Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 53 Records) |
Query Trace: Medley A [original query] |
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Social network strategy (SNS) for HIV testing: a new approach for identifying individuals with undiagnosed HIV infection in Tanzania
Rwabiyago OE , Katale A , Bingham T , Grund JM , Machangu O , Medley A , Nkomela ZM , Kayange A , King'ori GN , Juma JM , Ismail A , Kategile U , Akom E , Mlole NT , Schaad N , Maokola W , Nyagonde N , Magesa D , Kazitanga JC , Maruyama H , Temu F , Kimambo S , Sando D , Mbatia R , Chalamila ST , Ogwang BE , Njelekela MA , Kazaura K , Wong VJ , Gongo R , Njau PF , Mbunda A , Nondi J , Bateganya M , Greene J , Breda M , Mgomella G , Rwebembera A , Swaminathan M . AIDS Care 2024 1-10 Social network strategy (SNS) testing uses network connections to refer individuals at high risk to HIV testing services (HTS). In Tanzania, SNS testing is offered in communities and health facilities. In communities, SNS testing targets key and vulnerable populations (KVP), while in health facilities it complements index testing by reaching unelicited index contacts. Routine data were used to assess performance and trends over time in PEPFAR-supported sites between October 2021 and March 2023. Key indicators included SNS social contacts tested, and new HIV-positives individuals identified. Descriptive and statistical analysis were conducted. Univariable and multivariable analysis were applied, and variables with P-values <0.2 at univariable analysis were considered for multivariable analysis. Overall, 121,739 SNS contacts were tested, and 7731 (6.4%) previously undiagnosed individuals living with HIV were identified. Tested contacts and identified HIV-positives were mostly aged ≥15 years (>99.7%) and females (80.6% of tests, 79.4% of HIV-positives). Most SNS contacts were tested (78,363; 64.7%) and diagnosed (6376; 82.5%) in communities. SNS tests and HIV-positives grew 11.5 and 6.1-fold respectively, from October-December 2021 to January-March 2023, with majority of clients reached in communities vs. facilities (78,763 vs. 42,976). These results indicate that SNS testing is a promising HIV case-finding approach in Tanzania. |
Improving HIV case finding through index testing: Findings from health facilities in 12 districts of South Africa, October 2019-September 2021
Aheron S , Paredes-Vincent A , Patton ME , Gross J , Medley A , Mona G , Mtimkulu N , Nkuna K , Grund JM . AIDS Behav 2024 To assess the importance of index testing in HIV case finding, we analyzed quarterly data from October 2019 to September 2021 from 371 facilities in 12 districts in South Africa. Index testing accounted for 2.6% of all HIV tests (index and non-index) (n = 163,633), but 17.8% of all HIV-positive results, with an HIV-positivity 4-times higher than non-index testing modalities (4.1%). Despite twice as many adult females ≥ 15 years accepting index testing (n = 206,715) compared to adult males ≥ 15 years (n = 102,180), females identified fewer contacts (n = 91,123) than males (n = 113,939). Slightly more than half (51.2%) of all contacts elicited were tested (n = 163,633/319,680), while 19.7% (n = 62,978) of elicited contacts were previously diagnosed as HIV-positive and not eligible for further testing. These findings indicate index testing can be effective in increasing HIV diagnoses in South Africa. Further operational research is needed to address gaps identified in the index testing cascade, including elicitation and testing of contacts. |
Establishment of district-led production of WHO-recommended Alcohol-Based Hand Rub (ABHR) during the COVID-19 pandemic: a model for improving access to ABHR during health emergencies
Tusabe F , Lamorde M , Medley A , Kesande M , Lozier MJ , Yapswale S , Ociti F , Isabirye H , Nuwamanya E , Nanyondo J , Boore A , Vosburgh W , Kasule JN , Pratt C , Berendes D . J Water Sanit Hyg Develop 2023 13 (10) 847-856 In response to the COVID-19 pandemic, we established and sustained local production of Alcohol-Based Hand Rub (ABHR) at a district scale for healthcare facilities and community, public locations in four districts in Uganda. District officials provided space and staff for production units. The project renovated space for production, trained staff on ABHR production, and transported ABHR to key locations. The production officer conducted internal ABHR quality assessments while trained district health inspectors conducted external quality assessments prior to distribution. Information, education, and communication materials accompanied ABHR distribution. Onsite ABHR consumption was moni-tored by site staff using stock cards. On average, it took 11 days (range: 8–14) and 5,760 USD (range: 4,400–7,710) to setup a production unit. From March to December 2021, 21,600 L of quality-controlled ABHR were produced for 111 healthcare facilities and community locations at an average cost of 4.30 USD/L (range: 3.50–5.76). All ABHR passed both internal and external quality control (average ethanol concentration of 80%, range: 78–81%). This case study demonstrated that establishing centralized, local production of quality-controlled, affordable ABHR at a district-wide scale is feasible and strengthens the ability of healthcare workers and community locations to access and use ABHR during infectious disease outbreaks in low-resource countries. © 2023 The Authors. |
Access to and use of hand hygiene resources during the COVID-19 pandemic in two districts in Uganda, January-April 2021
Pratt C , Kesande M , Tusabe F , Medley A , Prentice-Mott G , Lozier M , Trinies V , Yapswale S , Nabatyanga S , Isabirye H , Lamorde M , Berendes D . Am J Trop Med Hyg 2023 109 (4) 881-889 To understand access to and use of hand hygiene in healthcare facilities (HCFs) and community locations during the COVID-19 pandemic, we evaluated factors associated with hand hygiene in 60 priority HCFs and community locations in two border districts in Uganda. We assessed water and hand hygiene resource availability and observed hand hygiene practice by staff or patrons. Regression modeling estimated factors associated with the availability or use of hand hygiene. In HCFs, most inpatient (61%), outpatient (71%), and laboratory or staff (90%) rooms contained hand hygiene materials. Only 38% of community locations had hand hygiene materials at all entrances and exits, 35% of congregation areas had hand hygiene materials. Overall, 38% of healthcare staff, 48% of patrons post-latrine use, and 21% of patrons entering or exiting community locations practiced hand hygiene. HCF hand hygiene access was lower in inpatient rooms (odds ratio [OR] = 0.17, 95% CI: 0.06-0.45) and outpatient rooms (OR = 0.23, 95% CI: 0.07-0.70) compared with laboratory/staff rooms. HCF hand hygiene practice was higher for doctors than nurses (OR = 3.58, 95% CI: 1.15-11.14) and with new versus existing patient encounters (OR = 2.27, 95% CI: 1.20-4.27); it was lower before versus after patient contact for both invasive (OR = 0.03, 95% CI: 0.00-0.20) and noninvasive (OR = 0.66, 95% CI: 0.45-0.95) procedures. In community settings, hand hygiene practice after using the latrine was higher than at an entrances/exits (OR = 3.39, 95% CI: 2.08-5.52). Hand hygiene rates were relatively low in healthcare and community settings. Greater emphasis on hand hygiene before patient interactions (at HCFs) and at community entrances/exits for patrons is also needed. |
