Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
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PrEP initiation and adherence among Black cisgender women in Mississippi: The role of HIV and PrEP stigma and social support
Knight D , Monger M , Phillips K , Antar A , Baral S , Stockman JK , Nunn A , Chan P , Mayer K , Mena L , Kershaw T , Willie TC . Womens Health (Lond) 2024 20 17455057241296905 BACKGROUND: Stigma and lack of social support are barriers to HIV prevention, especially among cisgender Black women in the United States. While HIV pre-exposure prophylaxis (PrEP) can decrease HIV transmission, PrEP initiation and adherence remains low among Black women, especially in the U.S. South. OBJECTIVES: The purpose of this study was to characterize experiences with stigma and social support among PrEP-naïve and PrEP-experienced Black cisgender women in Mississippi. DESIGN: Qualitative study in which semi-structured interviews and focus groups were conducted. METHODS: We purposively recruited PrEP-naïve cisgender Black women who met PrEP indications to participate in focus groups and all PrEP-experienced cisgender Black women at a sexual health clinic in Jackson, Mississippi to participate in one-on-one semi-structured interviews. Inductive thematic analysis was used to analyze focus group and interview transcripts. RESULTS: A total of 37 PrEP-naïve Black cisgender women participated across 6 focus groups and 8 PrEP-experienced cisgender Black women completed semi-structured interviews. Four themes were identified: (1) the intersection of gendered racism, discrimination, and HIV stigma, (2) enacted and anticipated PrEP stigma, (3) stigma mitigation strategies and PrEP adherence, and (4) social support's role in PrEP initiation and adherence. PrEP-naïve and -experienced Black women discussed the negative consequence that sexual stigmatization and gendered racism has on HIV testing. PrEP-naïve Black women discussed how HIV stigma decreases PrEP initiation. Conversely, PrEP-experienced Black women were able to identify strategies they utilized to mitigate stigma. PrEP-experienced Black women discussed how differing levels of social support impact their PrEP use. CONCLUSION: Improving social support and stigma mitigation strategies could help improve PrEP initiation and adherence among cisgender Black women at-risk of acquiring HIV in the U.S. South. Educating communities on PrEP, and training providers on stigma-mitigating strategies when serving Black women in the U.S. South who are seeking HIV prevention is paramount. | PrEP initiation and adherence among Black cisgender women in Mississippi: The role of HIV and PrEP stigma and social supportWhy was the study done?Stigma and lack of social support have been demonstrated as barriers to HIV prevention, especially among cisgender Black women in the United States (U.S.). While HIV pre-exposure prophylaxis (PrEP), a HIV prevention medication, has the ability to decrease HIV transmission, rates of starting PrEP remain low among Black women, especially in the U.S. South. Improving PrEP programs for US Black women calls for understanding how stigma and social support impact PrEP use among Black women.What did the researchers do?We recruited cisgender Black women who was eligible for PrEP but have never taken PrEP (PrEP-naïve) to participate in focus groups and cisgender Black women who have taken PrEP (PrEP-experienced) to participate in one-on-one in-depth interviews from healthcare clinics in Jackson, Mississippi. Inductive thematic analysis was used to analyze focus group and interview transcripts.What did the researchers find?A total of 37 Black cisgender women across six groups participated in focus groups and eight cisgender Black women were interviewed. PrEP-naïve women reported: · HIV stigma in the community, which can lead to anticipated PrEP stigma · Experiencing sex-based sexual stigmatization at provider’s offices when seeking HIV testing PrEP-experienced Black women reported: Experiencing stigma when disclosing their PrEP use, such as their family and friends thinking that the woman and/or her partner is living with HIV. PrEP-experienced Black women who were in serodifferent partnership and had others in their network who knew about PrEP received support to take PrEP.What do the findings mean?Improving social support and stigma mitigation strategies could help improve PrEP initiation and adherence among cisgender Black women at-risk of acquiring HIV in the U.S. South. This includes educating communities on HIV and PrEP, and training providers on stigma-mitigating strategies when serving Black women in the U.S. South. | eng |
Perspectives on a peer-driven intervention to promote pre-exposure prophylaxis (PrEP) uptake among men who have sex with men in southern New England: a qualitative study
