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34 emner vises.
Di Giacomo S, Toussaint F, Ledesma-García L, et al.
FEMS Microbiology Reviews, 7.03.2022
Tilføjet 14.03.2022
AbstractNowadays, the growing human population exacerbates the need for sustainable resources. Inspiration and achievements in nutrient production or human/animal health might emanate from microorganisms and their adaptive strategies. Here, we exemplify the benefits of lactic acid bacteria (LAB) for numerous biotechnological applications and showcase their natural transformability as a fast and robust method to hereditarily influence their phenotype/traits in fundamental and applied research contexts. We described the biogenesis of the transformation machinery and we analyzed the genome of hundreds of LAB strains exploitable for human needs to predict their transformation capabilities. Finally, we provide a stepwise rational path to stimulate and optimize natural transformation with standard and synthetic biology techniques. A comprehensive understanding of the molecular mechanisms driving natural transformation will facilitate and accelerate the improvement of bacteria with properties that serve broad societal interests.
Læs mere Tjek på PubMedGallagher K, Leick M, Larson R, et al.
Clinical Infectious Diseases, 12.03.2022
Tilføjet 14.03.2022
AbstractCOVID-19 breakthrough cases among vaccinated individuals demonstrate the value of measuring long-term immunity to SARS-CoV-2 and its variants. We demonstrate that anti-spike T-cell responses and IgG antibody levels are maintained but decrease over time and are lower in the BNT162b2- versus mRNA-1273-vaccinated individuals. T-cell responses to the variants are relatively unaffected.
Læs mere Tjek på PubMedAby E, Vaughn B, Enns E, et al.
Clinical Infectious Diseases, 11.03.2022
Tilføjet 14.03.2022
AbstractBackgroundBoth the American College of Gastroenterology and the Infectious Disease Society of America (IDSA) / Society of Healthcare Epidemiology of American 2021 Clostridioides difficile infection (CDI) guidelines recommend fecal microbiota transplantation (FMT) for persons with multiple recurrent CDI. Emerging data suggest that FMT may have high cure rates when used for first recurrent CDI. The aim of this study was to assess the cost-effectiveness of FMT for first recurrent CDI.MethodsWe developed a Markov model to simulate a cohort of patients presenting with initial CDI infection. The model estimated the costs, effectiveness, and cost-effectiveness of different CDI treatment regimens recommended in the 2021 IDSA guidelines, with the additional option of FMT for first recurrent CDI. The model includes stratification by the severity of initial infection, estimates of cure, recurrence, and mortality. Data sources were taken from IDSA guidelines and published literature on treatment outcomes. Outcome measures were quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).ResultsWhen FMT is available for first recurrent CDI, the optimal cost-effective treatment strategy is fidaxomicin for initial non-severe CDI, Vancomycin for initial severe CDI, and FMT for first and subsequent recurrent CDI, with an ICER of $27,135/QALY. In probabilistic sensitivity analysis at a $100,000 cost-effectiveness threshold, FMT for first and subsequent CDI recurrence was cost-effective 90% of the time given parameter uncertainty.ConclusionsFMT is a cost-effective strategy for first recurrent CDI. Prospective evaluation of FMT for first recurrent CDI is warranted to determine the efficacy and risk of recurrence.
Læs mere Tjek på PubMedKarampatsas K, Davies H, Mynarek M, et al.
Clinical Infectious Diseases, 11.03.2022
Tilføjet 14.03.2022
AbstractBackgroundGroup B streptococcal (GBS) infection remains one of the most significant causes of late-onset sepsis and meningitis (LOGBS) among young infants. However, transmission routes and risk factors for LOGBS are not yet fully understood.MethodsWe conducted systematic reviews on clinical risk factors previously reported in the literature (prematurity, low birth weight [<2500 g], antenatal colonization, multiple-gestation pregnancy, maternal age <20 years, male infant sex, intrapartum fever, prolonged rupture of membranes) and meta-analyses to determine pooled estimates of risk.ResultsWe included 27 articles, reporting 5315 cases. Prematurity (odds ratio 5.66; 95% confidence interval [4.43-7.22]), low birth weight (6.73; [4.68-9.67]), maternal colonization (2.67; [2.07-3.45]), and multiple-gestation pregnancies (8.01; [5.19-12.38]) were associated with an increased risk of LOGBS.ConclusionsPrematurity/low birth weight and maternal colonization are major risk factors for LOGBS. Future GBS vaccine studies should try to establish the optimal time for vaccination during pregnancy to protect preterm infants.
Læs mere Tjek på PubMedShivasabesan G, Logan B, Brennan X, et al.