Improving access to who formulations of alcohol-based hand rub in healthcare facilities: A district-wide approach
Tusabe F , Nanyondo J , Lozier MJ , Kesande M , Tumuhairwe O , Watsisi M , Twinomugisha F , Medley A , Mutoro J , Lamorde M , Berendes D . Am J Trop Med Hyg 2023 109 (1) 191-200 Alcohol-based hand rub (ABHR) is an effective hand hygiene measure to mitigate and prevent infectious disease transmission in healthcare facilities (HCFs); however, availability and affordability in low- and middle-income countries are limited. We sought to establish centralized local production of ABHR using a district-wide approach to increase provider access at all public HCFs in Kabarole and Kasese Districts in Western Uganda. Partner organizations worked with district governments to adapt and implement the WHO protocol for local ABHR production at the district scale. These groups identified and upgraded sites for ABHR production and storage to ensure recommended security, ventilation, and air conditioning. District governments selected technicians for training on ABHR production. Raw materials were sourced within Uganda. Alcohol-based hand rub underwent internal quality control by the production officer and external quality control (EQC) by a trained district health inspector before distribution to HCFs. We assessed ABHR production and demand from March 2019 to December 2020. All ABHR batches (N = 316) met protocol standards (alcohol concentration: 75.0-85.0%) with a mean of 79.9% (range: 78.5-80.5%). Internal quality control measurements (mean alcohol concentration: 80.0%, range: 79.5-81.0%) matched EQC measurements (mean: 79.8%, range: 78.0-80.0%). Production units supplied ABHR to 127 HCFs in Kasese District (100%) and 31 HCFs in Kabarole District (56%); 94% of HCFs were small (dispensary or next higher level). This district-wide production met quality standards and supplied ABHR to many HCFs where facility-level production would be unfeasible. Low- and middle-income countries may consider district models to expand ABHR production and supply to smaller HCFs. |
Considerations to improve pediatric HIV testing and close the treatment gap in 16 African countries
Gross J , Medley A , Rivadeneira E , Battey K , Srivastava M , Grillo M , Wolf H , Simmons P , Hast M , Patel M . Pediatr Infect Dis J 2023 42 (2) 110-118 BACKGROUND: In 2019, South Africa, Nigeria, Tanzania, Democratic Republic of Congo, Uganda, Mozambique, Zambia, Angola, Cameroon, Zimbabwe, Ghana, Ethiopia, Malawi, Kenya, South Sudan and Côte d'Ivoire accounted for 80% of children living with HIV (CLHIV) not receiving HIV treatment. This manuscript describes pediatric HIV testing to inform case-finding strategies. METHODS: We analyzed US President's Emergency Plan for AIDS Relief monitoring, evaluation, and reporting data (October 1, 2018 to September 30, 2019) for these 16 countries. Number of HIV tests and positive results were reported by age band, country, treatment coverage and testing modality. The number needed to test (NNT) to identify 1 new CLHIV 1-14 years was measured by testing modality and country. The pediatric testing gap was estimated by multiplying the estimated number of CLHIV unaware of their status by NNT per country. RESULTS: Among children, 6,961,225 HIV tests were conducted, and 101,762 CLHIV were identified (NNT 68), meeting 17.6% of the pediatric testing need. Index testing accounted for 13.0% of HIV tests (29.7% of positive results, NNT 30), provider-initiated testing and counseling 65.9% of tests (43.6% of positives, NNT 103), and universal testing at sick entry points 5.3% of tests (6.5% of positives, NNT 58). CONCLUSIONS: As countries near HIV epidemic control for adults, the need to increase pediatric testing continues. Each testing modality - PITC, universal testing at sick entry points, and index testing - offers unique benefits. These results illustrate the comparative advantages of including a strategic mix of testing modalities in national programs to increase pediatric HIV case finding. |
COVID-19 on the Nile: a cross-sectional investigation of COVID-19 among Nile River cruise travellers returning to the United States, February-march 2020.
Guagliardo SAJ , Quilter LAS , Uehara A , White SB , Talarico S , Tong S , Paden CR , Zhang J , Li Y , Pray I , Novak RT , Fukunaga R , Rodriguez A , Medley AM , Wagner R , Weinberg M , Brown CM , Friedman CR . J Travel Med 2022 BACKGROUND: Early in the pandemic, cruise travel exacerbated the global spread of SARS-CoV-2. We report epidemiologic and molecular findings from an investigation of a cluster of travelers with confirmed COVID-19 returning to the U.S. from Nile River cruises in Egypt. METHODS: State health departments reported data on real-time reverse transcription-polymerase chain reaction-confirmed COVID-19 cases with a history of Nile River cruise travel during February-March 2020 to the Centers for Disease Control and Prevention (CDC). Demographic and epidemiologic data were collected through routine surveillance channels. Sequences were obtained from either state health departments or from the Global Initiative on Sharing Avian Flu Data (GISAID). We conducted descriptive analyses of epidemiologic data and explored phylogenetic relationships between sequences. RESULTS: We identified 149 Nile River cruise travelers with confirmed COVID-19 who returned to 67 different U.S. counties in 27 states: among those with complete data, 4.7% (6/128) died and 28.1% (38/135) were hospitalized. These individuals traveled on 20 different Nile River cruise voyages (12 unique vessels). Fifteen community transmission events were identified in four states, with 73.3% (11/15) of these occurring in Wisconsin (as the result of a more detailed contact investigation in that state). Phylogenetic analyses supported the hypothesis that travelers were most likely infected in Egypt, with most sequences in Nextstrain clade 20A 93% (87/94). We observed genetic clustering by Nile River cruise voyage and vessel. CONCLUSIONS: Nile River cruise travelers with COVID-19 introduced SARS-CoV-2 over a very large geographic range, facilitating transmission across the United States early in the pandemic. Travelers who participate in cruises, even on small river vessels as investigated in this study, are at increased risk of SARS-CoV-2 exposure. Therefore, history of river cruise travel should be considered in contact tracing and outbreak investigations. |
Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19
