Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
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Query Trace: Dube S [original query] |
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Introduction to the child abuse and neglect special issue "epidemiology, risk factors, and impacts of adverse childhood experiences in low- and middle-income countries."
Gilbert LK , Annor FB , Brown C , Dube SR . Child Abuse Negl 2024 106748 |
Substantial but spatially heterogeneous progress in male circumcision for HIV prevention in South Africa
Thomas ML , Zuma K , Loykissoonlal D , Dube ZB , Vranken P , Porter SE , Kripke K , Seatlhodi T , Meyer-Rath G , Johnson LF , Imai-Eaton JW . Commun Med (Lond) 2024 4 (1) 1 BACKGROUND: Voluntary medical male circumcision (VMMC) reduces the risk of male HIV acquisition by 60%. Programmes to provide VMMCs for HIV prevention have been introduced in sub-Saharan African countries with high HIV burden. Traditional circumcision is also a long-standing male coming-of-age ritual, but practices vary considerably across populations. Accurate estimates of circumcision coverage by age, type, and time at subnational levels are required for planning and delivering VMMCs to meet targets and evaluating their impacts on HIV incidence. METHODS: We developed a Bayesian competing risks time-to-event model to produce region-age-time-type specific probabilities and coverage of male circumcision with probabilistic uncertainty. The model jointly synthesises data from household surveys and health system data on the number of VMMCs conducted. We demonstrated the model using data from five household surveys and VMMC programme data to produce estimates of circumcision coverage for 52 districts in South Africa between 2008 and 2019. RESULTS: Nationally, in 2008, 24.1% (95% CI: 23.4-24.8%) of men aged 15-49 were traditionally circumcised and 19.4% (18.9-20.0%) were medically circumcised. Between 2010 and 2019, 4.25 million VMMCs were conducted. Circumcision coverage among men aged 15-49 increased to 64.0% (63.2-64.9%) and medical circumcision coverage to 42% (41.3-43.0%). Circumcision coverage varied widely across districts, ranging from 13.4 to 86.3%. The average age of traditional circumcision ranged between 13 and 19 years, depending on local cultural practices. CONCLUSION: South Africa has made substantial, but heterogeneous, progress towards increasing medical circumcision coverage. Detailed subnational information on coverage and practices can guide programmes to identify unmet need to achieve national and international targets. | Voluntary medical male circumcision reduces the risk of male HIV acquisition. Programmes to provide circumcisions for HIV prevention have been introduced in sub-Saharan African countries with high HIV burden. Estimates of circumcision coverage are needed for planning and delivering circumcisions to meet targets and evaluate their impacts on HIV incidence. We developed a model to integrate date from both household surveys and health systems on the number of circumcisions conducted, and applied it to understand how the practices and coverage of circumcision are changing in South Africa. National circumcision coverage increased considerably between 2008 and 2019, however, there remains a substantial subnational variation across districts and age groups. Further progress is needed to reach national and international targets. | eng |
Approaches for measuring cumulative childhood adversity: A study of youth from 5 sub-Saharan African countries
Gilbert LK , Matthews S , Dube SR , Annor FB . Child Abuse Negl 2023 106542 BACKGROUND: Adverse childhood experiences (ACEs) include forms of abuse, neglect, and household stressors that are potentially early life traumatic experiences. A summed integer count of ACEs is often used to examine cumulative childhood adversity (CCA) but has limitations. OBJECTIVES: The current study tests two additional methods for measuring CCA using large samples of youth in low- and middle-income countries. PARTICIPANTS AND SETTING: Pooled data were analyzed from a multi-country, nationally representative sample of youth aged 18-24 years (N = 11,498) who completed the Violence Against Children and Youth Surveys (VACS) in Lesotho, Cote d'Ivoire, Kenya, Namibia, and Mozambique. METHODS: ACE exposures included: physical, sexual, and emotional violence; witnessing interparental violence; witnessing community violence; orphanhood. CCA was operationalized using an ACE score, ACE impact (standardized regression coefficients from outcome severity), and ACE exposure context (household; intimate partner; peer; community). Associations between CCA with mental distress (MD) were examined by sex using p ≤ 0.05 as the significance level. RESULTS: Exposure to ≥3 ACEs was associated with MD (p < 0.05) for both sexes. Among females, all contexts contributed to MD except peer ACEs (p < 0.05). Among males, household and community ACEs contributed to MD. High-impact ACEs were associated with MD both sexes. ACE context was the best-fitting model for these data. CONCLUSIONS: The challenges operationalizing CCA warrant continued research to ensure adversity type, severity, and context lead to validly assessing ACEs impact on child wellbeing. |
Parental absence as an adverse childhood experience among young adults in sub-Saharan Africa
Annor FB , Amene EW , Zhu L , Stamatakis C , Picchetti V , Matthews S , Miedema SS , Brown C , Thorsen VC , Manuel P , Gilbert LK , Kambona C , Coomer R , Trika J , Kamuingona R , Dube SR , Massetti GM . Child Abuse Negl 2023 106556 BACKGROUND: Parental absence in childhood has been associated with multiple negative consequences, such as depression and anxiety in young adulthood. OBJECTIVE: To assess whether parental absence for six months or more in childhood is associated with poor mental health and substance use in young adulthood and whether parental absence accounts for additional variance beyond those explained by other adverse childhood experiences (ACEs) among youth in sub-Saharan Africa. PARTICIPANTS AND SETTINGS: We used combined Violence Against Children and Youth Survey (VACS) data from Cote d'Ivoire (2018), Lesotho (2018), Kenya (2019), Namibia (2019), and Mozambique (2019). Analyses were restricted to 18-24-year-olds (n(f) = 7699; n(m) = 2482). METHODS: We used logistic regression to examine sex-stratified relationships between parental absence in childhood (defined as biological mother or father being away for six months or more before age 18) and mental health problems and substance use and whether parental absence explained additional variance beyond those explained by other ACEs. RESULTS: In sub-Saharan Africa, parental absence in childhood was common (30.5 % in females and 25.1 % in males), significantly associated with poor mental health and substance use among females and males and accounted for additional variance beyond those explained by conventional ACEs. For example, after controlling for study covariates and other ACEs, females who experienced any parental absence had 1.52 (95 % CI = 1.02-2.26) higher odds of experiencing moderate/serious psychological distress compared with those who did not. CONCLUSION: The observed association between parental absence and poor mental health suggests that this experience has significant adverse consequences and merits consideration as an ACE. |
Genomic epidemiology of Streptococcus pneumoniae serotype 16F lineages
