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Background: The increasing shortage of specialized health care services contributes to the ongoing HIV epidemic. Telemedicine (TM) is a potential tool to improve HIV care, but little is known about its effectiveness when compared with traditional (face-to-face [F2F]) care in rural populations. The objective of this study was to compare the effectiveness of HIV care delivered through TM with the F2F model., Methods: We conducted a retrospective chart review of a subset of patients with HIV who attended a TM clinic in Dublin, Georgia, and an F2F clinic in Augusta, Georgia, between May 2017 and April 2018. All TM patients were matched to F2F patients based on gender, age, and race. HIV viral load (VL) and CD4 count gain were compared using t test and Mann-Whitney U statistics., Results: Three hundred eighty-five patients were included in the analyses (F2F = 200; TM = 185). The mean CD4 in the TM group was higher (643.9 cells/mm 3 ) than that of the F2F group (596.3 cells/mm 3 ; P  < .001). There was no statistically significant difference in VL reduction, control, or mean VL (F2F = 416.8 cp/mL; TM = 713.4 cp/mL; P  = .30). Thirty-eight of eighty-five patients with detectable VL achieved viral suppression during the study period (F2F = 24/54; TM = 14/31), with a mean change of 3.34 × 10 4 and -1 to 0.24 × 10 4 , respectively ( P  = 1.00)., Conclusions: TM was associated with outcome measures comparable to F2F. Increased access to specialty HIV care through TM can facilitate HIV control in communities with limited health care access in the rural United States. Rigorous prospective evaluation of TM for HIV care effectiveness is warranted., (© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Odontogenic bacteremia, most commonly involving gram-positive oral flora, can result from daily self-care practices or professional dental procedures. Though usually transient and quickly cleared by the immune system, the presence of periodontal disease increases the frequency of exposure and risk of persistence of oral-systemic infections. Comorbidities such as asplenia, alcoholism, and immunocompromise increase the risk of complications of hematogenous spread and severe systemic illness. Capnocytophaga is a genus of anaerobic fastidious gram-negative bacilli, which is a common member of human oral flora, and its density is proportional to mass of dental plaques and periodontal diseases. Capnocytophaga spp that colonize humans are less virulent and are uncommon causes of bacteremia when compared with the Capnocytophaga typical of canines. C gingivalis has been rarely reported as a cause of disease in immunocompromised or immunocompetent hosts. In this article, we present a case of an immunocompromised 70-year-old man with poor oral hygiene, on methotrexate and prednisone for rheumatoid arthritis and sarcoidosis, who was admitted for chronic obstructive pulmonary disease exacerbation and developed C gingivalis bacteremia and septic shock after an episode of upper gastrointestinal bleeding. Poor oral hygiene in our patient is believed to have increased his risk as an immunocompromised patient to developing C gingivalis bacteremia. This case highlights the importance of oral care in immunocompromised patients especially while hospitalized, and those about to receive transplant, chemotherapy, or on immune modulators.

The debate around the COVID-19 response in Africa has mostly focused on effects and implications of public health measures, in light of the socio-economic peculiarities of the continent. However, there has been limited exploration of the impact of differences in epidemiology of key comorbidities, and related healthcare factors, on the course and parameters of the pandemic. We summarise what is known about (a) the pathophysiological processes underlying the interaction of coinfections and comorbidities in shaping prognosis of COVID-19 patients, (b) the epidemiology of key coinfections and comorbidities, and the state of related healthcare infrastructure that might shape the course of the pandemic, and (c) implications of (a) and (b) for pandemic management and post-pandemic priorities. There is a critical need to generate empirical data on clinical profiles and the predictors of morbidity and mortality from COVID-19. Improved protocols for acute febrile illness and access to diagnostic facilities, not just for SARS-CoV-2 but also other viral infections, are of urgent importance. The role of malaria, HIV/TB and chronic malnutrition on pandemic dynamics should be further investigated. Although chronic non-communicable diseases account for a relatively lighter burden, they have a significant effect on COVID-19 prognosis, and the fragility of care delivery systems implies that adjustments to clinical procedures and re-organisation of care delivery that have been useful in other regions are unlikely to be feasible. Africa is a large region with local variations in factors that can shape pandemic dynamics. A one-size-fits-all response is not optimal, but there are broad lessons relating to differences in epidemiology and healthcare delivery factors, that should be considered as part of a regional COVID-19 response framework., (© 2020 John Wiley & Sons Ltd.)