Berendes D , Martinsen A , Lozier M , Rajasingham A , Medley A , Osborne T , Trinies V , Schweitzer R , Prentice-Mott G , Pratt C , Murphy J , Craig C , Lamorde M , Kesande M , Tusabe F , Mwaki A , Eleveld A , Odhiambo A , Ngere I , Kariuki Njenga M , Cordon-Rosales C , Contreras APG , Call D , Ramay BM , Ramm RES , Paulino CJT , Schnorr CD , Aubin M , Dumas D , Murray KO , Bivens N , Ly A , Hawes E , Maliga A , Morazan GH , Manzanero R , Morey F , Maes P , Diallo Y , Ilboudo M , Richemond D , Hattab OE , Oger PY , Matsuhashi A , Nsambi G , Antoine J , Ayebare R , Nakubulwa T , Vosburgh W , Boore A , Herman-Roloff A , Zielinski-Gutierrez E , Handzel T . PLOS Water 2022 1 (6) Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices-for example, hand hygiene-are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors. |
Use of point-of-care handheld ultrasound for splenomegaly in United States-bound refugees: A novel technology with far-reaching implications
Kummer T , Medley AM , Klosovsky A , Mann E , Mburu P , Ekernas K , Bonass B , Stauffer JC , Walukaga S , Weinberg M , Dunlop SJ , Stauffer WM . Am J Trop Med Hyg 2022 108 (1) 12-14 Ultrasound (US) is an invaluable clinical tool. New point-of-care US technology holds great promise for hard-to-reach and mobile populations such as refugees. The implementation of US in unique and challenging settings has been hindered by cost, fragility of equipment, need for uninterrupted electricity, training, and difficulty in sharing data/image files impeding quality assurance. The recent development of more flexible, durable, high-quality, low-cost, handheld US technology has offered increased potential to address many of these barriers. We describe a pilot program using a new point-of-care US technology to identify and monitor splenomegaly in United States-bound Congolese refugees. This experience and model may hold lessons for planning and development of similar approaches in other hard-to-reach mobile populations. |
An evaluation of an enhanced model of integrating family planning into HIV treatment services in Zambia, April 2018 - June 2019
Medley A , Tsiouris F , Pals S , Senyana B , Hanene S , Kayeye S , Casquete RR , Lasry A , Braaten M , Aholou T , Kasonde P , Chisenga T , Mweebo K , Harris TG . J Acquir Immune Defic Syndr 2022 92 (2) 134-143 BACKGROUND: We designed and implemented an enhanced model of integrating family planning (FP) into existing HIV treatment services at six health facilities in Lusaka, Zambia. METHODS: The enhanced model included: improving FP documentation within HIV monitoring systems; training HIV providers in FP services; offering contraceptives within the HIV clinic; and facilitated referral to community-based distributors. Independent samples of women living with HIV (WLHIV) aged ≥16 years were interviewed pre- and post-intervention and their clinical data abstracted from medical charts. Logistic regression models were used to assess differences in key outcomes between the two time periods. RESULTS: A total of 629 WLHIV were interviewed pre-intervention and 684 post-intervention. Current FP use increased from 35% to 49% comparing the pre- and post-intervention periods (P=0.0025). Increased use was seen for injectables (15% vs. 25%, P<0.0001) and implants (5% vs. 8%, P>0.05) but not for pills (10% vs. 8%, P<0.05) or intra-uterine devices (1% vs. 1%, P >0.05). Dual method use (contraceptive + barrier method) increased from 8% to 18% (P=0.0003) while unmet need for FP decreased from 59% to 46% (P=0.0003). Receipt of safer conception counseling increased from 27% to 39% (P<0.0001). The estimated total intervention cost was $83,293 (2018 USD). CONCLUSIONS: Our model of FP/HIV integration significantly increased the number of WLHIV reporting current FP and dual method use, a met need for FP, and safer conception counseling. These results support continued efforts to integrate FP and HIV services to improve women's access to sexual and reproductive health services. |
Pediatric HIV Case Identification Across 22 PEPFAR-Supported Countries During the COVID-19 Pandemic, October 2019-September 2020.
Traub AM , Medley A , Gross J , Sloan M , Amzel A , Gleason MM , Fernando NB , Wong V , Grillo MP , Wolf HT , Al-Samarrai T , Frawley A , Segwabe M , Motswere C , Baramperanye E , Nzima V , Mange Mayer M , Balachandra S , N'Siesi F X , Longuma HO , Nyembo P , Mazibuko S , Tilahun T , Teferi W , Desinor O , Reginald JL , Simiyu T , Nyabiage L , Mirembe J , Ts'oeu M , Zomba G , Nyangulu M , Wate A , Greenberg Cowan J , Mali D , Pietersen I , Ogundehin D , Onotu D , Ikpeazu A , Niyonsaba E , Bamwesigye J , Mabasa H , Kindra G , Bunga S , Rwegerera F , Machage E , King'ori G , Calnan J , Nazziwa E , Lingenda G , Musokotwane K , Bulaya-Tembo R , Maphosa T , Srivastava M . MMWR Morb Mortal Wkly Rep 2022 71 (28) 894-898 During 2020, an estimated 150,000 persons aged 0-14 years acquired HIV globally (1). Case identification is the first step to ensure children living with HIV are linked to life-saving treatment, achieve viral suppression, and live long, healthy lives. Successful interventions to optimize pediatric HIV testing during the COVID-19 pandemic are needed to sustain progress toward achieving Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 targets.* Changes in HIV testing and diagnoses among persons aged 1-14 years (children) were assessed in 22 U.S. President's Emergency Plan for AIDS Relief (PEPFAR)-supported countries during October 1, 2019-September 30, 2020. This period corresponds to the two fiscal quarters before the COVID-19 pandemic (i.e., Q1 and Q2) and the two quarters after the pandemic began (i.e., Q3 and Q4). Testing was disaggregated by age group, testing strategy, and fiscal year quarter. During October 2019-September 2020, PEPFAR supported 4,312,343 HIV tests and identified 74,658 children living with HIV (CLHIV). The number of HIV tests performed was similar during Q1 and Q2, decreased 40.1% from Q2 to Q3, and increased 19.7% from Q3 to Q4. The number of HIV cases identified among children aged 1-14 years (cases identified) increased 7.4% from Q1 to Q2, decreased 29.4% from Q2 to Q3, and increased 3.3% from Q3 to Q4. Although testing in outpatient departments decreased 21% from Q1 to Q4, testing from other strategies increased during the same period, including mobile testing by 38%, facility-based index testing (offering an HIV test to partners and biological children of persons living with HIV) by 8%, and testing children with signs or symptoms of malnutrition within health facilities by 7%. In addition, most tests (61.3%) and cases identified (60.9%) were among children aged 5-14 years (school-aged children), highlighting the need to continue offering HIV testing to older children. These findings provide important information on the most effective strategies for identifying CLHIV during the COVID-19 pandemic. HIV testing programs should continue to use programmatic, surveillance, and financial data at both national and subnational levels to determine the optimal mix of testing strategies to minimize disruptions in pediatric case identification during the COVID-19 pandemic. |
Lessons Learned from Programmatic Gains in HIV Service Delivery During the COVID-19 Pandemic - 41 PEPFAR-Supported Countries, 2020.