Mokaya J , Mellor KC , Murray GGR , Kalizang'oma A , Lekhuleni C , Zar HJ , Nicol MP , McGee L , Bentley SD , Lo SW , Dube F . Microb Genom 2023 9 (11) Due to the emergence of non-vaccine serotypes in vaccinated populations, Streptococcus pneumoniae remains a major global health challenge despite advances in vaccine development. Serotype 16F is among the predominant non-vaccine serotypes identified among vaccinated infants in South Africa (SA). To characterize lineages and antimicrobial resistance in 16F isolates obtained from South Africa and place the local findings in a global context, we analysed 10 923 S. pneumoniae carriage isolates obtained from infants recruited as part of a broader SA birth cohort. We inferred serotype, resistance profile for penicillin, chloramphenicol, cotrimoxazole, erythromycin and tetracycline, and global pneumococcal sequence clusters (GPSCs) from genomic data. To ensure global representation, we also included S. pneumoniae carriage and disease isolates from the Global Pneumococcal Sequencing (GPS) project database (n=19 607, collected from 49 countries across 5 continents, 1995-2018, accessed 17 March 2022). Nine per cent (934/10923) of isolates obtained from infants in the Drakenstein community in SA and 2 %(419/19607) of genomes in the GPS dataset were serotype 16F. Serotype 16F isolates were from 28 different lineages of S. pneumoniae, with GPSC33 and GPSC46 having the highest proportion of serotype 16F isolates at 26 % (346/1353) and 53 % (716/1353), respectively. Serotype 16F isolates were identified globally, but most isolates were collected from Africa. GPSC33 was associated with carriage [OR (95 % CI) 0.24 (0.09-0.66); P=0.003], while GPSC46 was associated with disease [OR (95 % CI) 19.9 (2.56-906.50); P=0.0004]. Ten per cent (37/346) and 15 % (53/346) of isolates within GPSC33 had genes associated with resistance to penicillin and co-trimoxazole, respectively, and 18 % (128/716) of isolates within GPSC46 had genes associated with resistance to co-trimoxazole. Resistant isolates formed genetic clusters, which may suggest emerging resistant lineages. Serotype 16F lineages were common in southern Africa. Some of these lineages were associated with disease and resistance to penicillin and cotrimoxazole. We recommend continuous genomic surveillance to determine the long-term impact of serotype 16F lineages on vaccine efficacy and antimicrobial therapy globally. Investing in vaccine strategies that offer protection over a wide range of serotypes/lineages remains essential. This paper contains data hosted by Microreact. |
Adverse childhood experiences and associations with mental health, substance use, and violence perpetration among young adults in sub-Saharan Africa
Brown C , Nkemjika S , Ratto J , Dube SR , Gilbert L , Chiang L , Picchetti V , Coomer R , Kambona C , McOwen J , Akani B , Kamagate MF , Low A , Manuel P , Agusto A , Annor FB . Child Abuse Negl 2023 Background: Adverse childhood experiences (ACEs) can have debilitating effects on child well-being, with consequences persisting into adulthood. Most ACE studies have been conducted in high-income countries and show a graded relationship between multiple ACE exposures and adverse health outcomes. Less is known about the types and burden of ACEs in sub-Saharan Africa (SSA). Objective: To estimate the pooled prevalence of six individual and cumulative ACE exposures (physical, sexual, and emotional violence; orphanhood; witnessing interparental and community violence) and assess their association with mental health outcomes, substance use, and violence perpetration among young adults in SSA. Participants and setting: Aggregate data from the Violence Against Children and Youth Survey (VACS) in Cote d'Ivoire 2018, Kenya 2019, Lesotho 2018, Mozambique 2019, and Namibia 2019 included a sample of 11,498 young adults aged 18–24 years. Methods: Cumulative ACEs were defined by an integer count of the total number of individual ACEs (0 to 6). Weighted prevalence and adjusted odds ratios were estimated. Result: ACEs prevalence ranged from 7.8 % (emotional violence) to 55.0 % (witnessing community violence). Strong graded relationships between cumulative ACE exposure and all study outcomes for both males and females were observed. Among females, witnessing interparental violence was the only individual ACE risk factor significantly associated with increased odds of substance use; among males, emotional violence was significantly associated with all outcomes. Conclusion: ACEs are associated with adverse mental health, substance use, and violence perpetration in SSA. Gender-specific and culturally sensitive intervention strategies are needed to effectively mitigate ACEs in this population. © 2023 |
Comparison of methods to assess adolescent gender identity in the ABCD Study
Dube SL , Johns MM , Robin L , Hoffman E , Potter AS . JAMA Pediatr 2023 This cross-sectional study assesses the reliability and validity of methods used to capture gender identity in Adolescent Brain Cognitive Development (ABCD) Study participants. | eng |
Moving cholera vaccines ahead of the epidemic curve
Memish ZA , Blumberg L , Al-Maani AS , Baru R , Dube E , Gao GF , Jernigan DB , Leo YS , Peiris JSM , Masud JHB , McVernon J , Nonvignon J , Ogunsola FT , Reese H , Safdar RM , Ungchusak K , Wieler LH , Heymann D . Lancet 2023 The ongoing multi-country cholera outbreaks deserve greater attention and higher prioritisation globally.1 Since the early 1800s, there have been seven characterised global outbreaks of cholera. The seventh and current pandemic has been causing considerable illness effects since the early 1960s.2 Most recently, floods, droughts, natural disasters, and conflicts have displaced millions of people who have restricted access to clean water and live in settings with poor sewage management and increasing disease risk, further increasing the devasting effect of cholera around the globe.3 Currently, 1 billion people are at risk of contracting cholera and, concerningly, 28 countries with outbreaks in 2023, and 24 countries with active outbreaks were recorded by WHO by Sept 10, 2023 alone.4 In addition, recent outbreaks have had a high case fatality rate.5 The average cholera case fatality rate reported globally in 2021 was 1·9% (2·9% in Africa), a significant increase above the accepted target rate (<1%) and the highest recorded in over a decade.1, 5 Preliminary data suggest a similar trend for 2022 and 2023.1 Cholera is an old adversary that is both preventable and treatable.5 Despite widespread calls for strengthened pandemic preparedness and response, the global public health community are failing to apply lessons learned from COVID-19 to old challenges such as cholera. A key lesson learned from the COVID-19 pandemic is that early, rapid, and aggressive action is crucial in implementing public health interventions and countermeasure development.6 |
Health equity and antibiotic prescribing in the United States: A systematic scoping review
Kim C , Kabbani S , Dube WC , Neuhauser M , Tsay S , Hersh A , Marcelin JR , Hicks LA . Open Forum Infect Dis 2023 10 (9) ofad440 We performed a scoping review of articles published from 1 January 2000 to 4 January 2022 to characterize inequities in antibiotic prescribing and use across healthcare settings in the United States to inform antibiotic stewardship interventions and research. We included 34 observational studies, 21 cross-sectional survey studies, 4 intervention studies, and 2 systematic reviews. Most studies (55 of 61 [90%]) described the outpatient setting, 3 articles were from dentistry, 2 were from long-term care, and 1 was from acute care. Differences in antibiotic prescribing were found by patient's race and ethnicity, sex, age, socioeconomic factors, geography, clinician's age and specialty, and healthcare setting, with an emphasis on outpatient settings. Few studies assessed stewardship interventions. Clinicians, antibiotic stewardship experts, and health systems should be aware that prescribing behavior varies according to both clinician- and patient-level markers. Prescribing differences likely represent structural inequities; however, no studies reported underlying drivers of inequities in antibiotic prescribing. |