Clinical Infectious Diseases, 11.03.2022
Tilføjet 14.03.2022
AbstractWe present the first published case of successfully treated disseminated Aspergillus lentulus infection in a solid organ transplant recipient with invasive pulmonary disease, endophthalmitis, and a cerebral abscess. This case highlights important challenges associated with treating Aspergillus lentulus, particularly regarding antifungal resistance and toxicities associated with long-term antifungal therapy.
Læs mere Tjek på PubMedIzurieta P, AbdelGhany M, Paynter J, et al.
Clinical Infectious Diseases, 11.03.2022
Tilføjet 14.03.2022
Effie E. Bastounis, Prathima Radhakrishnan, Christopher K. Prinz, Julie A. Theriot aInterfaculty Institute of Microbiology & Infection Medicine, Cluster of Excellence CMFI, University of Tübingen, Tübingen, Baden-Württemberg, Germany bDepartment of Biology, University of Washington, Seattle, Washington, USA cHoward Hughes Medical Institute, University of Washington, Seattle, Washington, USA dBiophysics Program, Stanford University, Stanford, California, USA
Microbiology and Molecular Biology Reviews, 14.03.2022
Tilføjet 14.03.2022
M, J., Ganeshkumar, P., Kaur, P., Masanam Sriramulu, H., Sakthivel, M., Rubeshkumar, P., Raju, M., Murugesan, L., Ganapathi, R., Srinivasan, M., Sukumar, A., Ilangovan, K., Reddy, M., Shanmugam, D., Govindasamy, P., Murhekar, M.
BMJ Open, 14.03.2022
Tilføjet 14.03.2022
Objectives
To describe the public health strategies and their effect in controlling the COVID-19 pandemic from March to October 2020 in Chennai, India.
Setting
Chennai, a densely populated metropolitan city in Southern India, was one of the five cities which contributed to more than half of the COVID-19 cases in India from March to May 2020. A comprehensive community-centric public health strategy was implemented for controlling COVID-19, including surveillance, testing, contact tracing, isolation and quarantine. In addition, there were different levels of restrictions between March and October 2020.
Participants
We collected the deidentified line list of all the 192 450 COVID-19 cases reported from 17 March to 31 October 2020 in Chennai and their contacts for the analysis. We defined a COVID-19 case based on the real-time reverse transcriptase-PCR (RT-PCR) positive test conducted in one of the government-approved labs.
Outcome measures
The primary outcomes of interest were incidence of COVID-19 per million population, case fatality ratio (CFR), deaths per million, and the effective reproduction number (Rt). We also analysed the surveillance, testing, contact tracing and isolation indicators.
Results
Of the 192 450 RT-PCR confirmed COVID-19 cases reported in Chennai from 17 March to 31 October 2020, 114 889 (60%) were males. The highest incidence was 41 064 per million population among those 61–80 years. The incidence peaked during June 2020 at 5239 per million and declined to 3627 per million in October 2020. The city reported 3543 deaths, with a case fatality ratio of 1.8%. In March, Rt was 4.2, dropped below one in July and remained so until October, even with the relaxation of restrictions.
Conclusion
The combination of public health strategies might have contributed to controlling the COVID-19 epidemic in a large, densely populated city in India. We recommend continuing the test-trace-isolate strategy and appropriate restrictions to prevent resurgence.
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Pelkonen, T., Roine, I., Kallio, M., Jahnukainen, K., Peltola, H.
BMJ Open, 14.03.2022
Tilføjet 14.03.2022
Objectives
To describe the prevalence and severity of anaemia and to examine its associations with outcome in children with bacterial meningitis (BM).
Design
Secondary analysis of descriptive data from five randomised BM treatment trials.
Setting
Hospitals in Finland, Latin America and Angola.
Participants
Consecutive children from 2 months to 15 years of age admitted with BM and who had haemoglobin (Hb) measured on admission.
Outcome measures
Prevalence and degree of anaemia using the WHO criteria, and their associations with recovery with sequelae or death.
Results
The median Hb was 11.8 g/dL in Finland (N=341), 9.2 g/dL in Latin America (N=597) and 7.6 g/dL in Angola (N=1085). Of the children, 79% had anaemia, which was severe in 29%, moderate in 58% and mild in 13% of cases. Besides study area, having anaemia was independently associated with age <1 year, treatment delay >3 days, weight-for-age z-score <–3 and other than meningococcal aetiology. Irrespective of the study area, anaemia correlated with the markers of disease severity. In children with severe to moderate anaemia (vs mild or no anaemia), the risk ratio for death was 3.38 and for death or severe sequelae was 3.07.
Conclusion
Anaemia, mostly moderate, was common in children with BM, especially in Angola, in underweight children, among those with treatment delay, and in pneumococcal meningitis. Poor outcome was associated with anaemia in all three continents.
Trial registration number
The registration numbers of Angolan trials were ISRCTN62824827 and NCT01540838.