Fisher KA , Patel SV , Mehta N , Stewart A , Medley A , Dokubo EK , Shang JD , Wright J , Rodas J , Balachandra S , Kitenge F , Mpingulu M , García MC , Bonilla L , Quaye S , Melchior M , Banchongphanith K , Phokhasawad K , Nkanaunena K , Maida A , Couto A , Mizela J , Ibrahim J , Charles OO , Malamba SS , Musoni C , Bolo A , Bunga S , Lolekha R , Kiatchanon W , Bhatia R , Nguyen C , Aberle-Grasse J . MMWR Morb Mortal Wkly Rep 2022 71 (12) 447-452 The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supports country programs in identifying persons living with HIV infection (PLHIV), providing life-saving treatment, and reducing the spread of HIV in countries around the world (1,2). CDC used Monitoring, Evaluation, and Reporting (MER) data* to assess the extent to which COVID-19 mitigation strategies affected HIV service delivery across the HIV care continuum(†) globally during the first year of the COVID-19 pandemic. Indicators included the number of reported HIV-positive test results, the number of PLHIV who were receiving antiretroviral therapy (ART), and the rates of HIV viral load suppression. Percent change in performance was assessed between countries during the first 3 months of 2020, before COVID-19 mitigation efforts began (January-March 2020), and the last 3 months of the calendar year (October-December 2020). Data were reviewed for all 41 countries to assess total and country-level percent change for each indicator. Then, qualitative data were reviewed among countries in the upper quartile to assess specific strategies that contributed to programmatic gains. Overall, positive percent change was observed in PEPFAR-supported countries in HIV treatment (5%) and viral load suppression (2%) during 2020. Countries reporting the highest gains across the HIV care continuum during 2020 attributed successes to reducing or streamlining facility attendance through strategies such as enhancing index testing (offering of testing to the biologic children and partners of PLHIV)(§) and community- and home-based testing; treatment delivery approaches; and improvements in data use through monitoring activities, systems, and data quality checks. Countries that reported program improvements during the first year of the COVID-19 pandemic offer important information about how lifesaving HIV treatment might be provided during a global public health crisis. |
Mongooses (Urva auropunctata) as reservoir hosts of Leptospira species in the United States Virgin Islands, 2019-2020.
Cranford HM , Browne AS , LeCount K , Anderson T , Hamond C , Schlater L , Stuber T , Burke-France VJ , Taylor M , Harrison CJ , Matias KY , Medley A , Rossow J , Wiese N , Jankelunas L , de Wilde L , Mehalick M , Blanchard GL , Garcia KR , McKinley AS , Lombard CD , Angeli NF , Horner D , Kelley T , Worthington DJ , Valiulis J , Bradford B , Berentsen A , Salzer JS , Galloway R , Schafer IJ , Bisgard K , Roth J , Ellis BR , Ellis EM , Nally JE . PLoS Negl Trop Dis 2021 15 (11) e0009859 During 2019-2020, the Virgin Islands Department of Health investigated potential animal reservoirs of Leptospira spp., the bacteria that cause leptospirosis. In this cross-sectional study, we investigated Leptospira spp. exposure and carriage in the small Indian mongoose (Urva auropunctata, syn: Herpestes auropunctatus), an invasive animal species. This study was conducted across the three main islands of the U.S. Virgin Islands (USVI), which are St. Croix, St. Thomas, and St. John. We used the microscopic agglutination test (MAT), fluorescent antibody test (FAT), real-time polymerase chain reaction (lipl32 rt-PCR), and bacterial culture to evaluate serum and kidney specimens and compared the sensitivity, specificity, positive predictive value, and negative predictive value of these laboratory methods. Mongooses (n = 274) were live-trapped at 31 field sites in ten regions across USVI and humanely euthanized for Leptospira spp. testing. Bacterial isolates were sequenced and evaluated for species and phylogenetic analysis using the ppk gene. Anti-Leptospira spp. antibodies were detected in 34% (87/256) of mongooses. Reactions were observed with the following serogroups: Sejroe, Icterohaemorrhagiae, Pyrogenes, Mini, Cynopteri, Australis, Hebdomadis, Autumnalis, Mankarso, Pomona, and Ballum. Of the kidney specimens examined, 5.8% (16/270) were FAT-positive, 10% (27/274) were culture-positive, and 12.4% (34/274) were positive by rt-PCR. Of the Leptospira spp. isolated from mongooses, 25 were L. borgpetersenii, one was L. interrogans, and one was L. kirschneri. Positive predictive values of FAT and rt-PCR testing for predicting successful isolation of Leptospira by culture were 88% and 65%, respectively. The isolation and identification of Leptospira spp. in mongooses highlights the potential role of mongooses as a wildlife reservoir of leptospirosis; mongooses could be a source of Leptospira spp. infections for other wildlife, domestic animals, and humans. |
Low SARS-CoV-2 Seroprevalence and No Active Infections among Dogs and Cats in Animal Shelters with Laboratory-Confirmed COVID-19 Human Cases among Employees.
