Journal articles: 'Academic HIV Infections Delivery of Health Care' – Grafiati (2024)

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HIV pre-exposure prophylaxis (PrEP) has been demonstrated to be a safe and effective method of reducing HIV incidence. Questions remain regarding PrEP's efficacy and outcomes in real-world clinical settings. We conducted a retrospective review to assess PrEP outcomes in an academic clinic setting and focused on retention in care, reasons for discontinuation, and receipt of appropriate preventive care (immunizations, HIV testing, and STI testing). One hundred thirty-four patients were seen between 2010 and 2016 over 309 visits. One hundred sixteen patients (87%) started daily PrEP and of those, 88 (76%) attended at least one 6-month follow-up visit. Over 60% of PrEP patients completed all recommended STI screening after starting PrEP. Only 40% of patients had all appropriate immunizations at baseline; 78% had all appropriate immunizations at study completion. This study demonstrated high rates of both retention and of attaining recommended preventive care in a clinical setting outside of the rigors of clinical trials.

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Abstract Background Trauma—emotional, physical, and psychological—is common and associated with increased risk behaviors, low rates of care engagement and viral suppression, and overall poor health outcomes for people living with HIV (PLWH). In the United States, there are limited data on how trauma affects reproductive health beliefs for PLWH and even less data on HIV providers’ understanding and consideration of these experiences in their approach to patients. Methods Fifteen semi-structured interviews were conducted with PLWH and nine semi-structured interviews were conducted with HIV care and service providers at an academic medical center in the Southeastern United States. Transcripts were analyzed using thematic analysis. Each transcript was coded by two investigators and discussed to ensure consensus. Results Participants’ narratives described diverse traumas, including sexual abuse (n = 6), the loss of a loved one (n = 8), and personal illness (n = 7). Types of trauma shared with providers included physical, sexual, illness, loss, and psychological. For patients, trauma was both a motivation for having children and a reason to stop having children. Providers perceived a variety of effects of trauma on both sexual behaviors and reproductive intentions. Reproductive counseling by HIV care providers (n = 5) focused on maintaining a healthy pregnancy and less on reproductive intentions prior to pregnancy. Reproductive discussions with pregnant female patients typically centered on reducing the risk of transmission in utero (including the importance of medication adherence to maintain viral suppression), what will happen during delivery, and breastfeeding risks. Reproductive discussions with males typically centered on preventing infection or re-infection of the mother. Conclusion PLWH interpret their trauma experiences differently, particularly when considering reproduction. Providers may not incorporate this information in counseling around reproductive health, highlighting the need fora trauma-informed healthcare practice that promotes awareness, education on the effect of past traumas on health, and access to appropriate resources. Disclosures All authors: No reported disclosures.

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The global commitment to end HIV-AIDS is a bold one; requiring a multi-sectoral response strongly embedded within effective HIV-AIDS prevention efforts, patient advocacy and effective healthcare programme delivery. UNAIDS estimates that, of the 36.7 million individuals infected with HIV-AIDS globally, 19.1 million reside in South Africa (UNAIDS Gap report, 2016).In addition, approximately 2.1 million new HIV infections occurred in 2015 with almost 960 000 of those occurring in South Africa signalling that the rates of infections are not dropping as expected (UNAIDS Gap report, 2016). Given the unrelenting nature of this disease burden, even greater efforts are now required to turn the tide on HIV-AIDS globally, but more so in South Africa. These efforts entail more effective HIV-AIDS service delivery with combination prevention modalities, access to HIV-AIDS treatment and care, harm reduction of HIV-AIDS stigma and discrimination together with HIV-AIDS education, awareness and advocacy. Enhancing HIV-AIDS service delivery requires strong commitment with implementation of quality management systems in programme service delivery resulting in sustainable, effective and well run HIV-AIDS programmes. Quality management systems in HIV-AIDS programmes allow programmes to successfully meet their objectives thus allowing optimal patient care through effective and efficient means. To date there has been minimal implementation of quality systems in healthcare especially in South Africa. The use of health quality tools and systems in HIV-AIDS programmes locally and globally will allow for efficient and cost effective benefits for the optimal wellbeing of all those affected and infected by HIV-AIDS. This article reviews available data on the prevalence of quality management systems in HIV-AIDS healthcare and identifies gaps and smart practises towards recommendations for comprehensive global HIV-AIDS standards development.