Assessing pathogen transmission opportunities: Variation in nursing home staff-resident interactions
Nelson Chang NC , Leecaster M , Fridkin S , Dube W , Katz M , Polgreen P , Roghmann MC , Khader K , Li L , Dumyati G , Tsay R , Lynfield R , Mahoehney JP , Nadle J , Hutson J , Pierce R , Zhang A , Wilson C , Haroldsen C , Mulvey D , Reddy SC , Stone ND , Slayton RB , Thompson ND , Stratford K , Samore M , Visnovsky LD . J Am Med Dir Assoc 2023 24 (5) 735 e1-735 e9 OBJECTIVES: The Centers for Disease Control and Prevention (CDC) recommends implementing Enhanced Barrier Precautions (EBP) for all nursing home (NH) residents known to be colonized with targeted multidrug-resistant organisms (MDROs), wounds, or medical devices. Differences in health care personnel (HCP) and resident interactions between units may affect risk of acquiring and transmitting MDROs, affecting EBP implementation. We studied HCP-resident interactions across a variety of NHs to characterize MDRO transmission opportunities. DESIGN: 2 cross-sectional visits. SETTING AND PARTICIPANTS: Four CDC Epicenter sites and CDC Emerging Infection Program sites in 7 states recruited NHs with a mix of unit care types (≥30 beds or ≥2 units). HCP were observed providing resident care. METHODS: Room-based observations and HCP interviews assessed HCP-resident interactions, care type provided, and equipment use. Observations and interviews were conducted for 7-8 hours in 3-6-month intervals per unit. Chart reviews collected deidentified resident demographics and MDRO risk factors (eg, indwelling devices, pressure injuries, and antibiotic use). RESULTS: We recruited 25 NHs (49 units) with no loss to follow-up, conducted 2540 room-based observations (total duration: 405 hours), and 924 HCP interviews. HCP averaged 2.5 interactions per resident per hour (long-term care units) to 3.4 per resident per hour (ventilator care units). Nurses provided care to more residents (n = 12) than certified nursing assistants (CNAs) and respiratory therapists (RTs) (CNA: 9.8 and RT: 9) but nurses performed significantly fewer task types per interaction compared to CNAs (incidence rate ratio (IRR): 0.61, P < .05). Short-stay (IRR: 0.89) and ventilator-capable (IRR: 0.94) units had less varied care compared with long-term care units (P < .05), although HCP visited residents in these units at similar rates. CONCLUSIONS AND IMPLICATIONS: Resident-HCP interaction rates are similar across NH unit types, differing primarily in types of care provided. Current and future interventions such as EBP, care bundling, or targeted infection prevention education should consider unit-specific HCP-resident interaction patterns. |
Evaluation of community-based, mobile HIV-care, peer-delivered linkage case management in Manzini Region, Eswatini
Suraratdecha C , MacKellar D , Hlophe T , Dlamini M , Ujamaa D , Pals S , Dube L , Williams D , Byrd J , Mndzebele P , Behel S , Pathmanathan I , Mazibuko S , Tilahun E , Ryan C . Int J Environ Res Public Health 2022 20 (1) The success of antiretroviral therapy (ART) requires continuous engagement in care and optimal levels of adherence to achieve sustained HIV viral suppression. We evaluated HIV-care cascade costs and outcomes of a community-based, mobile HIV-care, peer-delivered linkage case-management program (CommLink) implemented in Manzini region, Eswatini. Abstraction teams visited referral facilities during July 2019-April 2020 to locate, match, and abstract the clinical data of CommLink clients diagnosed between March 2016 and March 2018. An ingredients-based costing approach was used to assess economic costs associated with CommLink. The estimated total CommLink costs were $2 million. Personnel costs were the dominant component, followed by travel, commodities and supplies, and training. Costs per client tested positive were $499. Costs per client initiated on ART within 7, 30, and 90 days of diagnosis were $2114, $1634, and $1480, respectively. Costs per client initiated and retained on ART 6, 12, and 18 months after diagnosis were $2343, $2378, and $2462, respectively. CommLink outcomes and costs can help inform community-based HIV testing, linkage, and retention programs in other settings to strengthen effectiveness and improve efficiency. |
Antiretroviral therapy initiation and retention among clients who received peer-delivered linkage case management and standard linkage services, Eswatini, 2016-2020: retrospective comparative cohort study
MacKellar D , Hlophe T , Ujamaa D , Pals S , Dlamini M , Dube L , Suraratdecha C , Williams D , Byrd J , Tobias J , Mndzebele P , Behel S , Pathmanathan I , Mazibuko S , Tilahun E , Ryan C . Arch Public Health 2022 80 (1) 74 BACKGROUND: Persons living with HIV infection (PLHIV) who are diagnosed in community settings in sub-Saharan Africa are particularly vulnerable to barriers to care that prevent or delay many from obtaining antiretroviral therapy (ART). METHODS: We conducted a retrospective cohort study to assess if a package of peer-delivered linkage case management and treatment navigation services (CommLink) was more effective than peer-delivered counseling, referral, and telephone follow-up (standard linkage services, SLS) in initiating and retaining PLHIV on ART after diagnosis in community settings in Eswatini. HIV-test records of 773 CommLink and 769 SLS clients aged15years diagnosed between March 2016 and March 2018, matched by urban and rural settings of diagnosis, were selected for the study. CommLink counselors recorded resolved and unresolved barriers to care (e.g., perceived wellbeing, fear of partner response, stigmatization) during a median of 52days (interquartile range: 35-69) of case management. RESULTS: Twice as many CommLink than SLS clients initiated ART by 90days of diagnosis overall (88.4% vs. 37.9%, adjusted relative risk (aRR): 2.33, 95% confidence interval (CI): 1.97, 2.77) and during test and treat when all PLHIV were eligible for ART (96.2% vs. 37.1%, aRR: 2.59, 95% CI: 2.20, 3.04). By 18months of diagnosis, 54% more CommLink than SLS clients were initiated and retained on ART (76.3% vs. 49.5%, aRR: 1.54, 95% CI: 1.33, 1.79). Peer counselors helped resolve 896 (65%) of 1372 identified barriers of CommLink clients. Compared with clients with3 unresolved barriers to care, 42% (aRR: 1.42, 95% CI: 1.19, 1.68) more clients with 1-2 unresolved barriers, 44% (aRR: 1.44, 95% CI: 1.25, 1.66) more clients with all barriers resolved, and 54% (aRR: 1.54, 95% CI: 1.30, 1.81) more clients who had no identified barriers were initiated and retained on ART by 18months of diagnosis. CONCLUSIONS: To improve early ART initiation and retention among PLHIV diagnosed in community settings, HIV prevention programs should consider providing a package of peer-delivered linkage case management and treatment navigation services. Clients with multiple unresolved barriers to care measured as part of that package should be triaged for differentiated linkage and retention services. |
Occupational risk factors for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection among healthcare personnel: A 6-month prospective analysis of the COVID-19 Prevention in Emory Healthcare Personnel (COPE) Study.