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Chan, S.-Y., Lai, Y.-J., Ko, M.-C., Chen, Y.-Y., Tsai, Y.-F., Hsu, L.-F., Ku, P.-W., Chen, L.-J., Chuang, P.-H., Chen, C.-C., Yen, Y.-F.
BMJ Open, 14.03.2022
Tilføjet 14.03.2022
Objective
Hospice care could improve the quality of life among advanced HIV patients during end-of-life (EOL) treatment. However, providing hospice care services for people living with HIV (PLWH) is challenging due to HIV-related stigma. This nationwide cohort study aims to determine the utilisation of hospice care services among PLWH and HIV-negative individuals during EOL treatment.
Design
A retrospective cohort study.
Setting
From 2000 to 2018, we identified adult PLWH from the Taiwan centres for disease control HIV Surveillance System. Individuals who had positive HIV-1 western blots were regarded as HIV-infected. Age-matched and sex-matched controls without HIV infection were selected from the Taiwan National Health Insurance Research Database for comparison. All PLWH and controls were followed until death or 31 December 2018.
Participants
32 647 PLWH and 326 470 HIV-negative controls were analysed.
Primary outcome measures
Utilisation of hospice care services during the last year of life among PLWH and HIV-negative individuals.
Results
A total of 20 413 subjects died during the 3 434 699 person-years of follow-up. Of the deceased patients, 2139 (10.5%) utilised hospice care services during their last year of life, including 328 (5.76%) PLWH and 1811 (12.30%) controls. Adjusting for demographics and comorbidities, PLWH were less likely to receive hospice care services during the last year of life, compared with HIV-negative individuals (adjusted OR: 0.66; 95% CI: 0.57 to 0.75).
Conclusions
PLWH had significantly lower utilisation of hospice care services during the last year of life. Our results suggest that future hospice care programmes should particularly target PLWH to increase the optimal utilisation of hospice care services during EOL treatment.
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Schietzel, S., Bally, L., Cereghetti, G., Faller, N., Moor, M. B., Vogt, B., Rintelen, F., Trelle, S., Fuster, D.
BMJ Open, 14.03.2022
Tilføjet 14.03.2022
Introduction
Kidney stones are a global healthcare problem. Given high recurrence rates and the morbidity associated with symptomatic stone disease, effective medical prophylaxis is clearly an unmet need. Explanatory analyses of randomised controlled trials with sodium/glucose cotransporter isoform 2 inhibitors indicated a 30%–50% reduced rate of stone events in patients with diabetes. Underlying mechanisms remain unclear. We aim to determine the effect of empagliflozin on urinary supersaturations in non-diabetic kidney stone formers to evaluate their therapeutic potential for recurrence prevention. We will provide first clinical trial evidence on whether urinary supersaturations are affected by empagliflozin in kidney stone formers.
Methods and analysis
The SWEETSTONE trial is a randomised, double-blind, placebo-controlled, cross-over, exploratory study to assess the impact of empagliflozin on urinary supersaturations of calcium oxalate, calcium phosphate and uric acid in kidney stone formers. We plan to include 46 non-diabetic adults (18–74 years) with ≥1 past kidney stone event and stone composition with ≥80% of calcium or ≥80% of uric acid. Patients with secondary causes of kidney stones or chronic kidney disease will be excluded. Eligible individuals will be randomised in equal proportions to receive either a 14-day treatment with 25 mg empagliflozin followed after the 2–6 weeks wash out period by a 14-day treatment with a matching placebo or the reverse procedure. Secondary outcomes will include electrolyte concentrations, renal function, mineral metabolism and glycaemic parameters, urinary volume and safety.
Results will be presented as effect measures (95% CIs) with p values and hypothesis testing for primary outcomes (significance level 0.02).
Ethics and dissemination
The SWEETSTONE trial was approved by the Swiss ethics committee and Swissmedic. First results are expected in the fourth quarter of 2022.
Trial registration number
NCT04911660; Pre-results.
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BMJ Open, 14.03.2022
Tilføjet 14.03.2022
Prajitha KC, Rahul A, Chintha S, et al. Strategies and challenges in Kerala’s response to the initial phase of COVID-19 pandemic: a qualitative descriptive study. BMJ Open 2021;11:e051410. doi:10.1136/bmjopen-2021-051410 This article was previously published with an error. The competing interests statement has been updated to: Author TSNA is a member of the state expert committee group, a scientific group that helps the state to assimilate available scientific evidence on COVID-19 and provide evidence-based opinions on prevention and control of the COVID-19 pandemic. Author ARK is a member of the state expert committee group, state rapid response team with a role to assess and formulate responses to infectious diseases of public health importance, and state medical board providing evidence-based opinions on patient management to the institutional level medical boards during the pandemic. Author SV is joint secretary to the Government of Kerala in the department of Health and Family Welfare....