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The global commitment to end HIV-AIDS is a bold one; requiring a multi-sectoral response strongly embedded within effective HIV-AIDS prevention efforts, patient advocacy and effective healthcare programme delivery. UNAIDS estimates that, of the 36.7 million individuals infected with HIV-AIDS globally, 19.1 million reside in South Africa (UNAIDS Gap report, 2016).In addition, approximately 2.1 million new HIV infections occurred in 2015 with almost 960 000 of those occurring in South Africa signalling that the rates of infections are not dropping as expected (UNAIDS Gap report, 2016). Given the unrelenting nature of this disease burden, even greater efforts are now required to turn the tide on HIV-AIDS globally, but more so in South Africa. These efforts entail more effective HIV-AIDS service delivery with combination prevention modalities, access to HIV-AIDS treatment and care, harm reduction of HIV-AIDS stigma and discrimination together with HIV-AIDS education, awareness and advocacy. Enhancing HIV-AIDS service delivery requires strong commitment with implementation of quality management systems in programme service delivery resulting in sustainable, effective and well run HIV-AIDS programmes. Quality management systems in HIV-AIDS programmes allow programmes to successfully meet their objectives thus allowing optimal patient care through effective and efficient means. To date there has been minimal implementation of quality systems in healthcare especially in South Africa. The use of health quality tools and systems in HIV-AIDS programmes locally and globally will allow for efficient and cost effective benefits for the optimal wellbeing of all those affected and infected by HIV-AIDS. This article reviews available data on the prevalence of quality management systems in HIV-AIDS healthcare and identifies gaps and smart practises towards recommendations for comprehensive global HIV-AIDS standards development.

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This article focuses our attention on the means by which healthcare is provided to HIV-infected patients who require comprehensive and coordinated care to address the variety of changing and challenging needs presented by the acquired immunodeficiency syndrome (AIDS). Improved clinical management of HIV infection over the past decade, with antiretroviral agents, protease inhibitors and prophylactic therapies against opportunistic infections has transformed HIV infection from an acute to a chronic illness. Many individuals with AIDS are now living longer with more chronic conditions. Concomitant with the transformation of HIV infection from an acute to a chronic illness comes the challenge to provide effective, humane and economical care to patients with chronic conditions that continue to reside in the community, within a healthcare delivery system that has evolved to treat patients with acute diseases.

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Background Pakistan’s National AIDS Control Program has registered 44,000 HIV/AIDS patients to date, but the actual number of cases have been estimated to be as high as 150,000–170,000. The health care system has a very important role to play in this equation and must be reformed to improve the health care services in Pakistan, with regards to HIV/AIDS. Methods It was a qualitative research employing a phenomenological approach. The principal researcher visited nine public and private health care facilities and conducted 19 key informant interviews with people working for providing preventive and curative services, in addition to the observations made on the site. Results Pakistan’s health system has a limited capacity to address the HIV spread in the country, with its current resources. There is an obvious scarcity of resources at the preventive, diagnostic and curative level. However, menace can be curtailed through measures taken at the service delivery level by checking the unsafe needles practices, unclean surgical procedures and an unregulated and untrained private health workforce which are dangerous potentials routes of transmission of the virus to the general population. Healthcare establishments carry the chances of nosocomial infections including HIV/AIDS. Poverty, illiteracy and stigma associated with the disease is compounding the overall situation. Conclusion Improved accessibility to service delivery with a greater focus on prevention would be imperative to address the threat of HIV/AIDS in Pakistan. A health systems approach would help in identifying gaps at both strategic and operational levels, and concurrently find and implement solutions.

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Background Pre-exposure prophylaxis (PrEP) is an effective and cost-effective strategy for HIV prevention. Spain carried out an implementation study in order to assess the feasibility of implementing PrEP programmes within its heterogeneous health system. Methods Observational longitudinal study conducted on four different types of health-care setting: a community centre (CC), a sexually transmitted infections clinic (STIC), a hospital-based HIV unit (HBHIVU) and a hospital-based STI unit (HBSTIU). We recruited gay, bisexual and other men who have sex with men (GBSM) and transgender women at risk of HIV infections, gave them PrEP and monitored clinical, behavioural PrEP-related and satisfaction information for 52 weeks. We collected perceptions on PrEP implementation feasibility from health-care professionals participating in the study. Results A total of 321 participants were recruited, with 99.1% being GBMSM. Overall retention was 87.2% and it was highest at the CC (92.6%). Condom use decreased during the study period, while STIs did not increase consistently. The percentage of people who did not miss any doses of PrEP during the previous week remained at over 93%. No HIV seroconversions occurred. We observed overall decreases in GHB (32.5% to 21.8%), cocaine (27.5% to 21.4%), MDMA (25.7% to 14.3%), speed (11.4% to 5.7%) and mephedrone use (10.7% to 5.0%). The overall participant satisfaction with PrEP was 98.6%. Health-care professionals’ perceptions of PrEP feasibility were positive, except for the lack of personnel. Conclusions PrEP implementation is feasible in four types of health-care settings. Local specificities have to be taken into consideration while implementing PrEP.