The co-infection of HIV and COVID-19 is a pressing health concern, carrying substantial potential consequences. This study focuses on the vital task of comprehending the dynamics of HIV-COVID-19 coinfection, a fundamental step in formulating efficacious control strategies and optimizing healthcare approaches. Here, we introduce an innovative mathematical model grounded in Caputo fractional order differential equations, specifically designed to encapsulate the intricate dynamics of co-infection. This model encompasses multiple critical facets: the transmission dynamics of both HIV and COVID-19, the host’s immune responses, and the influence of treatment interventions. Our approach embraces the complexity of these factors to offer an exhaustive portrayal of co-infection dynamics. To tackle the fractional order model, we employ the Laplace-Adomian decomposition method, a potent mathematical tool for approximating solutions in fractional order differential equations. Utilizing this technique, we simulate the intricate interactions between these variables, yielding profound insights into the propagation of co-infection. Notably, we identify pivotal contributors to its advancement. In addition, we conduct a meticulous analysis of the convergence properties inherent in the series solutions acquired through the Laplace-Adomian decomposition method. This examination assures the reliability and accuracy of our mathematical methodology in approximating solutions. Our findings hold significant implications for the formulation of effective control strategies. Policymakers, healthcare professionals, and public health authorities will benefit from this research as they endeavor to curtail the proliferation and impact of HIV-COVID-19 co-infection. [ABSTRACT FROM AUTHOR]

Telemedicine has been increasingly utilized in health sector. In our study we bring to light various applications of telemedicine consultation for patients receiving antiretroviral therapy. We have observed that in a resource-limited setting, CD4-based assessment via telemedicine can still be useful, provided a serial record is maintained. We evaluated 430 cases in terms of demographics, CD4-trend and adverse effect profile. Tracking and monitoring of lost to follow-up cases could be done using this platform. Aim: The study focuses on the benefits of using telemedicine as a tool for consultation and referral of people living with HIV at centers located away from tertiary care institutes. Settings and Design: The study was conducted at telemedicine center, which is a tertiary referral center for all the districts in Maharashtra. We retrospectively analyzed the data obtained from telemedicine consultations carried out for patients from district‑level antiretroviral therapy (ART) center. Methods and Material: The subjects who satisfied the following criteria were included for data analysis. Inclusion Criteria: All the HIV‑infected persons on antiretroviral therapy enrolled at distant ART centers for which opinion was sought through telemedicine. This is an observational retrospective study. We reviewed the records of all patients enrolled in HIV healthcare through National Aids Control Organization from distant treating antiretroviral therapy centers (henceforth referred to as ART centers) for whom expert consultation was sought through telemedicine. These patients were given opinion for several consultations including response to therapy, management of opportunistic infections, drug‑related adverse events, and treatment failure. We analyzed the demographics, the duration of treatment, and response to therapy. Statistical Analysis Used: Descriptive data analysis is used in this study. Results: We analyzed 430 case referrals through telemedicine from ART center. In 21% (N = 94) patients, CD4 was less than 50 and 11 cases had CD4 more than 500. An increasing CD4 trend was noted in 190 cases and a decreasing trend in 204 cases. In 36 cases, there was no change in CD4 progression. We had 20 cases lost to follow‑up. The baseline regimen was Zidovudine Lamivudine Nevirapine (ZLN) in most cases (N = 237). Adverse drug reactions were the reasons for referral in 79 cases, maximum being AZT‑induced anemia (N = 57). Of the total 430 cases referred, 253 cases had been wait‑listed for SACEP meeting as per existing protocol. In 177 cases, physical attendance for the SACEP meeting could be deferred. Conclusion: Telemedicine has emerged as an immensely useful tool in management of People Living with HIV (PLHIV). [ABSTRACT FROM AUTHOR]