Tao J , Parent H , Karki I , Martin H , Marshall SA , Kapadia J , Nunn AS , Marshall BDL , Raymond HF , Mena L , Chan PA . BMC Health Serv Res 2024 24 (1) 1023 BACKGROUND: Pre-exposure prophylaxis (PrEP) is a highly effective pharmaceutical intervention that prevents HIV infection, but PrEP uptake across the US has been slow among men who have sex with men (MSM), especially among Black/African American (B/AA) and Hispanic /Latino (H/L) MSM. This study investigates the acceptability and essential components of a peer-driven intervention (PDI) for promoting PrEP uptake among MSM, with a specific focus on B/AA and H/L communities. METHODS: We conducted 28 semi-structured, qualitative interviews with MSM in southern New England to explore the components of a PDI, including attitudes, content, and effective communication methods. A purposive sampling strategy was used to recruit diverse participants who reflect the communities with the highest burden of HIV infection. RESULTS: Of 28 study participants, the median age was 28 years (interquartile range [IQR]: 25, 35). The sample comprised B/AA (39%, n = 11) and H/L (50%, n = 14) individuals. Notably, nearly half of the participants (46%) were current PrEP users. We found that many participants were in favor of using a PDI approach for promoting PrEP. Additionally, several participants showed interest in becoming peer educators themselves. They emphasized the need for strong communication skills to effectively teach others about PrEP. Moreover, participants noted that peer education should cover key topics like how PrEP works, how effective it is, and any possible side effects. CONCLUSIONS: Our study shows that effective PDIs, facilitated by well-trained peers knowledgeable about PrEP, could enhance PrEP uptake among MSM, addressing health disparities and potentially reducing HIV transmission in B/AA and H/L communities. |
Evidence review and recommendations for the implementation of genomics for antimicrobial resistance surveillance: reports from an international expert group
Baker KS , Jauneikaite E , Nunn JG , Midega JT , Atun R , Holt KE , Walia K , Howden BP , Tate H , Okeke IN , Carattoli A , Hsu LY , Hopkins KL , Muloi DM , Wheeler NE , Aanensen DM , Mason LCE , Rodgus J , Hendriksen RS , Essack SY , Egyir B , Halpin AL , MacCannell DR , Campos J , Srikantiah P , Feasey NA , Peacock SJ . Lancet Microbe 2023 4 (12) e1035-e1039 ![]() ![]() Nearly a century after the beginning of the antibiotic era, which has been associated with unparalleled improvements in human health and reductions in mortality associated with infection, the dwindling pipeline for new antibiotic classes coupled with the inevitable spread of antimicrobial resistance (AMR) poses a major global challenge. Historically, surveillance of bacteria with AMR typically relied on phenotypic analysis of isolates taken from infected individuals, which provides only a low-resolution view of the epidemiology behind an individual infection or wider outbreak. Recent years have seen increasing adoption of powerful new genomic technologies with the potential to revolutionise AMR surveillance by providing a high-resolution picture of the AMR profile of the bacteria causing infections and providing real-time actionable information for treating and preventing infection. However, many barriers remain to be overcome before genomic technologies can be adopted as a standard part of routine AMR surveillance around the world. Accordingly, the Surveillance and Epidemiology of Drug-resistant Infections Consortium convened an expert working group to assess the benefits and challenges of using genomics for AMR surveillance. In this Series, we detail these discussions and provide recommendations from the working group that can help to realise the massive potential benefits for genomics in surveillance of AMR. |
Genomics for antimicrobial resistance surveillance to support infection prevention and control in health-care facilities
Jauneikaite E , Baker KS , Nunn JG , Midega JT , Hsu LY , Singh SR , Halpin AL , Hopkins KL , Price JR , Srikantiah P , Egyir B , Okeke IN , Holt KE , Peacock SJ , Feasey NA . Lancet Microbe 2023 4 (12) e1040-e1046 ![]() ![]() Integration of genomic technologies into routine antimicrobial resistance (AMR) surveillance in health-care facilities has the potential to generate rapid, actionable information for patient management and inform infection prevention and control measures in near real time. However, substantial challenges limit the implementation of genomics for AMR surveillance in clinical settings. Through a workshop series and online consultation, international experts from across the AMR and pathogen genomics fields convened to review the evidence base underpinning the use of genomics for AMR surveillance in a range of settings. Here, we summarise the identified challenges and potential benefits of genomic AMR surveillance in health-care settings, and outline the recommendations of the working group to realise this potential. These recommendations include the definition of viable and cost-effective use cases for genomic AMR surveillance, strengthening training competencies (particularly in bioinformatics), and building capacity at local, national, and regional levels using hub and spoke models. |
A Public Health Research Agenda for Managing Infodemics: Methods and Results of the First WHO Infodemiology Conference.