Læs mere Tjek på PubMedMitra M. Elgrail, Edwin Chen, Marla G. Shaffer, Vatsala Srinivasa, Marissa P. Griffith, Mustapha M. Mustapha, Ryan K. Shields, Daria Van Tyne, Matthew J. Culyba aDepartment of Medicine, Division of Infectious Diseases, University of Pittsburghgrid.21925.3d School of Medicine, Pittsburgh, Pennsylvania, USA bCenter for Evolutionary Biology and Medicine, University of Pittsburghgrid.21925.3d School of Medicine, Pittsburgh, Pennsylvania, USA, Victor J. Torres
Infection and Immunity, 14.03.2022
Tilføjet 14.03.2022
Nanyan Jiang, Meiping Ye, Jingmin Yan, Chunjie Liao, Mengya Shang, Guixuan Wang, Ruirui Peng, Juan Wu, Tengfei Qi, Liyan Ni, Zhifang Guan, Wei Zhao, Pingyu Zhou
International Journal of Infectious Diseases, 14.03.2022
Tilføjet 14.03.2022
Peter V. Markov, Aris Katzourakis, Nikolaos I. Stilianakis
Nat Rev Microbiol, 14.03.2022
Tilføjet 14.03.2022
Nature Reviews Microbiology, Published online: 14 March 2022; doi:10.1038/s41579-022-00722-zThe comparatively milder infections with the Omicron variant and higher levels of population immunity have raised hopes for a weakening of the pandemic. We argue that the lower severity of Omicron is a coincidence and that ongoing rapid antigenic evolution is likely to produce new variants that may escape immunity and be more severe.
Læs mere Tjek på PubMedBrendan O'Kelly, Louise Vidal, Gordana Avramovic, John Broughan, Stephen Peter Connolly, Aoife G Cotter, Walter Cullen, Shannon Glaspy, Tina McHugh, James Woo, John S Lambert
International Journal of Infectious Diseases, 14.03.2022
Tilføjet 14.03.2022
Florin Elec, Jesper Magnusson, Alina Elec, Adriana Muntean, Oana Antal, Tudor Moisoiu, Cristina Cismaru, Mihaela Lupse, Mihai Oltean
International Journal of Infectious Diseases, 14.03.2022
Tilføjet 14.03.2022
: The aim of the study is to evaluate the impact of remdesivir on overall mortality, ICU mortality and renal functional outcome in hospitalized Covid 19 kidney transplant patients.
Læs mere Tjek på PubMedFrancine Ntoumi, Eskild Petersen, Peter Mwaba, Eleni Aklillu, Sayoki Mfinanga, Dorothy Yeboah-Manu, Markus Maeurer, Alimuddin Zumla
International Journal of Infectious Diseases, 14.03.2022
Tilføjet 14.03.2022
Samithamby Jeyaseelan, Hong Wei Chu, Scott K. Young, Mason W. Freeman, G. Scott Worthen aDivision of Respiratory Infections, Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado, USA bDivision of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences, Aurora, Colorado, USA cHarvard Medical Schoolgrid.471403.5, Boston, Massachusetts, USA
Infection and Immunity, 14.03.2022
Tilføjet 14.03.2022
Catherine Arsenault, Anna Gage, Min Kyung Kim, Neena R. Kapoor, Patricia Akweongo, Freddie Amponsah, Amit Aryal, Daisuke Asai, John Koku Awoonor-Williams, Wondimu Ayele, Paula Bedregal, Svetlana V. Doubova, Mahesh Dulal, Dominic Dormenyo Gadeka, Georgiana Gordon-Strachan, Damen Haile Mariam, Dilipkumar Hensman, Jean Paul Joseph, Phanuwich Kaewkamjornchai, Munir Kassa Eshetu, Solomon Kassahun Gelaw, Shogo Kubota, Borwornsom Leerapan, Paula Margozzini, Anagaw Derseh Mebratie, Suresh Mehata, Mosa Moshabela, Londiwe Mthethwa, Adiam Nega, Juhwan Oh, Sookyung Park, Álvaro Passi-Solar, Ricardo Pérez-Cuevas, Alongkhone Phengsavanh, Tarylee Reddy, Thanitsara Rittiphairoj, Jaime C. Sapag, Roody Thermidor, Boikhutso Tlou, Francisco Valenzuela Guiñez, Sebastian Bauhoff, Margaret E. Kruk
Nature, 14.03.2022
Tilføjet 14.03.2022
Nature Medicine, Published online: 14 March 2022; doi:10.1038/s41591-022-01750-1An interrupted time series analysis of 31 healthcare services in ten low-income, middle-income and high-income countries demonstrates that the COVID-19 pandemic caused immediate, heterogeneous and prolonged disruptions in service delivery, highlighting the need for health system resilience in pandemic preparedness.