Howard-Anderson J , Adams C , Dube WC , Smith TC , Sherman AC , Edupuganti N , Mendez M , Chea N , Magill SS , Espinoza DO , Zhu Y , Phadke VK , Edupuganti S , Steinberg JP , Lopman BA , Jacob JT , Fridkin SK , Collins MH . Infect Control Hosp Epidemiol 2022 43 (11) 1-30 OBJECTIVE: Determine the incidence of SARS-CoV-2 infection among healthcare personnel (HCP) and assess occupational risks for SARS-CoV-2 infection. DESIGN: Prospective cohort of HCP followed for 6-months from May-December 2020. SETTING: Large academic healthcare system including four hospitals and affiliated clinics in Atlanta, GA. PARTICIPANTS: HCP, including those with and without direct patient care activities, working during the COVID-19 pandemic. METHODS: Incident SARS-CoV-2 infections were determined through serologic testing for SARS-CoV-2 IgG at enrollment, 3 and 6 months. HCP completed monthly surveys regarding occupational activities. Multivariable logistic regression was used to identify occupational factors that increased the risk of SARS-CoV-2 infection. RESULTS: Of the 304 evaluable HCP that were seronegative at enrollment, 26 (9%) seroconverted for SARS-CoV-2 IgG by 6 months. Participants self-identified predominantly as White (n=219, 73%), nurses (n=119, 40%), and working in inpatient medical/surgical floors (n=121, 40%). In a multivariable analysis, HCP who identified as Black were more likely to seroconvert than HCP who identified as White (odds ratio 4.5, 95% confidence interval 1.3-14.2). Increased risk for SARS-CoV-2 infection was not identified for any occupational activity, including spending >50% of a typical shift at a patient's bedside, working in COVID-19 units, or performing/being present for aerosol generating procedures (AGPs). CONCLUSIONS: In our study cohort of HCP working in an academic healthcare system, <10% had evidence of SARS-CoV-2 infection over six months. No specific occupational activities were identified as increasing risk for SARS-CoV-2 infection. |
Measurement of gender and sexuality in the Adolescent Brain Cognitive Development (ABCD) study
Potter AS , Dube SL , Barrios LC , Bookheimer S , Espinoza A , Feldstein Ewing SW , Freedman EG , Hoffman EA , Ivanova M , Jefferys H , McGlade EC , Tapert SF , Johns MM . Dev Cogn Neurosci 2022 53 101057 The Adolescent Brain Cognitive Development(SM) (ABCD) study is a longitudinal study of adolescent brain development and health that includes over 11,800 youth in the United States. The ABCD study includes broad developmental domains, and gender and sexuality are two of these with noted changes across late childhood and early adolescence. The Gender Identity and Sexual Health (GISH) workgroup recommends measures of gender and sexuality for the ABCD study, prioritizing those that are developmentally sensitive, capture individual differences in the experience of gender and sexuality, and minimize participant burden. This manuscript describes the gender and sexuality measures used in ABCD and provides guidance for researchers using these data. Data showing the utility of these measures and longitudinal trends are presented. Including assessment of gender and sexuality in ABCD allows for characterization of developmental trajectories of gender and sexuality, and the broad scope of ABCD data collection allows examination of identity development in an intersectional manner. |
HIV testing and ART initiation among partners, family members, and high-risk associates of index clients participating in the CommLink linkage case management program, Eswatini, 2016-2018
Williams D , MacKellar D , Dlamini M , Byrd J , Dube L , Mndzebele P , Mazibuko S , Ao T , Pathmanathan I , Beyer A , Ryan C . PLoS One 2021 16 (12) e0261605 To help diagnose and initiate antiretroviral therapy (ART) for ≥95% of all persons living with HIV (PLHIV), the World Health Organization (WHO) recommends offering HIV testing to biological children, and sexual and needle-sharing partners of all PLHIV (index-client testing, ICT). Many index clients, however, do not identify or have contactable partners, and often substantially fewer than 95% of HIV-positive partners initiate ART soon after index testing. To help improve early HIV diagnosis and ART initiation in Eswatini (formerly Swaziland), we implemented a community-based HIV testing and peer-delivered, linkage case management program (CommLink) that provided ICT as part of a comprehensive package of WHO recommended linkage services. CommLink was implemented June 2015 -March 2017 (Phase I), and April 2017 -September 2018 (Phase II). In addition to biological children and partners, HIV testing was offered to adult family members (Phases I and II) and high-risk associates including friends and acquaintances (Phase II) of CommLink index clients. Compared with Phase I, in Phase II proportionally more CommLink clients disclosed their HIV-infection status to a partner or family member [94% (562/598) vs. 75% (486/652)], and had ≥1 partners, family members, or high-risk associates (contacts) tested through CommLink [41% (245/598) vs. 18% (117/652)]. Of 537 contacts tested, 253 (47%) were HIV-positive and not currently in HIV care, including 17% (17/100) of family members aged <15 years, 42% (78/187) of non-partner family members aged ≥15 years, 60% (73/121) of sexual partners, and 66% (85/129) of high-risk associates. Among 210 HIV-positive contacts aged ≥15 years who participated in CommLink, nearly all received recommended linkage services including treatment navigation (95%), weekly telephone follow-up (93%), and ≥3 counseling sessions (94%); peer counselors resolved 76% (306/404) of identified barriers to care (e.g., perceived wellness); and 200 (95%) initiated ART at a healthcare facility, of whom 196 (98%) received at least one antiretroviral refill before case-management services ended. To help countries achieve ≥90% ART coverage among all PLHIV, expanding ICT for adult family members and high-risk associates of index clients, and providing peer-delivered linkage case management for all identified PLHIV, should be considered. |
Vaccine Hesitancy: Drivers and How the Allergy Community Can Help.