Calleja N , AbdAllah A , Abad N , Ahmed N , Albarracin D , Altieri E , Anoko JN , Arcos R , Azlan AA , Bayer J , Bechmann A , Bezbaruah S , Briand SC , Brooks I , Bucci LM , Burzo S , Czerniak C , De Domenico M , Dunn AG , Ecker UKH , Espinosa L , Francois C , Gradon K , Gruzd A , Gülgün BS , Haydarov R , Hurley C , Astuti SI , Ishizumi A , Johnson N , Johnson Restrepo D , Kajimoto M , Koyuncu A , Kulkarni S , Lamichhane J , Lewis R , Mahajan A , Mandil A , McAweeney E , Messer M , Moy W , Ndumbi Ngamala P , Nguyen T , Nunn M , Omer SB , Pagliari C , Patel P , Phuong L , Prybylski D , Rashidian A , Rempel E , Rubinelli S , Sacco P , Schneider A , Shu K , Smith M , Sufehmi H , Tangcharoensathien V , Terry R , Thacker N , Trewinnard T , Turner S , Tworek H , Uakkas S , Vraga E , Wardle C , Wasserman H , Wilhelm E , Würz A , Yau B , Zhou L , Purnat TD . JMIR Infodemiology 2021 1 (1) e30979 ![]() ![]() BACKGROUND: An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders. OBJECTIVE: The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics. METHODS: As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions. RESULTS: The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions. CONCLUSIONS: Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider. |
Advances in clinical trial design: Weaving tomorrow's TB treatments
Lienhardt C , Nunn A , Chaisson R , Vernon AA , Zignol M , Nahid P , Delaporte E , Kasaeva T . PLoS Med 2020 17 (2) e1003059 Christian Lienhardt and co-authors discuss the conclusions of the PLOS Medicine Collection on advances in clinical trial design for development of new tuberculosis treatments. |
Reducing the African American HIV disease burden in the deep south: Addressing the role of faith and spirituality
Nunn A , Jeffries WL 4th , Foster P , McCoy K , Sutten-Coats C , Willie TC , Ransome Y , Lanzi RG , Jackson E , Berkley-Patton J , Keefer M , Coleman JD . AIDS Behav 2019 23 319-330 Nearly half of HIV infections in the United States are concentrated among African Americans, and over half of new HIV infections occur in the South. African Americans have poorer outcomes in the entire continua of HIV and PrEP care. Complex social, structural, and behavioral factors contribute to our nation's alarming racial disparities in HIV infection, particularly in the Deep South. Despite the importance of faith, spirituality and religious practice in the lives of many African Americans, there has been little scientific investment exploring how African Americans' religious participation, faith and spirituality may impact our nation's HIV epidemic. This article summarizes the state of the science on this critical issue. We also identify opportunities for new scholarship on how faith, spirituality and religious participation may impact HIV care continuum outcomes in the South and call for greater federal research investment on these issues. |
Comparison of different treatments for isoniazid-resistant tuberculosis: an individual patient data meta-analysis
Fregonese F , Ahuja SD , Akkerman OW , Arakaki-Sanchez D , Ayakaka I , Baghaei P , Bang D , Bastos M , Benedetti A , Bonnet M , Cattamanchi A , Cegielski P , Chien JY , Cox H , Dedicoat M , Erkens C , Escalante P , Falzon D , Garcia-Prats AJ , Gegia M , Gillespie SH , Glynn JR , Goldberg S , Griffith D , Jacobson KR , Johnston JC , Jones-Lopez EC , Khan A , Koh WJ , Kritsk A , Lan ZY , Lee JH , Li PZ , Maciel EL , Galliez RM , Merle CSC , Munang M , Narendran G , Nguyen VN , Nunn A , Ohkado A , Park JS , Phillips PPJ , Ponnuraja C , Reves R , Romanowski K , Seung K , Schaaf HS , Skrahina A , van Soolingen D , Tabarsi P , Trajman A , Trieu L , Velayutham V Banurekha VV , Viiklepp P , Wang JY , Yoshiyama T , Menzies D . Lancet Respir Med 2018 6 (4) 265-275 BACKGROUND: Isoniazid-resistant, rifampicin-susceptible (INH-R) tuberculosis is the most common form of drug resistance, and is associated with failure, relapse, and acquired rifampicin resistance if treated with first-line anti-tuberculosis drugs. The aim of the study was to compare success, mortality, and acquired rifampicin resistance in patients with INH-R pulmonary tuberculosis given different durations of rifampicin, ethambutol, and pyrazinamide (REZ); a fluoroquinolone plus 6 months or more of REZ; and streptomycin plus a core regimen of REZ. METHODS: Studies with regimens and outcomes known for individual patients with INH-R tuberculosis were eligible, irrespective of the number of patients if randomised trials, or with at least 20 participants if a cohort study. Studies were identified from two relevant systematic