 million HIV-related [...]

Background: Human immunodeficiency virus (HIV) infection is the strongest risk factor for developing tuberculosis and has fuelled its resurgence, especially in sub-Saharan Africa. In 2010, there were an estimated 1.1 million incident cases of tuberculosis among the 34 million people living with HIV worldwide. Antiretroviral therapy has substantial potential to prevent HIV-associated tuberculosis. We conducted a systematic review of studies that analysed the impact of antiretroviral therapy on the incidence of tuberculosis in adults with HIV infection. Methods and Findings: PubMed, Embase, African Index Medicus, LILACS, and clinical trial registries were systematically searched. Randomised controlled trials, prospective cohort studies, and retrospective cohort studies were included if they compared tuberculosis incidence by antiretroviral therapy status in HIV-infected adults for a median of over 6 mo in developing countries. For the meta-analyses there were four categories based on CD4 counts at antiretroviral therapy initiation: (1) less than 200 cells/µl, (2) 200 to 350 cells/µl, (3) greater than 350 cells/µl, and (4) any CD4 count. Eleven studies met the inclusion criteria. Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis in all baseline CD4 count categories: (1) less than 200 cells/µl (hazard ratio [HR] 0.16, 95% confidence interval [CI] 0.07 to 0.36), (2) 200 to 350 cells/µl (HR 0.34, 95% CI 0.19 to 0.60), (3) greater than 350 cells/µl (HR 0.43, 95% CI 0.30 to 0.63), and (4) any CD4 count (HR 0.35, 95% CI 0.28 to 0.44). There was no evidence of hazard ratio modification with respect to baseline CD4 count category (p = 0.20). Conclusions: Antiretroviral therapy is strongly associated with a reduction in the incidence of tuberculosis across all CD4 count strata. Earlier initiation of antiretroviral therapy may be a key component of global and national strategies to control the HIV-associated tuberculosis syndemic. Review Registration: International Prospective Register of Systematic Reviews CRD42011001209 Please see later in the article for the Editors' Summary., Introduction Tuberculosis and human immunodeficiency virus (HIV) are major threats to global public health. HIV infection is the strongest risk factor for tuberculosis and has fuelled its resurgence [1]. In [...]

The article offers a report on key determinants of human immunodeficiency virus (HIV) drug resistance in low- and middle-income countries. it mentions 11 percent of antimicrobials contained subtherapeutic concentrations of active pharmaceutical ingredients; people with HIV exposed to subtherapeutic antiretroviral are at increased risk of developing HIV drug resistance; and importance of central procurement and distribution systems for sustained availability of quality-assured medicines.

Although COVID-19 generally results in milder disease in children and adolescents than in adults, severe illness from COVID-19 can occur in children and adolescents and might require hospitalization and intensive care unit (ICU) support (1-3). It is not known whether the B.1.617.2 (Delta) variant,* which has been the predominant variant of SARS-CoV-2 (the virus that causes COVID-19) in the United States since late June 2021, † causes different clinical outcomes in children and adolescents compared with variants that circulated earlier. To assess trends among children and adolescents, CDC analyzed new COVID-19 cases, emergency department (ED) visits with a COVID-19 diagnosis code, and hospital admissions of patients with confirmed COVID-19 among persons aged 0-17 years during August 1, 2020-August 27, 2021. Since July 2021, after Delta had become the predominant circulating variant, the rate of new COVID-19 cases and COVID-19-related ED visits increased for persons aged 0-4, 5-11, and 12-17 years, and hospital admissions of patients with confirmed COVID-19 increased for persons aged 0-17 years. Among persons aged 0-17 years during the most recent 2-week period (August 14-27, 2021), COVID-19-related ED visits and hospital admissions in the states with the lowest vaccination coverage were 3.4 and 3.7 times that in the states with the highest vaccination coverage, respectively. At selected hospitals, the proportion of COVID-19 patients aged 0-17 years who were admitted to an ICU ranged from 10% to 25% during August 2020-June 2021 and was 20% and 18% during July and August 2021, respectively. Broad, community-wide vaccination of all eligible persons is a critical component of mitigation strategies to protect pediatric populations from SARS-CoV-2 infection and severe COVID-19 illness., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Sapna Bamrah Morris serves on the data safety monitoring board for the PaTS COVID Cohort2 Trial (Africa). No other potential conflicts of interest were disclosed.

Background: Few studies have assessed the effects of antiretroviral therapy (ART) to prevent HIV transmission in Asian HIV epidemics. Vietnam has a concentrated HIV epidemic with the highest prevalence among people who inject drugs. We investigated the impact of expanded HIV testing and counseling (HTC) and early ART, combined with other prevention interventions on HIV transmission., Methods: A deterministic mathematical model was developed using HIV prevalence trends in Can Tho province, Vietnam. Scenarios included offering periodic HTC and immediate ART with and without targeting subpopulations and examining combined strategies with methadone maintenance therapy and condom use., Results: From 2011 to 2050, maintaining current interventions will incur an estimated 18,115 new HIV infections and will cost US $22.1 million (reference scenario). Annual HTC and immediate treatment, if offered to all adults, will reduce new HIV infections by 14,513 (80%) and will cost US $76.9 million. Annual HTC and immediate treatment offered only to people who inject drugs will reduce new infections by 13,578 (75%) and will cost only US $23.6 million. Annual HTC and immediate treatment for key populations, combined with scale-up of methadone maintenance therapy and condom use, will reduce new infections by 14,723 (81%) with similar costs (US $22.7 million). This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years and will result in a relative cost saving after 19 years., Conclusions: Targeted periodic HTC and immediate ART combined with other interventions is cost-effective and could lead to potential elimination of HIV in Can Tho.

Objective: This article reviews the antiretroviral therapy (ART)initiation criteria from national treatment guidelines for 70 countries and determines the extent of consistency with the current World Health Organization (WHO) recommendations., Methods: Published ART guidelines were collected from the Internet, databases, and WHO staff. ART eligibility criteria for asymptomatic people, pregnant women, people with HIV-associated tuberculosis, serodiscordant couples, injecting drug users, men who have sex with men, and sex workers were abstracted from them. Multiple regression analysis was used to determine the relation between ART eligibility criteria, ART coverage, and various population characteristics and policy interventions., Results: Of the 70 countries, 42 (60%) follow WHO’s ART guidelines for asymptomatic people and 31 (44%) for pregnant women,recommending ART at CD4 count of ≤350 cells/mm(3). Twenty-three(33%) countries recommend ART for people with HIV-associated tuberculosis irrespective of CD4 count. Nineteen countries are also recommending or considering earlier ART above CD4 count ≤350 cell/mm(3) for asymptomatic people, pregnant women, and/or serodiscordant couples. Multiple linear regression analysis shows that HIV prevalence, year of publication of guidelines, and HIV expenditure are significantly associated with published ART eligibility criteria. On average, the ART coverage is similar irrespective of published guidelines being consistent with the WHO recommendation(P , 0.53)., Conclusions: Published guidelines from a significant number of countries are not following WHO recommendations. Although published guidelines may not reflect practice, it is important to adapt recommendations and services quickly to reflect the emerging science on the health and prevention benefits of earlier access to ART.