Turner PJ , Larson H , Dubé È , Fisher A . J Allergy Clin Immunol Pract 2021 9 (10) 3568-3574 Vaccine hesitancy - defined by the World Health Organization (WHO) as a "delay in acceptance or refusal of vaccines despite availability of vaccination services" is not a recent phenomenon. Historical records indicate that vaccine hesitancy existed by the 18(th) century in Europe and even resulted in violent riots. The drivers of vaccine hesitancy have evolved over the last 200 years but not, perhaps, as much as one might expect. More problematic are the means by which concerns over vaccine hesitancy are communicated by a new landscape of digital communication, generating what has been described as an "infodemic" where an overabundance of information - both factual and misinformation - contributes to hesitancy. In this review, we discuss the background and current drivers of vaccine hesitancy and the evidence-base for strategies to combat this. We highlight the important role the allergy/immunology community could have in working to mitigate vaccine hesitancy, particularly with respect to the current COVID-19 pandemic. |
Unawareness of HIV Infection Among Men Aged 15-59 Years in 13 Sub-Saharan African Countries: Findings From the Population-Based HIV Impact Assessments, 2015-2019
West CA , Chang GC , Currie DW , Bray R , Kinchen S , Behel S , McCullough-Sanden R , Low A , Bissek A , Shang JD , Ndongmo CB , Dokubo EK , Balachandra S , Lobognon LR , Dube L , Nuwagaba-Biribonwoha H , Li M , Pasipamire M , Getaneh Y , Lulseged S , Eshetu F , Kingwara L , Zielinski-Gutierrez E , Tlhomola M , Ramphalla P , Kalua T , Auld AF , Williams DB , Remera E , Rwibasira GN , Mugisha V , Malamba SS , Mushi J , Jalloh MF , Mgomella GS , Kirungi WL , Biraro S , Awor AC , Barradas DT , Mugurungi O , Rogers JH , Bronson M , Bodika SM , Ajiboye A , Gaffga N , Moore C , Patel HK , Voetsch AC . J Acquir Immune Defic Syndr 2021 87 S97-s106 BACKGROUND: Identifying men living with HIV in sub-Saharan Africa (SSA) is critical to end the epidemic. We describe the underlying factors of unawareness among men aged 15-59 years who ever tested for HIV in 13 SSA countries. METHODS: Using pooled data from the nationally representative Population-based HIV Impact Assessments, we fit a log-binomial regression model to identify characteristics related to HIV positivity among HIV-positive unaware and HIV-negative men ever tested for HIV. RESULTS: A total of 114,776 men were interviewed and tested for HIV; 4.4% were HIV-positive. Of those, 33.7% were unaware of their HIV-positive status, (range: 20.2%-58.7%, in Rwanda and Cote d'Ivoire). Most unaware men reported they had ever received an HIV test (63.0%). Age, region, marital status, and education were significantly associated with HIV positivity. Men who had HIV-positive sexual partners (adjusted prevalence ratio [aPR]: 5.73; confidence interval [95% CI]: 4.13 to 7.95) or sexual partners with unknown HIV status (aPR: 2.32; 95% CI: 1.89 to 2.84) were more likely to be HIV-positive unaware, as were men who tested more than 12 months compared with HIV-negative men who tested within 12 months before the interview (aPR: 1.58; 95% CI: 1.31 to 1.91). Tuberculosis diagnosis and not being circumcised were also associated with HIV positivity. CONCLUSION: Targeting subgroups of men at risk for infection who once tested negative could improve yield of testing programs. Interventions include improving partner testing, frequency of testing, outreach and educational strategies, and availability of HIV testing where men are accessing routine health services. |
A One Health approach to child stunting: Evidence and research agenda
Gharpure R , Mor S , Viney M , Hodobo T , Lello J , Siwila J , Dube K , Robertson RC , Mutasa K , Berger CN , Hirai M , Brown T , Ntozini R , Evans C , Hoto P , Smith LE , Tavengwa NV , Joyeux M , Humphrey JH , Berendes D , Prendergast AJ . Am J Trop Med Hyg 2021 104 (5) 1620-1624 Stunting (low height for age) affects approximately one-quarter of children aged < 5 years worldwide. Given the limited impact of current interventions for stunting, new multisectoral evidence-based approaches are needed to decrease the burden of stunting in low- and middle-income countries (LMICs). Recognizing that the health of people, animals, and the environment are connected, we present the rationale and research agenda for considering a One Health approach to child stunting. We contend that a One Health strategy may uncover new approaches to tackling child stunting by addressing several interdependent factors that prevent children from thriving in LMICs, and that coordinated interventions among humans, animals, and environmental health sectors may have a synergistic effect in stunting reduction. |
Occupational Risk Factors for SARS-CoV-2 Infection among Healthcare Personnel: A Cross-Sectional Analysis of Subjects Enrolled in the COPE Study.
Howard-Anderson J , Adams C , Sherman AC , Dube WC , Smith TC , Edupuganti N , Chea N , Magill SS , Espinoza DO , Zhu Y , Phadke VK , Edupuganti S , Steinberg JP , Lopman BA , Jacob JT , Collins MH , Fridkin SK . Infect Control Hosp Epidemiol 2021 43 (3) 1-20 Among 353 healthcare personnel in a longitudinal cohort in four hospitals in Atlanta, GA (May-June 2020), 23 (6.5%) had SARS-CoV-2 antibodies. Spending >50% of a typical shift at bedside (OR 3.4, 95% CI: 1.2-10.5) and Black race (OR 8.4, 95% CI: 2.7-27.4) were associated with SARS-CoV-2 seropositivity. |
Sex differences in HIV testing - 20 PEPFAR-supported sub-Saharan African Countries, 2019
Drammeh B , Medley A , Dale H , De AK , Diekman S , Yee R , Aholou T , Lasry A , Auld A , Baack B , Duffus W , Shahul E , Wong V , Grillo M , Al-Samarrai T , Ally S , Nyangulu M , Nyirenda R , Olivier J , Chidarikire T , Khanyile N , Kayange AA , Rwabiyago OE , Kategile U , Bisimba J , Weber RA , Ncube G , Maguwu O , Pietersen I , Mali D , Dzinotyiweyi E , Nelson L , Bosco MJ , Dalsone K , Apolot M , Anangwe S , Soo LK , Mugambi M , Mbayiha A , Mugwaneza P , Malamba SS , Phiri A , Chisenga T , Boyd M , Temesgan C , Shimelis M , Weldegebreal T , Getachew M , Balachandra S , Eboi E , Shasha W , Doumatey N , Adjoua D , Meribe C , Gwamna J , Gado P , John-Dada I , Mukinda E , Lukusa LFK , Kalenga L , Bunga S , Achyut V , Mondi J , Loeto P , Mogomotsi G , Ledikwe J , Ramphalla P , Tlhomola M , Mirembe JK , Nkwoh T , Eno L , Bonono L , Honwana N , Chicuecue N , Simbine A , Malimane I , Dube L , Mirira M , Mndzebele P , Frawley A , Cardo YMR , Behel S . MMWR Morb Mortal Wkly Rep 2020 69 (48) 1801-1806 Despite progress toward controlling the human immunodeficiency virus (HIV) epidemic, testing gaps remain, particularly among men and young persons in sub-Saharan Africa (1). This observational study used routinely collected programmatic data from 20 African countries reported to the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) from October 2018 to September 2019 to assess HIV testing coverage and case finding among adults (defined as persons aged ≥15 years). Indicators included number of HIV tests conducted, number of HIV-positive test results, and percentage positivity rate. Overall, the majority of countries reported higher HIV case finding among women than among men. However, a slightly higher percentage positivity was recorded among men (4.7%) than among women (4.1%). Provider-initiated counseling and testing (PITC) in health facilities identified approximately two thirds of all new cases, but index testing had the highest percentage positivity in all countries among both sexes. Yields from voluntary counseling and testing (VCT) and mobile testing varied by sex and by country. These findings highlight the need to identify and implement the most efficient strategies for HIV case finding in these countries to close coverage gaps. Strategies might need to be tailored for men who remain underrepresented in the majority of HIV testing programs. |