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Background: The epidemiologic transition and double disease burden from chronic infections and Non-communicable diseases (NCDs) worldwide requires re-engineering of healthcare delivery systems. Healthcare workers (HCWs) need to adapt to new integrated disease management approaches and change from current disease-specific management. Objectives: The study aimed to determine HCWs knowledge, capacity and skills for management of NCDs among HIV patients and their attitudes towards integrated HIV/NCDs disease management approaches for future clinical practice. Methods: Descriptive cross-sectional survey among HCWs attending to HIV patients at selected government facilities. Results: One hundred out of 105 responses were analysed. Only 6% could fully define NCDs. Awareness levels of NCDs were high: Diabetes and hypertension 98%; cancer 96%; cardiovascular diseases 86%. However, 11.8% and 58% classified HIV and malaria respectively as NCDs. Most respondents (88%) believe that integrating HIV/NCDs care would be good use of resources while 62% disagreed with current separate facility management of HIV patients with NCDs. Over 60% routinely screened HIV patients for NCDs risk factors: Smoking (87.2%), alcohol (90.8%), diet (84.9%) and physical activity (73.5%). Conclusion: There were gaps in detailed knowledge on NCDs, but positive attitude towards routine primary care integrated HIV/NCDs management, showing likely support for implementation of such policy.Keywords: Non-communicable diseases, knowledge, attitude, HIV, integration.

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Human immunodeficiency virus (HIV) continues to be a major global public health issue and omnipresent sexually transmitted infections (STIs) increase the risk of HIV acquisition. Moreover, STIs and HIV in pregnant women can harm the unborn child. In this study, we systematically investigated the prevalence of HIV, relevant STIs and vagin*l group B streptococcus colonization among pregnant women presenting at Asella Teaching Hospital in central Ethiopia and their effect on perinatal mortality. A follow-up was performed six weeks after delivery. A total of 580 women were included, of which 26.6% tested positive for at least one pathogen ( Chlamydia trachomatis 9.8%, trichom*oniasis 5.3%, hepatitis B 5.3%, gonorrhoea 4.3%, group B streptococcus 2.4%, syphilis 2.2%, HIV 2.1%). None of the HIV infections were previously undiagnosed, indicating effective HIV screening activities in the region. Follow-up data were available for 473 (81.6%) children, of which 37 (7.8%) were stillborn or died within the first six weeks of life. Infection with Trichom*onas vagin*lis and recruitment at obstetric ward (versus antenatal care) were associated with mortality. High prevalence of STIs in pregnant women and their impact on the unborn child demonstrate the need for screening and treatment programmes in order to prevent perinatal mortality.

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Introduction: Viral hepatitis is a serious blood-borne and sexually transmitted systemic communicable disease affecting the liver. Commonly, it is caused by hepatitis B and C viruses. HIV infection has been one of the largest public health challenges that can also be transmitted vertically. Objective: To determine seroepidemiological patterns and predictors of hepatitis B, C and HIV viruses among pregnant women attending antenatal care clinic at Atat Hospital, Southern Ethiopia. Methods: Hospital-based cross-sectional study was conducted among 222 pregnant women from May to July, 2017. A structured questionnaire was used to collect socio-demographic characteristics and predicators of hepatitis B, C and HIV infections through face-to-face interview. Venous blood sample of 5 mL was collected from study participants, and serum was tested for HBsAg, anti-HCV and anti-HIV using rapid test kits and further confirmed by enzyme-linked immunosorbent assay. Logistic regression analysis was used to identify predictors of hepatitis and HIV infections. A p-value less than 0.05 was considered statistically significant. Results: The overall seroprevalence of hepatitis B, C and HIV infections were 4.5%, 1.8% and 2.7%, respectively. In multivariate analysis, the prevalence of hepatitis B virus infections was significantly higher among patients having history of poly-sexual practices (adjusted odds ratio = 11.31; 95% confidence interval = 1.24–28.69, p = 0.003), history of abortion (adjusted odds ratio = 8.64; 95% confidence interval = 5.5–30.36, p = 0.034), home delivery by traditional birth attendants (adjusted odds ratio = 9.06; 95% confidence interval = 2.01–13.36, p = 0.005) and blood transfusion (adjusted odds ratio = 18.1; 95% confidence interval = 2.63–114.24, p = 0.001). HIV co-infection was present in 40% and 100% of hepatitis B virus and hepatitis C virus positive pregnant women, respectively. All hepatitis C virus positive women had a history of ear piercing, abortion and home delivery. Conclusion: Hepatitis B, C and HIV were all uncommon infections in this population, with hepatitis B virus the most common. All hepatitis C virus positive pregnant women were co-infected with HIV. Significant association was found between hepatitis B virus infection and predictors. Therefore, continuous screening of pregnant women for hepatitis B and C infections should be performed.