Cossaboom CM , Medley AM , Spengler JR , Kukielka EA , Goryoka GW , Baird T , Bhavsar S , Campbell S , Campbell TS , Christensen D , Condrey JA , Dawson P , Doty JB , Feldpausch A , Gabel J , Jones D , Lim A , Loiacono CM , Jenkins-Moore M , Moore A , Noureddine C , Ortega J , Poulsen K , Rooney JA , Rossow J , Sheppard K , Sweet E , Stoddard R , Tell RM , Wallace RM , Williams C , Barton Behravesh C . Biology (Basel) 2021 10 (9) Human-to-animal and animal-to-animal transmission of SARS-CoV-2 has been documented; however, investigations into SARS-CoV-2 transmission in congregate animal settings are lacking. We investigated four animal shelters in the United States that had identified animals with exposure to shelter employees with laboratory-confirmed COVID-19. Of the 96 cats and dogs with specimens collected, only one dog had detectable SARS-CoV-2 neutralizing antibodies; no animal specimens had detectable viral RNA. These data indicate a low probability of human-to-animal transmission events in cats and dogs in shelter settings with early implementation of infection prevention interventions. |
Determination of freedom-from-rabies for small Indian mongoose populations in the United States Virgin Islands, 2019-2020
Browne AS , Cranford HM , Morgan CN , Ellison JA , Berentsen A , Wiese N , Medley A , Rossow J , Jankelunas L , McKinley AS , Lombard CD , Angeli NF , Kelley T , Valiulus J , Bradford B , Burke-France VJ , Harrison CJ , Guendel I , Taylor M , Blanchard GL , Doty JB , Worthington DJ , Horner D , Garcia KR , Roth J , Ellis BR , Bisgard KM , Wallace R , Ellis EM . PLoS Negl Trop Dis 2021 15 (7) e0009536 Mongooses, a nonnative species, are a known reservoir of rabies virus in the Caribbean region. A cross-sectional study of mongooses at 41 field sites on the US Virgin Islands of St. Croix, St. John, and St. Thomas captured 312 mongooses (32% capture rate). We determined the absence of rabies virus by antigen testing and rabies virus exposure by antibody testing in mongoose populations on all three islands. USVI is the first Caribbean state to determine freedom-from-rabies for its mongoose populations with a scientifically-led robust cross-sectional study. Ongoing surveillance activities will determine if other domestic and wildlife populations in USVI are rabies-free. |
Preventing the cross-border spread of zoonotic diseases: Multisectoral community engagement to characterize animal mobility-Uganda, 2020
Medley AM , Gasanani J , Nyolimati CA , McIntyre E , Ward S , Okuyo B , Kabiito D , Bender C , Jafari Z , LaMorde M , Babigumira PA , Nakiire L , Agwang C , Merrill R , Ndumu D , Doris K . Zoonoses Public Health 2021 68 (7) 747-759 In Uganda, the borders are highly porous to animal movement, which may contribute to zoonotic disease spread. We piloted an animal adaptation of an existing human-focused toolkit to collect data on animal movement patterns and interactions to inform One Health programs. During January 2020, we conducted focus group discussions and key informant interviews with participatory mapping of 2 national-level One Health stakeholders and 2 local-level abattoir representatives from Kampala. Zoonotic disease hotspots changed in 2020 compared with reports from 2017-2019. In contrast to local-level participants, national-level participants highlighted districts rather than specific locations. Everyone discussed livestock species; only national-level participants mentioned wildlife. Participants described seasonality differently. Stakeholders used the results to identify locations for zoonotic disease interventions and sites for future data collection. This implementation of an animal-adapted population mobility mapping exercise highlights the importance of multisectoral initiatives to promote One Health border health approaches. |
Use of US Public Health Travel Restrictions during COVID-19 Outbreak on Diamond Princess Ship, Japan, February-April 2020.
Medley AM , Marston BJ , Toda M , Kobayashi M , Weinberg M , Moriarty LF , Jungerman MR , Surpris ACA , Knust B , Acosta AM , Shockey CE , Daigle D , Schneider ZD , Charles J , Ishizumi A , Stewart A , Vonnahme LA , Brown C , White S , Cohen NJ , Cetron M . Emerg Infect Dis 2021 27 (3) 710-718 Public health travel restrictions (PHTR) are crucial measures during communicable disease outbreaks to prevent transmission during commercial airline travel and mitigate cross-border importation and spread. We evaluated PHTR implementation for US citizens on the Diamond Princess during its coronavirus disease (COVID-19) outbreak in Japan in February 2020 to explore how PHTR reduced importation of COVID-19 to the United States during the early phase of disease containment. Using PHTR required substantial collaboration among the US Centers for Disease Control and Prevention, other US government agencies, the cruise line, and public health authorities in Japan. Original US PHTR removal criteria were modified to reflect international testing protocols and enable removal of PHTR for persons who recovered from illness. The impact of PHTR on epidemic trajectory depends on the risk for transmission during travel and geographic spread of disease. Lessons learned from the Diamond Princess outbreak provide critical information for future PHTR use. |
Formative assessment to identify perceived benefits and barriers of HIV oral self-testing among female sex workers, service providers, outreach workers, and peer educators to inform scale-up in Kenya
Agot K , Cain M , Medley A , Kimani J , Gichangi P , Kiio C , Mukiri E , Odonde P , Toroitich-Ruto C , Bingham T , Downer M , Chesang K . AIDS Care 2021 34 (6) 1-8 In Kenya, HIV prevalence estimates among female sex workers (FSWs) are almost five times higher than among women in the general population. However, only 68% of infected FSWs are aware of their HIV-positive status. We aimed to identify perceived benefits, opportunities, and barriers of HIV self-testing (HIVST) in improving testing coverage among FSWs. Twenty focus group discussions were conducted with 77 service providers, 42 peer educators (PEs) and outreach workers, and 37 FSWs attending drop-in centers (DiCEs) in four regions of Kenya. An additional 8 FSWs with HIV-negative or unknown status-completed in-depth interviews. Data were analyzed thematically. Acceptability of HIVST was high, with cited benefits including confidentiality, convenience, and ease of use. Barriers included absence of counseling, potential for inaccurate results, fear of partner reaction, possible misuse, and fear that HIVST could lead to further stigmatization. PEs and DiCEs were the preferred models for distributing HIVST kits. FSWs wanted kits made available free or at a nominal cost (100 Kenya Shillings or ∼USD 1). Linkage to confirmatory testing, the efficiency of distributing HIVST kits using peers and DiCEs, and the types and content of effective HIVST messaging require further research. |
Barriers and opportunities for canine rabies vaccination campaigns in Addis Ababa, Ethiopia