Overcoming barriers to HIV care: Findings from a peer-delivered, community-based, linkage case management program (CommLink), Eswatini, 2015-2018
MacKellar D , Williams D , Dlamini M , Byrd J , Dube L , Mndzebele P , Mazibuko S , Pathmanathan I , Tilahun E , Ryan C . AIDS Behav 2020 25 (5) 1518-1531 To help persons living with HIV (PLHIV) in Eswatini initiate antiretroviral therapy (ART), the CommLink case-management program provided a comprehensive package of linkage services delivered by HIV-positive, peer counselors. Of 1250 PLHIV participants aged ≥ 15 years diagnosed in community settings, 75% reported one or more barriers to care (e.g., fearing stigmatization). Peer counselors helped resolve 1405 (65%) of 2166 identified barriers. During Test and Treat (October 2016-September 2018), the percentage of participants who initiated ART and returned for ≥ 1 antiretroviral refills was 92% overall (759/824); 99% (155/156) among participants without any identified barriers; 96% (544/564) among participants whose counselors helped resolve all or all but one barrier; and 58% (59/102) among participants who had ≥ 2 unresolved barriers to care. The success of CommLink is attributed, at least in part, to peer counselors who helped their clients avoid or at least temporarily resolve many well-known barriers to HIV care. |
Putting the "A" into WaSH: a call for integrated management of water, animals, sanitation, and hygiene
Prendergast AJ , Gharpure R , Mor S , Viney M , Dube K , Lello J , Berger C , Siwila J , Joyeux M , Hodobo T , Hurt L , Brown T , Hoto P , Tavengwa N , Mutasa K , Craddock S , Chasekwa B , Robertson RC , Evans C , Chidhanguro D , Mutasa B , Majo F , Smith LE , Hirai M , Ntozini R , Humphrey JH , Berendes D . Lancet Planet Health 2019 3 (8) e336-e337 Water, sanitation, and hygiene (WaSH) are foundational public health interventions for infectious disease control. Renewed efforts to end open defecation and provide universal access to safe drinking water, sanitation, and hygiene by 2030 are being enacted through the Sustainable Development Goals. However, results from clinical trials1, 2, 3 question the efficacy of conventional rural WaSH approaches in low-income and middle-income countries (LMICs). Randomised trials in Bangladesh,1 Kenya,2 and Zimbabwe,3 which introduced household pit latrines, hand-washing with soap, and point-of-use water chlorination, found no effect on child growth, and two of the three trials found no reductions in diarrhoea in children. We have, therefore, called for transformative WaSH approaches,4 to more effectively reduce pathogen burden and promote child health and growth in LMICs. However, currently, it remains uncertain what transformative WaSH entails. |
Early adolescent gender diversity and mental health in the Adolescent Brain Cognitive Development study
Potter A , Dube S , Allgaier N , Loso H , Ivanova M , Barrios LC , Bookheimer S , Chaarani B , Dumas J , Feldstein-Ewing S , Freedman EG , Garavan H , Hoffman E , McGlade E , Robin L , Johns MM . J Child Psychol Psychiatry 2020 62 (2) 171-179 BACKGROUND: There are known associations between mental health symptoms and transgender identity among adults. Whether this relationship extends to early adolescents and to gender domains other than identity is unclear. This study measured dimensions of gender in a large, diverse, sample of youth, and examined associations between diverse gender experiences and mental health. METHODS: The ABCD study is an ongoing, longitudinal, US cohort study. Baseline data (release 2.0) include 11,873 youth age 9/10 (48% female); and the 4,951 1-year follow-up visits (age 10/11; 48% female) completed prior to data release. A novel gender survey at the 1-year visit assessed felt-gender, gender noncontentedness, and gender nonconformity using a 5-point scale. Mental health measures included youth- and parent-reports. RESULTS: Roughly half a percent of 9/10-year-olds (n = 58) responded 'yes' or 'maybe' when asked, 'Are you transgender' at baseline. Recurrent thoughts of death were more prevalent among these youth compared to the rest of the cohort (19.6% vs. 6.4%, chi(2) = 16.0, p < .001). At the 1-year visit, when asked about the three dimensions of gender on a 5-point scale, 33.2% (n = 1,605) provided responses that were not exclusively and totally aligned with one gender. Significant relationships were observed between mental health symptoms and gender diversity for all dimensions assessed. CONCLUSIONS: Similar to adult studies, early adolescents identifying as transgender reported increased mental health symptoms. Results also point to considerable diversity in other dimensions of gender (felt-gender, gender noncontentedness, gender nonconformity) among 10/11-year-olds, and find this diversity to be related to critical mental health symptoms. These findings add to our limited understanding of the relationship between dimensions of gender and wellness for youth. |
Cervical determinants of anal HPV infection and high-grade anal lesions in women: a collaborative pooled analysis
Lin C , Slama J , Gonzalez P , Goodman MT , Xia N , Kreimer AR , Wu T , Hessol NA , Shvetsov Y , Ortiz AP , Grinsztejn B , Moscicki AB , Heard I , Del Refugio Gonzalez Losa M , Kojic EM , Schim van der Loeff MF , Wei F , Longatto-Filho A , Mbulawa ZA , Palefsky JM , Sohn AH , Hernandez BY , Robison K , Simpson SJr , Conley LJ , de Pokomandy A , van der Sande MAB , Dube Mandishora RS , Volpini LPB , Pierangeli A , Romero B , Wilkin T , Franceschi S , Hidalgo-Tenorio C , Ramautarsing RA , Park IU , Tso FK , Godbole S , D'Hauwers KWM , Sehnal B , Menezes LJ , Heraclio SA , Clifford GM . Lancet Infect Dis 2019 19 (8) 880-891 BACKGROUND: Cervical cancer screening might contribute to the prevention of anal cancer in women. We aimed to investigate if routine cervical cancer screening results-namely high-risk human papillomavirus (HPV) infection and cytohistopathology-predict anal HPV16 infection, anal high-grade squamous intraepithelial lesions (HSIL) and, hence, anal cancer. METHODS: We did a systematic review of MEDLINE, Embase, and the Cochrane library for studies of cervical determinants of anal HPV and HSIL published up to Aug 31, 2018. We centrally reanalysed individual-level data from 13 427 women with paired cervical and anal samples from 36 studies. We compared anal high-risk HPV prevalence by HIV status, cervical high-risk HPV, cervical cytohistopathology, age, and their combinations, using prevalence ratios (PR) and 95% CIs. Among 3255 women with anal cytohistopathology results, PRs were similarly calculated for all anal HSIL and HPV16-positive anal HSIL. FINDINGS: Cervical and anal HPV infections were highly correlated. In HIV-negative women, anal HPV16 prevalence was 41% (447/1097) in cervical HPV16-positive versus 2% (214/8663) in cervical HPV16-negative women (PR 16.5, 95% CI 14.2-19.2, p<0.0001); these values were 46% (125/273) versus 11% (272/2588) in HIV-positive women (4.4, 3.7-5.3, p<0.0001). Anal HPV16 was also associated with cervical cytohistopathology, with a prevalence of 44% [101/228] for cervical cancer in HIV-negative women (PR vs normal cytology 14.1, 11.1-17.9, p<0.0001). Anal