reviews, an updated search of one of the systematic reviews (for papers published between April 1, 2015, and Feb 10, 2016), and personal communications. Individual patient data were obtained from authors of eligible studies. The individual patient data meta-analysis was performed with propensity score matched logistic regression to estimate adjusted odds ratios (aOR) and risk differences of treatment success (cure or treatment completion), death during treatment, and acquired rifampicin resistance. Outcomes were measured across different treatment regimens to assess the effects of: different durations of REZ (</=6 months vs >6 months); addition of a fluoroquinolone to REZ (fluoroquinolone plus 6 months or more of REZ vs 6 months or more of REZ); and addition of streptomycin to REZ (streptomycin plus 6 months of rifampicin and ethambutol and 1-3 months of pyrazinamide vs 6 months or more of REZ). The overall quality of the evidence was assessed using GRADE methodology. FINDINGS: Individual patient data were requested for 57 cohort studies and 17 randomised trials including 8089 patients with INH-R tuberculosis. We received 33 datasets with 6424 patients, of which 3923 patients in 23 studies received regimens related to the study objectives. Compared with a daily regimen of 6 months of (H)REZ (REZ with or without isoniazid), extending the duration to 8-9 months had similar outcomes; as such, 6 months or more of (H)REZ was used for subsequent comparisons. Addition of a fluoroquinolone to 6 months or more of (H)REZ was associated with significantly greater treatment success (aOR 2.8, 95% CI 1.1-7.3), but no significant effect on mortality (aOR 0.7, 0.4-1.1) or acquired rifampicin resistance (aOR 0.1, 0.0-1.2). Compared with 6 months or more of (H)REZ, the standardised retreatment regimen (2 months of streptomycin, 3 months of pyrazinamide, and 8 months of isoniazid, rifampicin, and ethambutol) was associated with significantly worse treatment success (aOR 0.4, 0.2-0.7). The quality of the evidence was very low for all outcomes and treatment regimens assessed, owing to the observational nature of most of the data, the diverse settings, and the imprecision of estimates. INTERPRETATION: In patients with INH-R tuberculosis, compared with treatment with at least 6 months of daily REZ, addition of a fluoroquinolone was associated with better treatment success, whereas addition of streptomycin was associated with less treatment success; however, the quality of the evidence was very low. These results support the conduct of randomised trials to identify the optimum regimen for this important and common form of drug-resistant tuberculosis. FUNDING: World Health Organization and Canadian Institutes of Health Research. |
Identifying wildlife reservoirs of neglected taeniid tapeworms: Non-invasive diagnosis of endemic Taenia serialis infection in a wild primate population
Schneider-Crease I , Griffin RH , Gomery MA , Dorny P , Noh JC , Handali S , Chastain HM , Wilkins PP , Nunn CL , Snyder-Mackler N , Beehner JC , Bergman TJ . PLoS Negl Trop Dis 2017 11 (7) e0005709 Despite the global distribution and public health consequences of Taenia tapeworms, the life cycles of taeniids infecting wildlife hosts remain largely undescribed. The larval stage of Taenia serialis commonly parasitizes rodents and lagomorphs, but has been reported in a wide range of hosts that includes geladas (Theropithecus gelada), primates endemic to Ethiopia. Geladas exhibit protuberant larval cysts indicative of advanced T. serialis infection that are associated with high mortality. However, non-protuberant larvae can develop in deep tissue or the abdominal cavity, leading to underestimates of prevalence based solely on observable cysts. We adapted a non-invasive monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) to detect circulating Taenia spp. antigen in dried gelada urine. Analysis revealed that this assay was highly accurate in detecting Taenia antigen, with 98.4% specificity, 98.5% sensitivity, and an area under the curve of 0.99. We used this assay to investigate the prevalence of T. serialis infection in a wild gelada population, finding that infection is substantially more widespread than the occurrence of visible T. serialis cysts (16.4% tested positive at least once, while only 6% of the same population exhibited cysts). We examined whether age or sex predicted T. serialis infection as indicated by external cysts and antigen presence. Contrary to the female-bias observed in many Taenia-host systems, we found no significant sex bias in either cyst presence or antigen presence. Age, on the other hand, predicted cyst presence (older individuals were more likely to show cysts) but not antigen presence. We interpret this finding to indicate that T. serialis may infect individuals early in life but only result in visible disease later in life. This is the first application of an antigen ELISA to the study of larval Taenia infection in wildlife, opening the doors to the identification and description of infection dynamics in reservoir populations. |