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Human immunodeficiency virus (HIV) and the re-emerging Ebola virus disease (EVD) are closely intertwined and remain a persistent public health threat and global challenge. Their origin and rapid transmission and spread have similar boundaries and share overlapping impact characteristics, including related symptoms and other interactions. The controversies and global threat of these viruses require rapid response policy and evidence-based implementation findings. The constraints and dual burden inflicted by Ebola and HIV infections are highly characterized by similar socio-demographics, socio-economic and political factors. EVD has similar effects and burdens to HIV infection. This study seeks to understand EVD in the context of HIV epidemic despite the challenges in developing an effective vaccine against HIV and EVD. Our findings show that early understanding, prevention and treatment of these diseases a global health threat mainly in Africa is important and valuable. The lessons learned so far from HIV and Ebola epidemics are crucial in health programming and execution of rapid response interventions and continued vigilance against EVD before it become another worldwide health menace. Therefore, the current regional West Africa EVD requires strengthening healthcare systems and building preparedness and response capacity. Importantly, appropriate community participation, health education and resilience coupled with deployment of effective novel diagnostic approaches in early warning and surveillance of threats and emerging diseases. Therefore, there is an urgent need to develop novel key strategies are crucial in curbing the constant viral resurgence, persistence transmission dynamics and spread, as well in accelerating Ebola vaccines regimen (immunization) development and national implementation plans in achieving sustained control, and eventual elimination.

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Routine infectious diseases screening of Sudanese pregnant women has been patchy due to scarcity of healthcare resources and social stigma. We sought to determine the seroprevalence of HIV, hepatitis B, and syphilis among pregnant women attending antenatal care (ANC) at El Obeid Maternity Hospital in western Sudan. We also explored the association between these infections and a set of socio-demographic and maternal variables. Unlinked anonymous testing for HIV-1/2 antibodies, hepatitis B surface antigen, and Treponema pallidum antibodies was performed on residual blood samples collected during routine ANC (August 2016–March 2017). Seroprevalence of HIV was 1.13% (5/444; 95% CI 0.37–2.61%), hepatitis B 2.93% (13/444; 95% CI 1.57–4.95%), and syphilis 7.43% (33/444; 95% CI 5.17–10.28%). On bivariate analysis, there were no statistically significant associations between hepatitis B, syphilis, or a composite outcome including any of the three infections and age, stage of pregnancy, gravidity, parity, previous mode of delivery, history of blood transfusion, or husband polygamy. Urgent action is needed to scale up routine maternal screening for HIV, hepatitis B, and syphilis on an opt-out basis. Further research into the socio-demographic and behavioural determinants of these infections as well as their clinical outcomes is needed.