HSIL was associated with cervical high-risk HPV, both in HIV-negative women (from 2% [11/527] in cervical high-risk HPV-negative women up to 24% [33/138] in cervical HPV16-positive women; PR 12.9, 95% CI 6.7-24.8, p<0.0001) and HIV-positive women (from 8% [84/1094] to 17% [31/186]; 2.3, 1.6-3.4, p<0.0001). Anal HSIL was also associated with cervical cytohistopathology, both in HIV-negative women (from 1% [5/498] in normal cytology up to 22% [59/273] in cervical HSIL; PR 23.1, 9.4-57.0, p<0.0001) and HIV-positive women (from 7% [105/1421] to 25% [25/101]; 3.6, 2.5-5.3, p<0.0001). Prevalence of HPV16-positive anal HSIL was 23-25% in cervical HPV16-positive women older than 45 years (5/20 in HIV-negative women, 12/52 in HIV-positive women). INTERPRETATION: HPV-based cervical cancer screening programmes might help to stratify anal cancer risk, irrespective of HIV status. For targeted secondary anal cancer prevention in high-risk groups, HIV-negative women with cervical HPV16, especially those older than 45 years, have a similar anal cancer risk profile to that of HIV-positive women. FUNDING: International Agency for Research on Cancer. |
Assessment of age-related differences in smoking status and health-related quality of life (HRQoL): Findings from the 2016 Behavioral Risk Factor Surveillance System
Dube SR , Liu J , Fan AZ , Meltzer MI , Thompson WW . J Community Psychol 2018 47 (1) 93-103 Despite significant declines in the use of cigarettes, a significant proportion of adults smoke. This study explores the association between smoking and health-related quality of life (HRQoL) by age. The 2016 Behavioral Risk Factor Surveillance System survey was administered to adults in 50 states and District of Columbia (n = 437,195). Physically unhealthy days (PUDs) and mentally unhealthy days (MUDs)) were regressed on age strata (18-24, 25-34, 35-44, 45-54, 55-64, ≥ 65 years) and smoking status (never, former, someday, and everyday) using negative binomial regression models with adjustment for sociodemographic covariates. For each age group, everyday smoking highly predicted PUDs and MUDs. Predicted PUDs increased with age; predicted MUDs decreased with age. Among adults aged 45-54 and 55-64 years, 3-day difference in PUDs was observed between never smokers and everyday smokers. Among young adults (18-24 years), a 4.3-day difference in MUDs was observed between everyday and never smokers. The discrepancies were nonlinear with age. The observed relationship between smoking and HRQoL provides novel information about the need to consider age when designing community-based interventions. Additional research can provide needed depth to understanding the relationship between smoking and HRQoL in specific age groups. |
Peer-delivered linkage case management and same-day ART initiation for men and young persons with HIV infection - Eswatini, 2015-2017
MacKellar D , Williams D , Bhembe B , Dlamini M , Byrd J , Dube L , Mazibuko S , Ao T , Pathmanathan I , Auld AF , Faura P , Lukhele N , Ryan C . MMWR Morb Mortal Wkly Rep 2018 67 (23) 663-667 To achieve epidemic control of human immunodeficiency virus (HIV) infection, sub-Saharan African countries are striving to diagnose 90% of HIV infections, initiate and retain 90% of HIV-diagnosed persons on antiretroviral therapy (ART), and achieve viral load suppression* for 90% of ART recipients (90-90-90) (1). In Eswatini (formerly Swaziland), the country with the world's highest estimated HIV prevalence (27.2%), achieving 90-90-90 depends upon improving access to early ART for men and young adults with HIV infection, two groups with low ART coverage (1-3). Although community-based strategies test many men and young adults with HIV infection in Eswatini, fewer than one third of all persons who test positive in community settings enroll in HIV care within 6 months of diagnosis after receiving standard referral services (4,5). To evaluate the effectiveness of peer-delivered linkage case management(dagger) in improving early ART initiation for persons with HIV infection diagnosed in community settings in Eswatini, CDC analyzed data on 651 participants in CommLink, a community-based, mobile HIV-testing, point-of-diagnosis HIV care, and peer-delivered linkage case management demonstration project, and found that after diagnosis, 635 (98%) enrolled in care within a median of 5 days (interquartile range [IQR] = 2-8 days), and 541 (83%) initiated ART within a median of 6 days (IQR = 2-14 days), including 402 (74%) on the day of their first clinic visit (same-day ART). After expanding ART eligibility to all persons with HIV infection on October 1, 2016, 96% of 225 CommLink clients initiated ART, including 87% at their first clinic visit. Compared with women and adult clients aged >/=30 years, similar high proportions of men and persons aged 15-29 years enrolled in HIV care and received same-day ART. To help achieve 90-90-90 by 2020, the United States President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the national scale-up of CommLink in Eswatini and recommending peer-delivered linkage case management as a potential strategy for countries to achieve >90% early enrollment in care and ART initiation after diagnosis of HIV infection (6). |
The WHO Tailoring Immunization Programmes (TIP) approach: Review of implementation to date
Dube E , Leask J , Wolff B , Hickler B , Balaban V , Hosein E , Habersaat K . Vaccine 2017 36 (11) 1509-1515 INTRODUCTION: The WHO Regional Office for Europe developed the Guide to tailoring immunization programmes (TIP), offering countries a process through which to diagnose barriers and motivators to vaccination in susceptible low vaccination coverage and design tailored interventions. A review of TIP implementation was conducted in the European Region. MATERIAL AND METHODS: The review was conducted during June to December 2016 by an external review committee and was based on visits in Bulgaria, Lithuania, Sweden and the United Kingdom that had conducted a TIP project; review of national and regional TIP documents and an online survey of the Member States in the WHO European Region that had not conducted a TIP project. A review committee workshop was held to formulate conclusions and recommendations. RESULTS: The review found the most commonly cited strengths of the TIP approach to be the social science research as well as the interdisciplinary approach and community engagement, enhancing the ability of programmes to "listen" and learn, to gain an understanding of community and individual perspectives. National immunization managers in the Region are generally aware that TIP exists and that there is strong demand for the type of research it addresses. Further work is needed to assist countries move towards implementable strategies based on the TIP findings, supported by an emphasis on enhanced local ownership; integrated diagnostic and intervention design; and follow-up meetings, advocacy and incentives for decision-makers to implement and invest in strategies. CONCLUSIONS: Understanding the perspectives of susceptible and low-coverage populations is crucial to improving immunization programmes. TIP provides a framework that facilitated this in four countries. In the future, the purpose of TIP should go beyond identification of susceptible groups and diagnosis of challenges and ensure a stronger focus on the design of strategies and appropriate and effective interventions to ensure long-term change. |
School-Based Influenza Vaccination: Health and Economic Impact of Maine's 2009 Influenza Vaccination Program.