Yoak AJ , Haile A , O'Quin J , Belu M , Birhane M , Bekele M , Murphy S , Medley A , Vincent E , Stewart D , Shiferaw ML , Tafese K , Garabed R , Pieracci EG . Prev Vet Med 2021 187 105256 BACKGROUND: Canine rabies is endemic in Ethiopia and presents a significant burden for both animal and human health. We investigate barriers to dog vaccination in Addis Ababa, Ethiopia. These results can be utilized to improve and target future rabies control efforts. METHODOLOGY/PRINCIPLE FINDINGS: During May of 2017, dog owners were surveyed during a free canine rabies vaccination programs that utilized both door-to-door (DtD) and central point (CP) vaccination methods. Surveys collected information on preferences for rabies vaccine delivery and were administered in Amharic. A total of 1057 surveys were completed. Of those surveyed, 62.4 % indicated that their dogs had been vaccinated against rabies within the last year. Commonly reported barriers to vaccination were a lack of awareness that dogs required rabies vaccines (18.1 %) and lack of knowledge about where to find vaccine (15.0 %). The median price owners were willing to pay for vaccination was 25 birr ($0.91 USD) and the median distance willing to travel was 1.0 km; however, 48.9 % of those surveyed during DtD were unwilling to travel at all. We identified 3 classes of respondents who were grouped due to their responses by latent class analysis: 'the Unaware', 'the Vaccinators', and 'the Multiple Barriers'. CONCLUSIONS/SIGNIFICANCE: Although many respondents were willing to pay for rabies vaccine (94.0 %); the preferred cost (median) was less than the actual cost of providing the vaccine. This supports the need for reduced-cost or free vaccine to achieve and sustain the 70 % vaccine coverage target threshold for canine rabies elimination. Additionally, a significant portion (41.5 %) of those surveyed indicated that they were unwilling to travel in order to have their dog vaccinated. The latent class analysis provides useful guidance on how to reach target vaccination. Owners from 'the Unaware' group made up 18.1 % of respondents and their high rate of allowing their dogs to roam identifies them as a prime target for canine health and behavior education. 'The Multiple Barriers' owners reported lower degrees of dog roaming and were substantially more likely to be found by DtD campaigns, possibly because they have limited ability/interest in handling their dogs. These results demonstrate the importance of incorporating DtD vaccination as well as subsidies to maximize vaccine coverage in Addis Ababa. |
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. |
Toxicological analysis of aerosols derived from three electronic nicotine delivery systems using Normal human bronchial epithelial cells
Pearce K , Gray N , Gaur P , Jeon J , Suarez A , Shannahan J , Pappas RS , Wright C . Toxicol In Vitro 2020 69 104997 Electronic nicotine delivery systems (ENDS) are a rapidly growing global market advertised as a safer alternative to combustible cigarettes. However, comprehensive investigations of END aerosol physicochemical and toxicological properties have not been fully explored across brands to assess relative safety. In this study, we evaluated aerosols collected from three ENDS - Juul Fruit Medley (5% nicotine), Logic Power (2.4% nicotine), and Mistic (1.8% nicotine). ENDS aerosols were generated using standard machine puffing regimen and collected with a novel fluoropolymer condensation trap. Triple quadrupole-inductively coupled plasma-mass determined the presence of heavy metals in collected aerosols. The toxicological effects of ENDS aerosols on normal human bronchial epithelial cells (NHBE) were investigated using cellular viability, reactive oxygen species, oxidative stress assays, along with DNA damage assessments using the CometChip©. Results indicated the total metal concentrations within collected ENDS aerosols were higher for Mistic and Logic compared to Juul. Logic Power aerosols elicited higher reactive oxygen species levels than Mistic and Juul in NHBE after 24-h exposure. Similar dose-dependent reductions of cellular viability and total glutathione were found for each exposure. However, Logic and Juul aerosols caused greater single stranded DNA damage compared to Mistic. Our study indicates that regardless of brand, ENDS aerosols are toxic to upper airway epithelial cells and may pose a potential respiratory hazard to occasional and frequent users. |
COVID-19 in Americans aboard the Diamond Princess cruise ship.
Plucinski MM , Wallace M , Uehara A , Kurbatova EV , Tobolowsky FA , Schneider ZD , Ishizumi A , Bozio CH , Kobayashi M , Toda M , Stewart A , Wagner RL , Moriarty LF , Murray R , Queen K , Tao Y , Paden C , Mauldin MR , Zhang J , Li Y , Elkins CA , Lu X , Herzig CTA , Novak R , Bower W , Medley AM , Acosta AM , Knust B , Cantey PT , Pesik NT , Halsey ES , Cetron MS , Tong S , Marston BJ , Friedman CR . Clin Infect Dis 2020 72 (10) e448-e457 BACKGROUND: The Diamond Princess cruise ship was the site of a large outbreak of coronavirus disease 2019 (COVID-19). Of 437 Americans and their travel companions on the ship, 114 (26%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: We interviewed 229 American passengers and crew after disembarkation following a ship-based quarantine to identify risk factors for infection and characterize transmission onboard the ship. RESULTS: The attack rate for passengers in single-person cabins or without infected cabinmates was 18% (58/329), compared with 63% (27/43) for those sharing a cabin with an asymptomatic infected cabinmate, and 81% (25/31) for those with a symptomatic infected cabinmate. Whole genome sequences from specimens from passengers who shared cabins clustered together. Of 66 SARS-CoV-2-positive American travelers with complete symptom information, 14 (21%) were asymptomatic while on the ship. Among SARS-CoV-2-positive Americans, 10 (9%) required intensive care, of whom 7 were ≥70 years. CONCLUSION: Our findings highlight the high risk of SARS-CoV-2 transmission on cruise ships. High rates of SARS-CoV-2 positivity in cabinmates of individuals with asymptomatic infections suggest that triage by symptom status in shared quarters is insufficient to halt transmission. A high rate of intensive care unit admission among older individuals complicates the prospect of future cruise travel during the pandemic, given typical cruise passenger demographics. The magnitude and severe outcomes of this outbreak were major factors contributing to the Centers for Disease Control and Prevention's decision to halt cruise ship travel in U.S. waters in March 2020. |
Increase in antiretroviral therapy enrollment among persons with HIV infection during the Lusaka HIV treatment surge - Lusaka Province, Zambia, January 2018-June 2019
Boyd MA , Shah M , Barradas DT , Herce M , Mulenga LB , Lumpa M , Ishimbulo S , Saadani A , Mumba M , Essiet-Gibson I , Tally L , Minchella P , Kancheya N , Mwila A , Zyambo K , Chungu C , Chanda S , Mbewe W , Zulu I , Siansalama T , Mweebo K , Nkwemu K , Simpungwe J , Medley A , Sikazwe I , Mwale C , Agolory S , Ellerbrock T . MMWR Morb Mortal Wkly Rep 2020 69 (31) 1039-1043 Within Zambia, a landlocked country in southern-central Africa, the highest prevalence of human immunodeficiency virus (HIV) infection is in Lusaka Province (population 3.2 million), where approximately 340,000 persons are estimated to be infected (1). The 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA) estimated the adult HIV prevalence in Lusaka Province to be 15.7%, with a 62.7% viral load suppression rate (HIV-1 RNA <1,000 copies/mL) (2). ZAMPHIA results highlighted remaining treatment gaps in Zambia overall and by subpopulation. In January 2018, Zambia launched the Lusaka Province HIV Treatment Surge (Surge project) to increase enrollment of persons with HIV infection onto antiretroviral therapy (ART). The Zambia Ministry of Health (MoH), CDC, and partners analyzed the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) Monitoring and Evaluation Reporting data set to assess the effectiveness of the first 18 months of the Surge project (January 2018-June 2019). During this period, approximately 100,000 persons with positive test results for HIV began ART. These new ART clients were more likely to be persons aged 15-24 years. In addition, the number of persons with documented viral load suppression doubled from 66,109 to 134,046. Lessons learned from the Surge project, including collaborative leadership, efforts to improve facility-level performance, and innovative strategies to disseminate successful practices, could increase HIV treatment rates in other high-prevalence settings. |
Public Health Responses to COVID-19 Outbreaks on Cruise Ships - Worldwide, February-March 2020.