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ObjectivesIn rural pregnant Indian women, multiple missed antenatal screening opportunities due to inadequate public health facility-based screening result in undiagnosed HIV and sexually transmitted bloodborne infections (STBBIs) and conditions (anaemia). Untreated infections complicate pregnancy management, precipitate adverse outcomes and risk mother-to-child transmission. Additionally, a shortage of trained doctors, rural women’s preference for home delivery and health illiteracy affect health service delivery. To address these issues, we developed AideSmart!, an innovative, app-based, cloud-connected, rapid screening strategy that offers multiplex screening for STBBIs and anaemia at the point of care. It offers connectivity, integration, expedited communications and linkages to clinical care throughout pregnancy.MethodsIn a cross-sectional study, we evaluated the AideSmart! strategy for feasibility, acceptability, preference and impact. We trained 15 healthcare professionals (HCPs) to offer the AideSmart! strategy to 510 pregnant women presenting for care to outreach rural service units of Christian Medical College, Vellore, India.ResultsWith the AideSmart! screening strategy, we recorded an acceptability of 100% (510/510), feasibility (completion rate) of 91.6% (466/510) and preference of 73%. We detected 239 infections/conditions (239/510, 46.8%) at the point-of-care, of which 168 (168/239; 70%) were lab confirmed, staged and treated rapidly. Of the 168 confirmed infections/conditions, 127 were anaemia, 11 Trichom*onas and 30 hepatitis B virus (HBV) (25 resolved naturally, 5 active infections). Four infants (4/5; 80%) were prophylaxed for HBV and were declared disease-free at 9 months. Recruited participants were young; mean age was 24 years (range: 17–40) and 74% (376/510) were in their second trimester. Furthermore, 95% of the participants were retained throughout their pregnancy.ConclusionThe AideSmart! strategy was deemed feasible to operationalise by HCPs. It was accepted and preferred by participants, resulting in timely screening and treatment of HIV/STIs and anaemia, preventing mother-to-child transmission. The strategy could be reverse-innovated to any context to maximise its health impact.

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OBJECTIVE: To estimate the prevalence of missed opportunities for congenital syphilis and HIV prevention in pregnant women who had access to prenatal care and to assess factors associated to non-testing of these infections. METHODS: Cross-sectional study comprising a randomly selected sample of 2,145 puerperal women who were admitted in maternity hospitals for delivery or curettage and had attended at least one prenatal care visit, in Brazil between 1999 and 2000. No syphilis and/or anti-HIV testing during pregnancy was a marker for missed prevention opportunity. Women who were not tested for either or both were compared to those who had at least one syphilis and one anti-HIV testing performed during pregnancy (reference category). The prevalence of missed prevention opportunity was estimated for each category with 95% confidence intervals. Factors independently associated with missed prevention opportunity were assessed through multinomial logistic regression. RESULTS: The prevalence of missed prevention opportunity for syphilis or anti-HIV was 41.2% and 56.0%, respectively. The multivariate analysis showed that race/skin color (non-white), schooling (<8 years), marital status (single), income (<3 monthly minimum wages), having sex during pregnancy, history of syphilis prior to the current pregnancy, number of prenatal care visits (<6), and last prenatal visit before the third trimester of gestation were associated with an increased risk of missed prevention opportunity. A negative association with missed prevention opportunity was found between marital status (single), prenatal care site (hospital) and first prenatal visit in the third trimester of gestation. CONCLUSIONS: High rates of non-tested women indicate failures in preventive and control actions for HIV infection and congenital syphilis. Pregnant women have been discontinuing prenatal care at an early stage and are failing to undergo prenatal screening for HIV and syphilis.

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Migration is a significant risk factor for the acquisition of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and other sexually transmitted infections (STIs). An increasing proportion of these infections in high-income countries, such as Australia, are among migrants moving from low and middle-income countries with a high prevalence of HIV, HBV and other STIs. This systematic review explored the prevention and control of HIV, HBV and other STIs in migrants (>18 years) from Southeast Asia, Northeast Asia and sub-Saharan Africa living in high-income countries with universal health care. This systematic review followed PRISMA guidelines and was registered with PROSPERO. Six academic databases were searched for articles published between 2002 and 2018. Sixteen peer-reviewed articles met the inclusion criteria, consisting of fourteen quantitative and two qualitative studies conducted in Australia, the Netherlands, Canada, Spain, Italy, and Germany. Three levels of interventions were identified: individual, community and structural interventions. Most studies addressed factors at an individual level; interventions were most commonly outreach testing for HIV, HBV and other STIs. Few studies addressed structural factors or demonstrated comprehensive evaluation of interventions. Limited population-specific findings could be determined. To prevent further transmission of HIV, HBV and other STIs, comprehensive public health approaches must consider the complex interactions between migration, health care system determinants, and broader socioeconomic and sociocultural factors.