Læs mere Tjek på PubMedLi-Hua Li, Hsu-Feng Lu, Yi-Fu Liu, Yi-Tsung Lin, Tsuey-Ching Yang aDepartment of Pathology and Laboratory Medicine, Taipei Veterans General Hospitalgrid.278247.c, Taipei, Taiwan bSchool of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan cDepartment of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan dDepartment of Biotechnology and Laboratory Science in Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan eDivision of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospitalgrid.278247.c, Taipei, Taiwan fSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
Antimicrobial Agents And Chemotherapy, 14.03.2022
Tilføjet 14.03.2022
Serdal Arslan, Mehmet Bakir, Burcu Bayyurt, Eylem Itir Aydemir, Kenan Kinaci, Aynur Engin
Journal of Medical Virology, 14.03.2022
Tilføjet 14.03.2022
Monray E. Williams, Vurayai Ruhanya, Robert H. Paul, Jonathan C. Ipser, Dan J. Stein, John A. Joska, Petrus J.W. Naudé
Journal of Medical Virology, 14.03.2022
Tilføjet 14.03.2022
Shengle Qin, Runfeng Li, Zhaoguang Zheng, Xuxin Zeng, Yutao Wang, Xinhua Wang
Journal of Medical Virology, 14.03.2022
Tilføjet 14.03.2022
BMC Infectious Diseases, 13.03.2022
Tilføjet 13.03.2022
Abstract
Background
In older adult patients, bloodstream infections cause significant mortality. However, data on long-term prognosis in very elderly patients are scarce. This study aims to assess 1-year mortality from bacteraemia in very elderly patients.
Methods
Retrospective cohort study in inpatients aged 80 years or older and suspected of having sepsis. Patients with (n = 336) and without (n = 336) confirmed bacteraemia were matched for age, sex, and date of culture, and their characteristics were compared. All-cause mortality and risk of death were assessed using the adjusted hazard ratio (aHR).
Results
Compared to controls, cases showed a higher 1-year mortality (34.8% vs. 45.2%) and mortality rate (0.46 vs. 0.69 deaths per person-year). Multivariable analysis showed significant risk of 1-year mortality in patients with bacteraemia (aHR: 1.31, 95% confidence interval [CI] 1.03–1.67), quick Sepsis Related Organ Failure Assessment (qSOFA) score of 2 or more (aHR: 2.71, 95% CI 2.05–3.57), and age of 90 years or older (aHR 1.53, 95% CI 1.17–1.99).
Conclusions
In elderly patients suspected of sepsis, bacteraemia is associated with a poor prognosis and higher long-term mortality. Other factors related to excess mortality were age over 90 years and a qSOFA score of 2 or more.
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BMC Infectious Diseases, 13.03.2022
Tilføjet 13.03.2022
Abstract
Background
Enteric parasites are endemic in many of the countries from which refugees originate. Clinical guidelines vary in approaches to screening for and treating intestinal parasites in refugee receiving countries. This study aims to investigate the prevalence and species of intestinal parasites identified in stool ova and parasite (O&P) specimens in a sample of newly arrived refugees in Toronto, Canada.
Methods
We conducted a retrospective chart review of 1042 refugee patients rostered at a specialized primary care clinic in Toronto from December 2011 to September 2016. Patients who completed recommended stool O&P analyses were included. Basic sociodemographic and clinical variables and results of stool O&P were examined.
Results
419 patients (40.2%) had a stool O&P positive for any protozoan or helminth species. Sixty-nine patients (6.6%) had clinically significant parasite species (excluding B hominis, D fragilis, and E dispar, given their lower risk for causing symptoms/complications): 2.3% had clinically significant protozoans and 4.2% had helminths on stool analysis.
Conclusion
Given the relatively low prevalence of clinically significant parasites identified, our findings do not support universal screening for enteric parasites with stool O&P among refugee claimants/asylum seekers. However, stool analysis should be considered in certain clinical situations, as part of a more tailored approach.
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Pedro L. Alonso, Katherine L. O’Brien
New England Journal of Medicine, 12.03.2022
Tilføjet 13.03.2022
Stockman, Jeni; Friedman, Jonathan; Sundberg, Johnna; Harris, Emily
Journal of Acquired Immune Deficiency Syndromes, 9.03.2022
Tilføjet 13.03.2022
Background:
A core objective of HIV/AIDS programming is keeping clients on treatment to improve their health outcomes and to limit spread. Machine learning and artificial intelligence can combine client, temporal, and locational attributes to identify which clients are at greatest risk of loss to follow-up (LTFU) and enable health providers to direct support interventions accordingly.