Moriarty LF , Plucinski MM , Marston BJ , Kurbatova EV , Knust B , Murray EL , Pesik N , Rose D , Fitter D , Kobayashi M , Toda M , Canty PT , Scheuer T , Halsey ES , Cohen NJ , Stockman L , Wadford DA , Medley AM , Green G , Regan JJ , Tardivel K , White S , Brown C , Morales C , Yen C , Wittry B , Freeland A , Naramore S , Novak RT , Daigle D , Weinberg M , Acosta A , Herzig C , Kapella BK , Jacobson KR , Lamba K , Ishizumi A , Sarisky J , Svendsen E , Blocher T , Wu C , Charles J , Wagner R , Stewart A , Mead PS , Kurylo E , Campbell S , Murray R , Weidle P , Cetron M , Friedman CR . MMWR Morb Mortal Wkly Rep 2020 69 (12) 347-352 An estimated 30 million passengers are transported on 272 cruise ships worldwide each year* (1). Cruise ships bring diverse populations into proximity for many days, facilitating transmission of respiratory illness (2). SARS-CoV-2, the virus that causes coronavirus disease (COVID-19) was first identified in Wuhan, China, in December 2019 and has since spread worldwide to at least 187 countries and territories. Widespread COVID-19 transmission on cruise ships has been reported as well (3). Passengers on certain cruise ship voyages might be aged >/=65 years, which places them at greater risk for severe consequences of SARS-CoV-2 infection (4). During February-March 2020, COVID-19 outbreaks associated with three cruise ship voyages have caused more than 800 laboratory-confirmed cases among passengers and crew, including 10 deaths. Transmission occurred across multiple voyages of several ships. This report describes public health responses to COVID-19 outbreaks on these ships. COVID-19 on cruise ships poses a risk for rapid spread of disease, causing outbreaks in a vulnerable population, and aggressive efforts are required to contain spread. All persons should defer all cruise travel worldwide during the COVID-19 pandemic. |
Quantifying the risk of rabies in biting dogs in Haiti
Ma X , Blanton JD , Millien MF , Medley AM , Etheart MD , Fenelon N , Wallace RM . Sci Rep 2020 10 (1) 1062 Rabies is a fatal viral disease typically transmitted through the bite of rabid animal. Domestic dogs cause over 99% of human rabies deaths. Over half of the world's population lives in a country where the canine rabies virus variant is endemic and dog bites are common. An estimated 29 million people worldwide receive post-bite vaccination after being exposed to animals suspected of rabies. Accurate and timely risk assessment of rabies in biting dogs is critical to ensure that rabies PEP is administered to all persons with a suspected rabies exposure, while avoiding PEP administration in situations where rabies can be definitively ruled out. In this study, a logistic regression model was developed to quantify the risk of rabies in biting dogs, using data from Haiti's animal rabies surveillance program. Significant risk factors identified in the model were used to quantify the probability of rabies in biting dogs. The risk of rabies in a biting dog as assessed through Haiti's rabies surveillance program was highly elevated when the dog displayed hypersalivation (OR = 34.6, 95% CI 11.3-106.5) or paralysis (OR = 19.0, 95% CI 4.8-74.8) and when the dog was dead at the time of the assessment (OR = 20.7, 95% CI 6.7-63.7). Lack of prior rabies vaccination, biting 2 or more people, and if the dog was a puppy also increased the probability that a biting dog would have rabies. The model showed high sensitivity (100%) and specificity (97%) when examined using validation data. This model enables us to project the risk of rabies in biting dogs in Haiti shortly after the bite event and make provisional PEP recommendations prior to laboratory testing or dog quarantine results. Application of this model may improve adherence to PEP for bite victims who can be educated on the quantitative risk of the exposure event. This model can also be used to reduce unnecessary PEP costs when the risk of rabies is determined as sufficiently low and the animal is available for observation. |
Case definitions used during the first 6 months of the 10th Ebola virus disease outbreak in the Democratic Republic of the Congo - four neighboring countries, August 2018-February 2019
Medley AM , Mavila O , Makumbi I , Nizeyemana F , Umutoni A , Balisanga H , Manoah YK , Geissler A , Bunga S , MacDonald G , Homsy J , Ojwang J , Ewetola R , Raghunathan PL , MacGurn A , Singler K , Ward S , Roohi S , Brown V , Shoemaker T , Lako R , Kabeja A , Muruta A , Lubula L , Merrill R . MMWR Morb Mortal Wkly Rep 2020 69 (1) 14-19 On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its 10th Ebola virus disease (Ebola) outbreak in an area with a high volume of cross-border population movement to and from neighboring countries. The World Health Organization (WHO) designated Rwanda, South Sudan, and Uganda as the highest priority countries for Ebola preparedness because of the high risk for cross-border spread from DRC (1). Countries might base their disease case definitions on global standards; however, historical context and perceived risk often affect why countries modify and adapt definitions over time, moving toward or away from regional harmonization. Discordance in case definitions among countries might reduce the effectiveness of cross-border initiatives during outbreaks with high risk for regional spread. CDC worked with the ministries of health (MOHs) in DRC, Rwanda, South Sudan, and Uganda to collect MOH-approved Ebola case definitions used during the first 6 months of the outbreak to assess concordance (i.e., commonality in category case definitions) among countries. Changes in MOH-approved Ebola case definitions were analyzed, referencing the WHO standard case definition, and concordance among the four countries for Ebola case categories (i.e., community alert, suspected, probable, confirmed, and case contact) was assessed at three dates (2). The number of country-level revisions ranged from two to four, with all countries revising Ebola definitions by February 2019 after a December 2018 peak in incidence in DRC. Case definition complexity increased over time; all countries included more criteria per category than the WHO standard definition did, except for the "case contact" and "confirmed" categories. Low case definition concordance and lack of awareness of regional differences by national-level health officials could reduce effectiveness of cross-border communication and collaboration. Working toward regional harmonization or considering systematic approaches to addressing country-level differences might increase efficiency in cross-border information sharing. |
Caregiver perspectives on TB case-finding and HIV clinical services for children diagnosed with TB in Tanzania