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The aim of this literature review is to elucidate what is known about HIV/AIDS and stigma in Sub-Saharan Africa. Literature about HIV/AIDS and stigma in Sub-Saharan Africa was systematically searched in Pubmed, Medscape, and Psycinfo up to March 31, 2009. No starting date limit was specified. The material was analyzed using Gilmore and Somerville's (1994) four processes of stigmatizing responses: the definition of the problem HIV/AIDS, identification of people living with HIV/AIDS (PLWHA), linking HIV/AIDS to immorality and other negative characteristics, and finally behavioural consequences of stigma (distancing, isolation, discrimination in care). It was found that the cultural construction of HIV/AIDS, based on beliefs about contamination, sexuality, and religion, plays a crucial role and contributes to the strength of distancing reactions and discrimination in society. Stigma prevents the delivery of effective social and medical care (including taking antiretroviral therapy) and also enhances the number of HIV infections. More qualitative studies on HIV/AIDS stigma including stigma in health care institutions in Sub-Saharan Africa are recommended.

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Background Diagnoses of chlamydia and gonorrhoea have increased steadily in Australia over the past decade. Testing and treatment is central to prevention and control but in some settings treatment may be delayed. Testing at the point of care has the potential to reduce these delays. We explored the potential utility of newly available accurate point-of-care tests in various clinical settings in Australia. Methods: In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with sexual health, primary care, remote Aboriginal health and laboratory expertise. Results: Participants reported that point-of-care testing would have greatest benefit in remote Aboriginal communities where prevalence of sexually transmissible infections is high and treatment delays are common. Some suggested that point-of-care testing could be useful in juvenile justice services where young Aboriginal people are over-represented and detention periods may be brief. Other suggested settings included outreach (where populations may be homeless, mobile or hard to access, such as sex workers in the unregulated sex industry and services that see gay, bisexual and other men who have sex with men). Point-of-care testing could also improve the consumer experience and facilitate increased testing for sexually transmissible infections among people with HIV infection between routine HIV-management visits. Some participants disagreed with the idea of introducing point-of-care testing to urban services with easy access to pathology facilities. Conclusions: Participants felt that point-of-care testing may enhance pathology service delivery in priority populations and in particular service settings. Further research is needed to assess test performance, cost, acceptability and impact.

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Background HIV continues to be a public health challenge adversely affecting youth and young adults, as they are the fastest-growing group of new HIV infections in the United States and the group with the poorest health outcomes among those living with HIV. HIV prevention science has turned to mobile health as a novel approach to reach and engage young people living with HIV (YPLWH) experiencing barriers to HIV care. Objective This study aimed to assess the feasibility and acceptability of a text message–based HIV care navigation intervention for YPLWH in San Francisco. Health eNavigation is a 6-month text message–based HIV care navigation where YPLWH are connected to their own HIV care navigator through text messaging to improve engagement in HIV primary care. Digital HIV care navigation included delivery of the following through SMS text messaging: (1) HIV care navigation, (2) health promotion and education, (3) motivational interviewing, and (4) social support. Methods We evaluated the feasibility and acceptability of a text message–based HIV care navigation intervention among YPLWH. We assessed feasibility using quantitative data for the overall sample (N=120) to describe participant text messaging activity during the intervention. Acceptability was assessed through semistructured, in-depth interviews with a subsample of 16 participants 12 months after enrollment. Interviews were audio-recorded, transcribed, and analyzed using grounded theory. Results Overall, the text message–based HIV care navigation intervention was feasible and acceptable. The majority of participants exhibited medium or high levels of engagement (50/120 [41.7%] and 26/120 [21.7%], respectively). Of the majority of participants who were newly diagnosed with HIV, 63% (24/38) had medium to high engagement. Similarly, among those who were not newly diagnosed, 63% (52/82) had medium to high engagement. The majority of participants found that the intervention added value to their lives and improved their engagement in HIV care, medication adherence, and viral suppression. Conclusions Text message–based HIV care navigation is a potentially powerful tool that may help bridge the gaps for linkage and retention and improve overall engagement in HIV care for many YPLWH. Our results indicate that participation in text message–based HIV care navigation is both feasible and acceptable across pervasive structural barriers that would otherwise hinder intervention engagement.