Basurto-Davila R , Meltzer MI , Mills DA , Beeler Asay GR , Cho BH , Graitcer SB , Dube NL , Thompson MG , Patel SA , Peasah SK , Ferdinands JM , Gargiullo P , Messonnier M , Shay DK . Health Serv Res 2017 52 Suppl 2 2307-2330 OBJECTIVE: To estimate the societal economic and health impacts of Maine's school-based influenza vaccination (SIV) program during the 2009 A(H1N1) influenza pandemic. DATA SOURCES: Primary and secondary data covering the 2008-09 and 2009-10 influenza seasons. STUDY DESIGN: We estimated weekly monovalent influenza vaccine uptake in Maine and 15 other states, using difference-in-difference-in-differences analysis to assess the program's impact on immunization among six age groups. We also developed a health and economic Markov microsimulation model and conducted Monte Carlo sensitivity analysis. DATA COLLECTION: We used national survey data to estimate the impact of the SIV program on vaccine coverage. We used primary data and published studies to develop the microsimulation model. PRINCIPAL FINDINGS: The program was associated with higher immunization among children and lower immunization among adults aged 18-49 years and 65 and older. The program prevented 4,600 influenza infections and generated $4.9 million in net economic benefits. Cost savings from lower adult vaccination accounted for 54 percent of the economic gain. Economic benefits were positive in 98 percent of Monte Carlo simulations. CONCLUSIONS: SIV may be a cost-beneficial approach to increase immunization during pandemics, but programs should be designed to prevent lower immunization among nontargeted groups. |
Rates of virological suppression and drug resistance in adult HIV-1-positive patients attending primary healthcare facilities in KwaZulu-Natal, South Africa
Hunt GM , Dokubo EK , Takuva S , de Oliveira T , Ledwaba J , Dube N , Moodley P , Sabatier J , Deyde V , Morris L , Raizes E . J Antimicrob Chemother 2017 72 (11) 3141-3148 Background: KwaZulu-Natal (KZN) Province in South Africa has the highest HIV disease burden in the country, with an estimated population prevalence of 24.7%. A pilot sentinel surveillance project was undertaken in KZN to classify the proportion of adult patients failing first-line ART and to describe the patterns of drug resistance mutations (DRMs) in patients with virological failure (VF). Methods: Cross-sectional surveillance of acquired HIV drug resistance was conducted in 15 sentinel ART clinics between August and November 2013. Two population groups were surveyed: on ART for 12-15 months (Cohort A) or 24-36 months (Cohort B). Plasma specimens with viral load ≥1000 copies/mL were defined as VF and genotyped for DRMs. Results: A total of 1299 adults were included in the analysis. The prevalence of VF was 4.0% (95% CI 1.8-8.8) among 540 adults in Cohort A and 7.7% (95% CI 4.4-13.0) of 759 adults in Cohort B. Treatment with efavirenz was more likely to suppress viral load in Cohort A ( P = 0.005). Independent predictors of VF for Cohort B included male gender, advanced WHO stage at ART initiation and treatment with stavudine or zidovudine compared with tenofovir. DRMs were detected in 89% of 123 specimens with VF, including M184I/V, K103N/S, K65N/R, V106A/M and Y181C. Conclusions: VF in adults in KZN was <8% up to 3 years post-ART initiation but was associated with a high frequency of DRMs. These data identify key groups for intensified adherence counselling and highlight the need to optimize first-line regimens to maintain viral suppression. |
Early impact of rotavirus vaccine in under 5year old children hospitalized due to diarrhea, Swaziland
Maphalala G , Phungwayo N , Masona G , Lukhele N , Tsegaye G , Dube N , Sindisiwe D , Khumalo L , Daniel F , Katsande R , Tate JE , Mwenda JM , Weldegebriel G . Vaccine 2017 36 (47) 7210-7214 BACKGROUND: Swaziland introduced rotavirus vaccine in the National Immunization Program, in May 2015, with the objective of reducing the burden of rotavirus diarrheal disease. We monitored the early impact of the vaccine in reducing rotavirus diarrhea. METHODS: We conducted sentinel rotavirus surveillance from January 2013 to December 2016 in children under five years of age admitted due to diarrhea attending Mbabane Government Referral Hospital in the Hhohho Region and Raleigh Fitkin Memorial Hospital in the Manzini Region. All cases had stool samples collected and tested for rotavirus antigen by enzyme immunoassay. RESULTS: Between 2013 and 2016, 596 samples were collected and tested. Rotavirus positivity reduced from average of 50.8% (172/338) (in 2013-2014 (pre vaccine period)) to 29% (24/82) in 2016, post-vaccine introduction. The median age of children with rotavirus infection increased from average of 10months in 2013-2014 to 13.7months in 2016. The peak season for all-cause diarrhea and rotavirus-specific hospitalizations among children under five years of age was June-August in all years with a blunting of the peak season in 2016. Rotavirus positivity among children 0-11months reduced from an average of 49% in 2013-2014 (116/236) to 33% (15/45) in 2016, a 33% reduction following rotavirus vaccine introduction. CONCLUSION: There has been a rapid reduction of all-cause diarrhea and rotavirus hospitalizations in Swaziland, particularly in young children and during the rotavirus season, after the introduction rotavirus vaccine. Continued surveillance is needed to monitor the long-term impact of rotavirus vaccine introduction. |
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