Setting:
The analysis was part of a PEPFAR- and USAID-funded project, Data for Implementation, and applied to data from publicly available sources (health facility data, geospatial data, and satellite imagery) and de-identified electronic medical record data on ART clients in Nigeria and Mozambique.
Methods:
The project applied binary classification techniques using temporal cross-validation to predict the risk that patients would be LTFU. Classifiers included logistic regression, neural networks, and tree-based models.
Results:
Models showed strong predictive power in both settings. In Mozambique, the best performing model, a random forest, achieved an area under the precision-recall curve of 0.65 compared against an underlying LTFU rate of 23%. In Nigeria, the best performing model, a boosted tree, achieved an area under the precision-recall curve of 0.52 compared against an underlying LTFU rate of 27%.
Conclusion:
Machine-learned models outperformed current classification techniques and showed potential to better direct health worker resources towards patients at greatest risk of LTFU. Moreover, models performed equally across sex and age groups, supporting the model’s generalizability and wider application.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedImbert, Elizabeth; Hickey, Matthew D.; Del Rosario, Jan Bing; Conte, Madellena; Kerkoff, Andrew D.; Clemenzi-Allen, Angelo; Riley, Elise D; Havlir, Diane V.; Gandhi, Monica
Journal of Acquired Immune Deficiency Syndromes, 9.03.2022
Tilføjet 13.03.2022
Background/Setting:
In San Francisco, HIV viral suppression is 71% among housed individuals, but only 20% among unhoused individuals. We conducted a discrete choice experiment (DCE) at a San Francisco public HIV clinic to evaluate care preferences among people living with HIV (PLH) experiencing homelessness/unstable housing during the COVID-19 pandemic.
Methods:
From July-November 2020, we conducted a DCE among PLH experiencing homelessness/unstable housing who accessed care through a) an incentivized, drop-in program (“POP-UP”) or b) traditional primary care. We investigated five program features: single provider vs team of providers; visit incentives ($0, $10, $20); location (current site vs current+additional site); drop-in vs scheduled visits; in-person only vs optional telehealth visits; and navigator assistance. We estimated relative preferences using mixed-effects logistic regression and conducted latent class analysis to evaluate preference heterogeneity.
Results:
We enrolled 115 PLH experiencing homelessness/unstable housing, 40% of whom lived outdoors. The strongest preferences were for the same provider (β=0.94, 95%CI 0.48-1.41), visit incentives (β=0.56 per $5; 95%CI 0.47-0.66), and drop-in visits (β=0.47, 95%CI 0.12-0.82). Telehealth was not preferred. Latent class analysis revealed two distinct groups: 78 (68%) preferred a flexible care model; while 37 (32%) preferred a single provider.
Conclusion:
We identified heterogeneous care preferences among PLH experiencing homelessness/unstable housing during the COVID pandemic, with two-thirds preferring greater flexibility and one-third preferring provider continuity. Telehealth was not preferred, even with navigator facilitation. Including patient choice in service delivery design can improve care engagement, particularly for marginalized populations, and is an essential tool for ending the HIV epidemic.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedRice, Brian; Machingura, Fortunate; Maringwa, Galven; Magutshwa, Sitholubuhle; Kujeke, Tatenda; Jamali, Gracious; Busza, Joanna; de Wit, Mariken; Fearon, Elizabeth; Hanisch, Dagmar; Yekeye, Raymond; Mugurungi, Owen; Hargreaves, James R; Cowan, Frances M
Journal of Acquired Immune Deficiency Syndromes, 9.03.2022
Tilføjet 13.03.2022
Background:
To reduce HIV incidence among adolescent girls who sell sex (AGSS) in Zimbabwe we need to better understand how vulnerabilities intersect with HIV infection, and how those living with HIV engage in care.
Methods:
In 2017, we conducted social mapping in four locations in Zimbabwe, and recruited girls aged 16 to 19 years who sell sex, using respondent driven sampling or census sampling methods. Participants completed a questionnaire and provided finger-prick blood samples for HIV antibody testing.
Results:
Of 605 AGSS recruited, 74.4% considered themselves sex workers, 24.4% reported experiencing violence in the past year, 91.7% were not in school, and 83.8% had less than a complete secondary education. Prevalence of HIV increasing steeply from 2.1% among those aged 16 years to 26.9% among those aged 19 years; overall 20.2% of AGSS were HIV positive. In multivariate analysis, age, education, marital status, and violence from a client were associated with HIV. Among the 605 AGSS, 86.3% had ever tested for HIV, with 64.1% having tested in the past six months. Among AGSS living with HIV, half (50.8%) were aware of their status, among whom 83.9% reported taking antiretroviral therapy.
Conclusion:
The steep rise in HIV prevalence between 16 and 19 years, suggests the window to engage with AGSS prior to HIV acquisition is short. To accelerate reductions in incidence among AGSS, intensified combination prevention strategies that address structural factors and tailor services to the needs of AGSS are required, particularly ensuring girls enrol and remain in school.