Increasing availability of prevention to communities disproportionately affected by HIV
McCree DH , Purcell DW , Cleveland JC , Brooks JT . Am J Public Health 2017 107 (7) 1027-1028 Advances in HIV testing, treatment, and prevention produced a decline in the number of new HIV diagnoses in the United States over the past 10 years, with the largest declines seen in mother-to-child transmission and among women and people who inject drugs. However, diagnoses have only stabilized among gay, bisexual, and other men who have sex with men (MSM) in the past five years, and increases continue among Hispanic/Latino MSM.1 Furthermore, disparities persist; MSM, transgender persons, African Americans and Hispanics/Latinos, and persons residing in the Southern United States are the most disproportionately affected subpopulations.1 | The disparities in HIV diagnoses are associated with myriad social, contextual, and structural factors. The National HIV/AIDS Strategy for the United States (NHAS), originally released in 2010 and updated to 2020,2 describes principles, priorities, and actions federal agencies should use to guide a collective national response that will reduce new HIV infections, increase access to care, improve outcomes for persons living with HIV, and reduce disparities. To achieve the NHAS goals, the Centers for Disease Control and Prevention (CDC) adopted a high-impact prevention (HIP) approach3 that targets the best combinations of scientifically proven, cost-effective, and scalable interventions to the right populations in the right geographic areas. Following up Nunn et al.,4 we discuss CDC’s HIV research and programmatic efforts under the HIP approach. |
Assessing carbon dioxide and synthetic lure-baited traps for dengue and chikungunya vector surveillance
Harwood JF , Arimoto H , Nunn P , Richardson AG , Obenauer PJ . J Am Mosq Control Assoc 2015 31 (3) 242-7 The Aedes mosquito vectors of dengue virus (DENV) and chikungunya virus (CHIKV) are attracted to specific host cues that are not generated by traditional light traps. For this reason multiple companies have designed traps to specifically target those species. Recently the standard trap for DENV and CHIKV vectors, the BG-Sentinel (BGS) trap, has been remodeled to be more durable and better suited for use in harsh field conditions, common during military operations, and relabeled the BG-Sentinel 2 (BGS2). This new trap was evaluated against the standard Centers for Disease Control and Prevention (CDC) light trap, Zumba Trap, and BG-Mosquitito Trap to determine relative effectiveness in collecting adult Aedes aegypti and Ae. albopictus. Evaluations were conducted under semifield and field conditions in suburban areas in northeastern Florida from May to August 2014. The BGS2 trap collected more DENV and CHIKV vectors than the standard CDC light trap, Zumba Trap, and BG-Mosquitito Trap, but attracted fewer species, while the BG-Mosquitito Trap attracted the greatest number of mosquito species. |
High-dose rifapentine with moxifloxacin for pulmonary tuberculosis
Jindani A , Harrison TS , Nunn AJ , Phillips PP , Churchyard GJ , Charalambous S , Hatherill M , Geldenhuys H , McIlleron HM , Zvada SP , Mungofa S , Shah NA , Zizhou S , Magweta L , Shepherd J , Nyirenda S , van Dijk JH , Clouting HE , Coleman D , Bateson AL , McHugh TD , Butcher PD , Mitchison DA . N Engl J Med 2014 371 (17) 1599-608 BACKGROUND: Tuberculosis regimens that are shorter and simpler than the current 6-month daily regimen are needed. METHODS: We randomly assigned patients with newly diagnosed, smear-positive, drug-sensitive tuberculosis to one of three regimens: a control regimen that included 2 months of ethambutol, isoniazid, rifampicin, and pyrazinamide administered daily followed by 4 months of daily isoniazid and rifampicin; a 4-month regimen in which the isoniazid in the control regimen was replaced by moxifloxacin administered daily for 2 months followed by moxifloxacin and 900 mg of rifapentine administered twice weekly for 2 months; or a 6-month regimen in which isoniazid was replaced by daily