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Background: Approximately 1.2 million Americans are living with HIV, and about 50,000 new infections occur each year. People living with HIV (PLWH) have numerous medical and psychosocial needs that impact HIV disease progression and challenge treatment outcomes. Purpose: Using CDC’s Program Collaboration and Service Integration (PCSI) framework, we examined strategies, challenges, and lessons learned from a local health department’s efforts to institute PCSI to address the diverse needs of their patients with HIV. Methods: We captured case study data through: 1) semi-structured interviews with key program administrators, 2) analysis of program documents, and 3) site observations and review of clinic procedures. Results: Findings highlight the importance of co-locating services, partnering to leverage resources, and conducting cross-training of staff. Providing co-located services reduced wait times and enhanced coordination of care. Partnering to leverage resources increased patient referrals and enhanced access to comprehensive services. Staff cross-training resulted in more coordinated care and efficient service delivery. Conclusion: The results show that PCSI is essential for optimal care for PLWH. Incorporating PCSI was a vital component of the health department’s comprehensive approach to addressing the multiple medical and support service needs of its HIV-infected clients.

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OBJECTIVE: To assess attitudes and opinions surrounding point-of-care HIV testing among Canadian women, and to determine predictors for acceptance of testing.METHODS: A survey assessing acceptability and attitudes toward rapid HIV testing was distributed on the labour and delivery unit in an academic hospital (St Michael’s Hospital) in Toronto, Ontario, in 2011. Information collected included demographic data, health and pregnancy history, willingness to undergo rapid HIV testing while in labour and barriers to testing.RESULTS: Responses in 92 completed questionnaires were analyzed. The mean age of respondents was 32 years and all were HIV negative. Twelve percent of patients reported having at least one risk factor for HIV transmission. The study showed that only 59% of women were willing to be tested at the time of survey completion, and these women stated that they would accept saliva, urine or serum testing. If found to be positive, 96% would accept antiretroviral treatment and 94% would formula feed their infants. Of the 41% who were not willing to be tested, their reasons for refusal included “don’t want to know” (39%) and being in “too much labour pain” (29%). Regardless of willingness to be tested, the most frequently cited barriers to testing were social stigma (64%) and reaction from partners (69%).CONCLUSIONS: Canadian women in labour were willing to undergo rapid HIV testing via urine, saliva or serum. If found to be positive, women were willing to undergo treatment and to formula feed to prevent mother-to-child transmission of HIV.

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The dual epidemics of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) infection are of growing concern in Asia including countries like Nepal. Tuberculosis incidence rates correlate positively with poverty rates and with HIV incidence rates. TB is a leading cause of morbidity and mortality in patients with HIV infections. TB and HIV are commonly known as the diseases of poverty and their co-infection are known to be the deadliest mixture. Social epidemiology of TB and HIV infection reveals that there are more commonalities of risk factors which are associated with poor individual as well as communal socioeconomic status. Poverty is not only a major factor for complexity but also there are more issues associated with social inequality and inaccessibility to health care services. The double burden of TB and HIV pose a serious threat to the people’s health that needs urgent address from health policy makers and health organizations to avert the economic loss in the future. This concept paper concludes that the TB/HIV co-infection is highly linked to an individual’s socio economic status, sociopsychosocial and ecosocial paradigms of disease manifestation and their impact.Journal of Advanced Academic Research Vol.1(1) 2014: 53-57

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Background Detection and management of acute HIV infection (AHI) is a clinical and public health priority, and HIV infections diagnosed among young adults aged 18 to 39 years are usually recent. Young adults with recent HIV acquisition frequently seek care for symptoms and could potentially be diagnosed through the health care system. Early recognition of HIV infection provides considerable individual and public health benefits, including linkage to treatment as prevention, access to risk reduction counseling and treatment, and notification of partners in need of HIV testing. Objective The Tambua Mapema Plus study aims to (1) test 1500 young adults (aged 18-39 years) identified by an AHI screening algorithm for acute and prevalent (ie, seropositive) HIV, linking all newly diagnosed HIV-infected patients to care and offering immediate treatment; (2) offer assisted HIV partner notification services to all patients with HIV, testing partners for acute and prevalent HIV infection and identifying local sexual networks; and (3) model the potential impact of these two interventions on the Kenyan HIV epidemic, estimating incremental costs per HIV infection averted, death averted, and disability-adjusted life year averted using data on study outcomes. Methods A modified stepped-wedge design is evaluating the yield of this HIV testing intervention at 4 public and 2 private health facilities in coastal Kenya before and after intervention delivery. The intervention uses point-of-care HIV-1 RNA testing combined with standard rapid antibody tests to diagnose AHI and prevalent HIV among young adults presenting for care, employs HIV partner notification services to identify linked acute and prevalent infections, and follows all newly diagnosed patients and their partners for 12 months to ascertain clinical outcomes, including linkage to care, antiretroviral therapy (ART) initiation and virologic suppression in HIV-infected patients, and pre-exposure prophylaxis uptake in uninfected individuals in discordant partnerships. Results Enrollment started in December 2017. As of April 2020, 1374 participants have been enrolled in the observation period and 1500 participants have been enrolled in the intervention period, with 13 new diagnoses (0.95%) in the observation period and 37 new diagnoses (2.47%), including 2 AHI diagnoses, in the intervention period. Analysis is ongoing and will include adjusted comparisons of the odds of the following outcomes in the observation and intervention periods: being tested for HIV infection, newly diagnosed with prevalent or acute HIV infection, linked to care, and starting ART by week 6 following HIV diagnosis. Participants newly diagnosed with acute or prevalent HIV infection in the intervention period are being followed for outcomes, including viral suppression by month 6 and month 12 following ART initiation and partner testing outcomes. Conclusions The Tambua Mapema Plus study will provide foundational data on the potential of this novel combination HIV prevention intervention to reduce ongoing HIV transmission in Kenya and other high-prevalence African settings. Trial Registration ClinicalTrials.gov NCT03508908; https://clinicaltrials.gov/ct2/show/NCT03508908 International Registered Report Identifier (IRRID) DERR1-10.2196/16198