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Læs mere Tjek på PubMedSsempijja, Victor; Nakigozi, Gertrude; Ssekubugu, Robert; Kagaayi, Joseph; Kigozi, Godfrey; Nalugoda, Fred; Nantume, Betty; Batte, James; Kigozi, Grace; Yeh, Ping Teresa; Nakawooya, Hadijja; Serwadda, David; Quinn, Thomas C.; Gray, Ronald H.; Wawer, Maria J.; Grabowski, Kate M.; Chang, Larry W.; van’t Hoog, Anja; Cobelens, Frank; Reynolds, Steven J.
Journal of Acquired Immune Deficiency Syndromes, 9.03.2022
Tilføjet 13.03.2022
Background:
The utility of using PrEP eligibility assessments to identify eligibility in general populations has not been well studied in sub-Saharan Africa. We used the Rakai Community Cohort Study to conduct a cross-sectional analysis to estimate PrEP eligibility and a cohort analysis to estimate HIV incidence associated with PrEP eligibility.
Methods:
Based on Uganda’s national PrEP eligibility tool, we defined eligibility as reporting at least one of the following HIV risks in the last 12 months: sexual intercourse with more than one partner of unknown HIV status; non-marital sex without a condom; sex in exchange for money, goods, or services; or genital ulcers. We used log-binomial and modified Poisson models to estimate prevalence ratios for PrEP eligibility and HIV incidence, respectively.
Findings:
We identified 12,764 participants among which to estimate PrEP eligibility prevalence, and 11,363 participants with 17,381 follow-up visits and 30,721 person-years (pys) of observation to estimate HIV incidence. Overall, 29% met at least one of the eligibility criteria. HIV incidence was significantly higher in PrEP-eligible versus non-PrEP-eligible participants (0·91/100 pys versus 0·41/100 pys; p<0·001), and independently higher in PrEP-eligible versus non-PrEP-eligible females (1·18/100 pys versus 0·50/100 pys; p<0·001). Among uncircumcised males, HIV incidence was significantly higher in PrEP-eligible versus non-PrEP-eligible (1·07/100 pys versus 0·27/100 pys; p=0·001), but there was no significant difference for circumcised males.
Interpretation:
Implementing PrEP as a standard HIV prevention tool in generalized HIV epidemics beyond currently recognized high-risk key populations could further reduce HIV acquisition and aid epidemic control efforts.
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Læs mere Tjek på PubMedMalaria Journal, 12.03.2022
Tilføjet 13.03.2022
Abstract
Background
Resistance to anti-malarials is a serious threat to the efforts to control and eliminate malaria. Surveillance based on simple field protocols with centralized testing to detect molecular markers associated with anti-malarial drug resistance can be used to identify locations where further investigations are needed.
Methods
Dried blood spots were collected from 398 patients (age range 5–59 years, 99% male) with Plasmodium falciparum infections detected using rapid diagnostic tests over two rounds of sample collection conducted in 2016 and 2017 in Komé, South-West Chad. Specimens were genotyped using amplicon sequencing or qPCR for validated markers of anti-malarial resistance including partner drugs used in artemisinin-based combination therapy (ACT).
Results
No mutations in the pfk13 gene known to be associated with artemisinin resistance were found but a high proportion of parasites carried other mutations, specifically K189T (190/349, 54.4%, 95%CI 49.0–59.8%). Of 331 specimens successfully genotyped for pfmdr1 and pfcrt, 52% (95%CI 46.4–57.5%) carried the NFD-K haplotype, known to be associated with reduced susceptibility to lumefantrine. Only 20 of 336 (6.0%, 95%CI 3.7–9.0%) had parasites with the pfmdr1-N86Y polymorphism associated with increased treatment failures with amodiaquine. Nearly all parasites carried at least one mutation in pfdhfr and/or pfdhps genes but ‘sextuple’ mutations in pfdhfr—pfdhps including pfdhps -A581G were rare (8/336 overall, 2.4%, 95%CI 1.2–4.6%). Only one specimen containing parasites with pfmdr1 gene amplification was detected.
Conclusions
These results provide information on the likely high efficacy of artemisinin-based combinations commonly used in Chad, but suggest decreasing levels of sensitivity to lumefantrine and high levels of resistance to sulfadoxine-pyrimethamine used for seasonal malaria chemoprevention and intermittent preventive therapy in pregnancy. A majority of parasites had mutations in the pfk13 gene, none of which are known to be associated with artemisinin resistance. A therapeutic efficacy study needs to be conducted to confirm the efficacy of artemether-lumefantrine.