moxifloxacin for 2 months followed by one weekly dose of both moxifloxacin and 1200 mg of rifapentine for 4 months. Sputum specimens were examined on microscopy and after culture at regular intervals. The primary end point was a composite treatment failure and relapse, with noninferiority based on a margin of 6 percentage points and 90% confidence intervals. RESULTS: We enrolled a total of 827 patients from South Africa, Zimbabwe, Botswana, and Zambia; 28% of patients were coinfected with the human immunodefiency virus. In the per-protocol analysis, the proportion of patients with an unfavorable response was 4.9% in the control group, 3.2% in the 6-month group (adjusted difference from control, -1.8 percentage points; 90% confidence interval [CI], -6.1 to 2.4), and 18.2% in the 4-month group (adjusted difference from control, 13.6 percentage points; 90% CI, 8.1 to 19.1). In the modified intention-to-treat analysis these proportions were 14.4% in the control group, 13.7% in the 6-month group (adjusted difference from control, 0.4 percentage points; 90% CI, -4.7 to 5.6), and 26.9% in the 4-month group (adjusted difference from control, 13.1 percentage points; 90% CI, 6.8 to 19.4). CONCLUSIONS: The 6-month regimen that included weekly administration of high-dose rifapentine and moxifloxacin was as effective as the control regimen. The 4-month regimen was not noninferior to the control regimen. (Funded by the European and Developing Countries Clinical Trials Partnership and the Wellcome Trust; RIFAQUIN Current Controlled Trials number, ISRCTN44153044.). |
WHO guidelines for the programmatic management of drug-resistant tuberculosis: 2011 update
Falzon D , Jaramillo E , Schunemann HJ , Arentz M , Bauer M , Bayona J , Blanc L , Caminero JA , Daley CL , Duncombe C , Fitzpatrick C , Gebhard A , Getahun H , Henkens M , Holtz TH , Keravec J , Keshavjee S , Khan AJ , Kulier R , Leimane V , Lienhardt C , Lu C , Mariandyshev A , Migliori GB , Mirzayev F , Mitnick CD , Nunn P , Nwagboniwe G , Oxlade O , Palmero D , Pavlinac P , Quelapio MI , Raviglione MC , Rich ML , Royce S , Rusch-Gerdes S , Salakaia A , Sarin R , Sculier D , Varaine F , Vitoria M , Walson JL , Wares F , Weyer K , White RA , Zignol M . Eur Respir J 2011 38 (3) 516-28 The production of guidelines for the management of drug-resistant tuberculosis (TB) fits the mandate of the World Health Organization (WHO) to support countries in the reinforcement of patient care. WHO commissioned external reviews to summarise evidence on priority questions regarding case-finding, treatment regimens for multidrug-resistant TB (MDR-TB), monitoring the response to MDR-TB treatment, and models of care. A multidisciplinary expert panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations. The recommendations support the wider use of rapid drug susceptibility testing for isoniazid and rifampicin or rifampicin alone using molecular techniques. Monitoring by sputum culture is important for early detection of failure during treatment. Regimens lasting ≥20 months and containing pyrazinamide, a fluoroquinolone, a second-line injectable drug, ethionamide (or prothionamide), and either cycloserine or p-aminosalicylic acid are recommended. The guidelines promote the early use of antiretroviral agents for TB patients with HIV on second-line drug regimens. Systems that primarily employ ambulatory models of care are recommended over others based mainly on hospitalisation. Scientific and medical associations should promote the recommendations among practitioners and public health decision makers involved in MDR-TB care. Controlled trials are needed to improve the quality of existing evidence, particularly on the optimal composition and duration of MDR-TB treatment regimens. |
Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis
Gandhi NR , Nunn P , Dheda K , Schaaf HS , Zignol M , van Soolingen D , Jensen P , Bayona J . Lancet 2010 375 (9728) 1830-43 Although progress has been made to reduce global incidence of drug-susceptible tuberculosis, the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis during the past decade threatens to undermine these advances. However, countries are responding far too slowly. Of the estimated 440,000 cases of MDR tuberculosis that occurred in 2008, only 7% were identified and reported to WHO. Of these cases, only a fifth were treated according to WHO standards. Although treatment of MDR and XDR tuberculosis is possible with currently available diagnostic techniques and drugs, the treatment course is substantially more costly and laborious than for drug-susceptible