Emerson C , Ndakidemi E , Ngowi B , Medley A , Ng'eno B , Godwin M , Ntinginya N , Carpenter D , Kohi W , Modi S . AIDS Care 2019 32 (4) 1-5 Caregivers of children with tuberculosis (TB) and HIV play a critical role in seeking healthcare for their children. To assess the perspectives of caregivers of pediatric TB patients, we conducted 76 in-depth interviews at 10 TB clinics in 5 districts of Tanzania in March 2016. We assessed how the child received their TB diagnosis, the decision-making process around testing the child for HIV, and the process of linking the child to HIV treatment in the event of an HIV diagnosis. Caregivers suspected TB due to cases in their family, or the child being ill and not improving. Most caregivers noted delays before confirmation of a TB diagnosis and having to visit multiple facilities before a diagnosis. Once diagnosed, some caregivers reported challenges administering TB medications due to lack of pediatric formulations. Reasons for accepting HIV testing included recurrent illness and HIV symptoms, history of HIV in the family, and recommendation of the clinical provider. Caregivers described a relatively seamless process for linking their child to HIV treatment, highlighting the success of TB/HIV integration efforts. The multiple clinic visits required prior to TB diagnosis suggests the need for additional training and sensitization of healthcare workers and better TB diagnostic tools. |
Health care worker perspectives on TB case finding and HIV services among pediatric TB patients in Tanzania
Ndakidemi E , Emerson C , Medley A , Ngowi B , Ng'eno B , Munuo G , Kohi W , Modi S . Int J Tuberc Lung Dis 2019 23 (7) 811-816 BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) infection in children are of concern due to the high morbidity and mortality they engender. Tanzania is working to improve TB and HIV case identification and treatment, as well as linkage of TB and HIV care in pediatric patients.METHODS: In-depth interviews were conducted in March 2016 at 10 high TB burden clinics in five districts of Tanzania to identify the barriers to pediatric TB diagnosis and HIV care. Health care workers (HCWs) at TB clinics who provided informed consent were administered interviews which were analyzed.RESULTS: Of 41 HCWs interviewed, 26 reported receiving pediatric TB training. Barriers to TB diagnosis included low community awareness, stigma and late presentation to the clinic. Barriers to HIV testing included children attending the TB clinic with someone who was not their parent/guardian and shortages of HIV rapid test kits. HCWs stressed the need for improved community education because it was perceived that some caregivers did not understand the importance of prompt TB and HIV treatment in children (although most were eager for a resolution of their child's illness).CONCLUSIONS: Efforts are needed to ensure effective TB and HIV diagnosis and treatment of children, provision of broader HCW and community education, enhanced TB-HIV contact tracing, and ensuring a continuous supply of HIV rapid test kits. |
The power of partners: positively engaging networks of people with HIV in testing, treatment and prevention
Katz DA , Wong VJ , Medley AM , Johnson CC , Cherutich PK , Green KE , Huong P , Baggaley RC . J Int AIDS Soc 2019 22 Suppl 3 e25314 When HIV diagnostic tests first became available in 1985, HIV testing was offered with caution. No treatment was available, prevention options were limited, and stigma and discrimination against people with HIV was pervasive. Concerns about preventing breaches of confidentiality and forced or mandatory testing, especially among groups at high risk for HIV infection, were dominant in early guidance released by the World Health Organization (WHO). An offer of an HIV test required extensive counselling both before and after the test to ensure the individual was able to cope with a possible reactive result. Then the development of point of care rapid HIV tests in 1987 offered the opportunity for immediate results in clinical and community settings 1. When antiretroviral therapy (ART) became available globally in the early 2000s, WHO launched its “3 × 5” Initiative to provide 3 million people in low and middle‐income countries (LMIC) with ART by 2005. Scale‐up of HIV testing through client‐initiated approaches using rapid test kits to provide same day results was a core component to the success of this Initiative 2, 3. |
Use of photography to identify free-roaming dogs during sight-resight surveys: Impacts on estimates of population size and vaccination coverage, Haiti 2016
Cleaton JM , Blanton JD , Dilius P , Ludder F , Crowdis K , Medley A , Chipman R , Estime F , Maciel E , Wallace RM . Vaccine: X 2019 2 100025 Background: Enumerating dog populations is essential to plan and evaluate rabies vaccination campaigns. To estimate vaccination coverage and dog population size in a Haitian commune, 15 sight-resight counts were conducted over two days following a government-sponsored vaccination campaign. Methods: Dogs received temporary laminated collars and livestock wax marks on the head and sides at the time of rabies vaccination. After the vaccination campaign, pairs of surveyors walked pre-defined routes through targeted neighborhoods, photographing and recording characteristics and location of each dog seen on a standardized data sheet. On the second survey day, surveyors retraced the prior day's track, followed the same procedure, and indicated in addition whether they believed the dogs were resighted from the prior day. After completion of the field survey, two independent evaluators reviewed photographs and characteristics of each dog to assess which had vaccination marks and which were resighted. Surveyor and photo-reviewer sight-resight decisions were compared using Cohen's kappa, and population estimates were compared using Lincoln-Petersen 95% confidence intervals. Results: Field-surveyors identified dogs consistent with the photograph evaluations in 629 out of 800 instances (78.6%, Cohen's kappa of 0.12). Despite this inconsistency, the population estimates resulting from the field and final determinations were not significantly different at 1,789 (95% CI 1,677 to 1,901) and 1,978 (95% CI 1,839 to 2,118). Vaccination coverage was also the same at 55% and 56%; however, an observed vaccination mark loss of 13.8% suggests that the true coverage may have been closer to 64%. Conclusion: Using photos improved dog identification during the sight-resight study, leading to a higher population estimate. Despite using a 2-mark system to temporarily identify vaccinated dogs, a significant proportion had lost all identifying marks by the second day of field surveys. Efforts to estimate vaccination coverage using sight-resight surveys should consider improvement of marking techniques or better accounting for potential loss of marks in their free-roaming dog vaccination coverage assessments. |
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