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Malaria Journal, 12.03.2022
Tilføjet 13.03.2022
Abstract
Background
Distribution of long-lasting insecticidal bed nets (LLINs) is one of the main control strategies for malaria. Improving malaria prevention programmes requires understanding usage patterns in households receiving LLINs, but there are limits to what standard cross-sectional surveys of self-reported LLIN use can provide. This study was designed to assess the performance of an accelerometer-based approach for measuring a range of LLIN use behaviours as a proof of concept for more granular LLIN-use monitoring over longer time periods.
Methods
This study was carried out under controlled conditions from May to July 2018 in Liverpool, UK. A single accelerometer was affixed to the side panel of an LLIN and participants carried out five LLIN use behaviours: (1) unfurling a net; (2) entering an unfurled net; (3) lying still as if sleeping; (4) exiting from under a net; and, (5) folding up a net. The randomForest package in R, a supervised non-linear classification algorithm, was used to train models on 20-s epochs of tagged accelerometer data. Models were compared in a validation dataset using overall accuracy, sensitivity and specificity, receiver operating curves and the area under the curve (AUC).
Results
The five-category model had overall accuracy of 82.9% in the validation dataset, a sensitivity of 0.681 for entering a net, 0.632 for exiting, 0.733 for net down, and 0.800 for net up. A simplified four-category model, combining entering/exiting a net into one category had accuracy of 94.8%, and increased sensitivity for net down (0.756) and net up (0.829). A further simplified three-category model, identifying sleeping, net up, and a combined net down/enter/exit category had accuracy of 96.2% (483/502), with an AUC of 0.997 for net down and 0.987 for net up. Models for detecting entering/exiting by adults were significantly more accurate than for children (87.8% vs 70.0%; p < 0.001) and had a higher AUC (p = 0.03).
Conclusions
Understanding how LLINs are used is crucial for planning malaria prevention programmes. Accelerometer-based systems provide a promising new methodology for studying LLIN use. Further work exploring accelerometer placement, frequency of measurements and other machine learning approaches could make these methods even more accurate in the future.
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Malaria Journal, 12.03.2022
Tilføjet 13.03.2022
Abstract
Background
Primaquine is a pro-drug and its active metabolite is potent against mature Plasmodium falciparum gametocytes. Primaquine is metabolized by a highly polymorphic cytochrome P450 2D6 (CYP2D6) enzyme. Mutations in the gene encoding this enzyme may lead to impaired primaquine activity. This study assessed if 0.25 mg/kg single-dose primaquine is safe and sufficient to reduce transmission of gametocytes in individuals with no, reduced, or increased CYP2D6 enzyme activity.
Methods
Between June 2019 and January 2020 children aged 1–10 years, attending at Yombo dispensary, Bagamoyo district, with confirmed microcopy-determined uncomplicated P. falciparum malaria were enrolled in the study. The enrolled patients were treated with a standard artemether-lumefantrine regimen plus 0.25 mg/kg single-dose primaquine and followed up for 28 days for clinical and laboratory assessment. Primaquine was administered with the first dose of artemether-lumefantrine. Safety assessment involved direct questioning and recording of the nature and incidence of clinical signs and symptoms, and measurement of haemoglobin (Hb) concentration. Blood samples collected from 100 patients were used for assessment of post-treatment infectiousness on day 7 using mosquito membrane feeding assays. Molecular methods were used to determine CYP2D6 and glucose-6-phosphate dehydrogenase (G6PD) status. The primary outcome was the safety of 0.25 mg/kg single-dose primaquine based on CYP2D6 status.
Results
In total, 157 children [median age 6.4 (Interquartile range 4.0–8.2) years] were recruited, of whom 21.0% (33/157) and 12.7% (20/157) had reduced CYP2D6 and deficient G6PD activity, respectively. Day 3 mean absolute Hb concentration reduction was 1.50 g/dL [95% confidence interval (CI) 1.10–1.90] and 1.51 g/dL (95% CI 1.31–1.71) in reduced and normal CYP2D6 patients, respectively (t = 0.012, p = 0.990). The day 3 mean absolute Hb concentration reduction in G6PD deficient, G6PD normal and heterozygous female was 1.82 g/dL (95% CI 1.32–2.32), 1.48 g/dL (95% CI 1.30–1.67) and 1.47 g/dL (95% CI 0.76–2.18), respectively (F = 0.838, p = 0.435). Sixteen percent (16/98) of the patients each infected at least one mosquito on day 7, and of these, 10.0% (2/20) and 17.9% (14/78) had reduced and normal CYP2D6 enzyme activity, respectively (x2 = 0.736, p = 0.513).
Conclusion
Single-dose 0.25 mg/kg primaquine was safe and sufficient for reducing transmission of P. falciparum gametocytes regardless of CYP2D6 or G6PD status.
Trial registration Study registration number: NCT03352843.
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