Oral Squamous Cell Carcinoma (OSCC) is the most common type of head and neck cancer worldwide. Emerging research suggests a strong association between OSCC and the oral microbiota, a diverse community of bacteria, fungi, viruses, and archaea. Pathogenic bacteria, in particular Porphyromonas gingivalis and Fusobacterium nucleatum, have been closely linked to OSCC. Moreover, certain oral fungi, such as Candida albicans, and viruses, like the human papillomavirus, have also been implicated in OSCC. Despite these findings, the precise mechanisms through which the oral microbiota influences OSCC development remain unclear and necessitate further research. This paper provides a comprehensive overview of the oral microbiota and its relationship with OSCC and discusses potential carcinogenic pathways that the oral microbiota may activate or modulate are also discussed. [ABSTRACT FROM AUTHOR]

Background: When the COVID pandemic hit the world, there was need for applied guides and training materials to support frontline health care staff to manage patients effectively and safely and to educate themselves and communities. This article reports on the development and piloting of such a set of materials in Sierra Leone, which were based on international evidence but adapted to the local context. Reflecting on this experience, including community and health system barriers and enablers, is important to prepare for future regional shocks. Methods: This study, in Bombali district in 2020, piloted user-friendly COVID guides for frontline health workers (the intervention), which was evaluated using facility checklists (pre and post training), routine data analysis and 32 key informant interviews. Results: Key informants at district, hospital and community health centre levels identified gains from the training and desk guides, including improved diagnosis, triaging, infection prevention and management of patients. They also reported greater confidence to share messages on protection with colleagues and community members, which was needed to encourage continued use of essential services during the pandemic. However, important barriers were also revealed, including the lack of testing facilities, which reduced the sense of urgency, as few cases were identified. Actions based on the Ebola experience, such as setting up testing and isolation centres, which the community avoided, were not appropriate to COVID. Stigma and fear were important factors, although these were reduced with outreach activities. Supplies of essential medicines and personal protective equipment were also lacking. Conclusion: This pilot study demonstrated the relevance and importance of guides adapted to the context, which were able to improve the confidence of health staff to manage their own and the community's fears in the face of a new pandemic and improve their skills. Previous epidemics, particularly Ebola, complicated this by both creating structures that could be revitalised but also assumptions and behaviours that were not adapted to the new disease. Our study documents positive adaptations and resilience by health staff but also chronic system weaknesses (particularly for medicines, supplies and equipment) which must be urgently addressed before the next shock arrives. [ABSTRACT FROM AUTHOR]

Purpose: Understanding the influence of microorganisms in patients with acquired nasolacrimal duct obstruction (NLDO) and investigating their effect on recurrence after external dacryocystorhinostomy (DCR). Methods: This prospective study included 50 patients. Evaluations were made before, on the first postoperative day and monthly after DCR. Nasolacrimal silicon tubes (NST) were removed after three months. Before the DCR, swab samples were taken from both hands and lower conjunctival fornices and from the lacrimal sac during the first DCR and from the relapsed cases during the second DCR. Results: Growth was observed in 90 (45%) cultures out of 200 and a total of 23 different strains were identified altogether. Staphylococcus aureus (40%) and Streptococcus pneumoniae (28%) were dominantly isolated which were all resistant to penicillin, tetracycline and erythromycin. Lacrimal syringing (LS) was successful in patients (100%) on the first postoperative day. After three months, before NST removal, purulent discharge from the punctum was observed in five patients, and blockage was detected by LS. S. pneumoniae was isolated from all five patients' obstructed side conjunctival cultures. Additionally, from their lacrimal sac, S. pneumoniae (4 patients), Capnocytophaga gingivalis, and Candida spp. (1 patient) strains were isolated. S pneumoniae was isolated in four out of five patients from the ipsilateral conjunctival and lacrimal sac cultures which obtained from the subsequent DCR. Conclusion: Our results showed that S. pneumoniae was an isolated and persistent strain in cases with early recurrence even after a successful DCR. [ABSTRACT FROM AUTHOR]