tuberculosis, with higher rates of treatment failure and mortality. Nonetheless, a few countries provide examples of how existing technologies can be used to reverse the epidemic of MDR tuberculosis within a decade. Major improvements in laboratory capacity, infection control, performance of tuberculosis control programmes, and treatment regimens for both drug-susceptible and drug-resistant disease will be needed, together with a massive scale-up in diagnosis and treatment of MDR and XDR tuberculosis to prevent drug-resistant strains from becoming the dominant form of tuberculosis. New diagnostic tests and drugs are likely to become available during the next few years and should accelerate control of MDR and XDR tuberculosis. Equally important, especially in the highest-burden countries of India, China, and Russia, will be a commitment to tuberculosis control including improvements in national policies and health systems that remove financial barriers to treatment, encourage rational drug use, and create the infrastructure necessary to manage MDR tuberculosis on a national scale. |
Characteristics of elderly and other vulnerable adult victims of homicide by a caregiver: National Violent Death Reporting System--17 U.S. States, 2003-2007
Karch D , Nunn KC . J Interpers Violence 2010 26 (1) 137-57 Homicides of dependent elderly and nonelderly adults by their caregivers violate trust and have long-term consequences for families. A better understanding of the characteristics of homicide by caregivers may provide insights that can inform prevention efforts. Data collected in the National Violent Death Reporting System (NVDRS) between 2003 and 2007 are used to characterize victims, perpetrators, and caregiver roles, and circumstances that precipitated homicides by a caregiver. A total 68 incidents are categorized into either homicide by neglect (n = 17), intentional injury of the victim only (n = 21), or homicide followed by suicide of the perpetrator (n = 30). Demographics, mechanism of injury, location of injury, and victim-suspect relationship variables are supplemented by narrative accounts of incidents. In general, findings show that adult homicide victims of a caregiver were widowed (42.6%), non-Hispanic (97.1%), White (88.2%), women (63.2%) killed in their homes (92.6%) with a firearm (35.3%) or by intentional neglect (25.0%) by a husband (30.9%) or a son (22.1%). Nearly half were aged 80 years and older (48.5%), 42.6% were aged 50 to 79 years, and 0.9% were aged 20 to 49 years. Many homicide by caregiver incidents are precipitated by physical illness of the victim or caregiver, opportunity for perpetrator financial gain, mental illness of the caregiver, substance use by the caregiver, or an impending crisis in the life of the caregiver not related to illness. Understanding the vulnerabilities of victims, the characteristics of suspects, and the multiple types of motivations is key to developing effective prevention efforts. |
Establishment of public health security in Saudi Arabia for the 2009 Hajj in response to pandemic influenza A H1N1
Memish Z , McNabb S , Mahoney F , Alrabiah F , Marano N , Ahmed Q , Mahjour J , Hajjeh R , Formenty P , Harmanci F , El Bushra H , Uyeki T , Nunn M , Isla N , Barbeschi M , The Jeddah Hajj Consultancy Group . Lancet 2009 384 (9703) 1786-91 Mass gatherings of people challenge public health capacities at host locations and the visitors' places of origin. Hajj-the yearly pilgrimage by Muslims to Saudi Arabia-is one of the largest, most culturally and geographically diverse mass gatherings in the world. With the 2009 pandemic influenza A H1N1 and upcoming Hajj, the Saudi Arabian Ministry of Health (MoH) convened a preparedness consultation in June, 2009. Consultants from global public health agencies met in their official capacities with their Saudi Arabian counterparts. The MoH aimed to pool and share public health knowledge about mass gatherings, and review the country's preparedness plans, focusing on the prevention and control of pandemic influenza. This process resulted in several practical recommendations, many to be put into practice before the start of Hajj and the rest during Hajj. These preparedness plans should ensure the optimum provision of health services for pilgrims to Saudi Arabia, and minimum disease transmission on their return home. Review of the implementation of these recommendations and their effect will not only inform future mass gatherings in Saudi Arabia, but will also strengthen preparedness efforts in other settings. |
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