The emergence of the COVID-19 pandemic necessitated rapid expansion of telehealth as part of healthcare delivery. This study compared HIV-related no-shows by visit type (in-person; video; telephone) during the COVID-19 pandemic (April 2020–September 2021) from the Data for Care Alabama project. Using all primary care provider visits, each visit's outcome was categorized as no-show or arrived. A logistic regression model using generalized estimating equations accounting for repeat measures in individuals and within sites calculated odds ratios (OR) and their accompanying 95% confidence interval (CI) for no-shows by visit modality. The multivariable models adjusted for sociodemographic factors. In-person versus telephone visits [OR (95% CI) 1.64 (1.48–1.82)] and in-person versus video visits [OR (95% CI) 1.53 (1.25–1.85)] had higher odds of being a no-show. In-person versus telephone and video no-shows were significantly higher. This may suggest success of telehealth visits as a method for HIV care delivery even beyond COVID-19. [ABSTRACT FROM AUTHOR]

Background: The resurgence of HIV outbreaks and rising prevalence among people who inject drugs (PWID) remain exigent obstacles to Ending the HIV Epidemic in the USA. Adapting a low threshold, comprehensive treatment model for PWID with HIV can leverage syringe services programs (SSPs) to increase availability and accessibility of antiretrovirals (ART), medications for opioid use disorder (MOUD), and hepatitis C cure. We developed Tele-Harm Reduction, a telehealth-enhanced, harm reduction intervention delivered within an SSP venue. Methods: The T-SHARP trial is an open-label, multi-site, randomized controlled superiority trial with two parallel treatment arms. Participants (n=240) recruited from SSPs in Miami, Ft. Lauderdale, and Tampa, Florida, who are PWID with uncontrolled HIV (i.e., HIV RNA>200) will be randomized to Tele-Harm Reduction or off-site linkage to HIV care. The primary objective is to compare the efficacy of Tele-Harm Reduction for initiation of ART at SSPs vs. off-site linkage to an HIV clinic with respect to viral suppression across follow-up (suppression at 3, 6, and 12 months post randomization). Participants with HIV RNA<200 copies/ml will be considered virally suppressed. The primary trial outcome is time-averaged HIV viral suppression (HIV RNA <200 copies/ml) over 3-, 6-, and 12-month follow-up. Secondary outcomes include initiation of MOUD measured by urine drug screen and HCV cure, defined as achieving 12-week sustained virologic response (negative HCV RNA at 12 weeks post treatment completion). A cost-effectiveness analysis will be performed. Discussion: The T-SHARP Trial will be the first to our knowledge to test the efficacy of an innovative telehealth intervention with PWID with uncontrolled HIV delivered via an SSP to support HIV viral suppression. Tele-Harm Reduction is further facilitated by a peer to support adherence and bridge the digital divide. This innovative, flipped healthcare model sets aside the traditional healthcare system, reduces multi-level barriers to care, and meets PWID where they are. The T-SHARP trial is a pragmatic clinical trial that seeks to transform the way that PWID access HIV care and improve HIV clinical outcomes. Trial registration: ClinicalTrials.gov NCT05208697. Trial registry name: Tele-Harm Reduction. Registration date: January 26, 2022. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review summarizes HIV care delivered via telemedicine before and during the COVID-19 pandemic and highlights areas of study to inform optimal usage of telemedicine in HIV clinical practice in the future. Recent Findings: To address barriers to care created by the COVID-19 pandemic, regulatory agencies and payors waived longstanding restrictions, which enabled rapid expansion of telemedicine across the country. Preliminary data show that providers and persons with HIV (PWH) view telemedicine favorably. Some data suggest telemedicine has facilitated retention in care, but other studies have found increasing numbers of PWH lost to follow-up and worsened virologic suppression rates despite offering video and/or telephone visits. Summary: The COVID-19 pandemic has exacerbated gaps in the HIV care continuum. To help mitigate the impact, most clinics have adopted new virtual care options and are now evaluating usage, impact, and concerns. Further research into the effects of telemedicine on HIV care and continued work towards universal access are needed. [ABSTRACT FROM AUTHOR]