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Encouraged by experimental trials demonstrating the efficacy of antiretrovirals (ARVs) in preventing HIV infection, countries across the Asia-Pacific region have committed to the achievement of ambitious targets tantamount to ending AIDS. The available data suggest that some countries still can make progress through targeted condom promotion and the expansion of harm-reduction interventions, but that none may realise its vision of ‘zero new HIV infections’ without more strategic use of ARVs as part of a combination of HIV prevention efforts targeting key populations. Low rates of HIV testing among men who have sex with men, people who inject drugs, sex workers and other key populations evidence low treatment coverage where treatment could have the greatest impact on curbing local epidemics. Studies have demonstrated the promise of adding ARV treatment and pre-exposure prophylaxis to the existing HIV prevention toolkit, but achieving population-level impact will require service-delivery approaches that overcome traditional prevention, care and treatment program distinctions. Priorities include: (1) innovative strategies to reach, test, treat and retain in services the individuals most likely to acquire or transmit HIV; (2) task shifting and enhanced partnerships between the public sector and civil society; (3) improved ‘cascade’ data systems to assess and promote service uptake and retention; and (4) policy and financing reform to enhance HIV testing and treatment access among key populations.

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Nigeria has the highest number of new HIV infections worldwide and Benue State was reported to have the highest HIV Prevalence in the country. These may partly be due to low coverage of Prevention-of-Mother-to-child-transmission services in private hospitals. Prevention-of-Mother-to-Child-Transmission outlets are concentrated in public facilities but many people patronize private hospitals. This study assessed Prevention-of-Mother-to-Child-Transmission Service provision by private hospitals in Makurdi. A Cross sectional survey of 12 (private-for-profit) registered hospitals with facilities for antenatal and delivery care was carried out. Information was obtained using structured questionnaires. All hospitals performed HIV testing. Six (50%) routinely counseled all pregnant women for testing. Eight (66.7%) offered Prevention-of-Mother-to-Child-Transmission Services. Four (33.3%) had staff trained in Prevention-of-Mother-to-Child-Transmission but one hospital where only midwives were trained did not provide Prevention-of-Mother-to-Child-Transmission Services. Five (41.7%) of the hospitals gave antiretroviral prophylaxis, none had facilities for CD4 count or viral load. A total of 4(50%) of the facilities provided care for infants but only one collected samples for early infant diagnosis. Service delivery appeared to be influenced by cost and staff training. Gaps in service delivery included lack of routine HIV testing, inadequate ARV prophylaxis, inadequate care and support to infants and family members, limited laboratory capacity and use of obstetric procedures which could increase transmission. Private health facilities need support from governments and international partners. Care must be taken to involve medical directors of hospitals in training, provide regular updates about protocols and linkages with other organizations offering services they lack. This would increase service coverage, improve quality of services and source data on Prevention-of-Mother-to-Child-Transmission Services.

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The Senegal pre-exposure prophylaxis (PrEP) Demonstration Project was an open-label cohort study assessing the delivery of daily oral PrEP to HIV-negative female sex workers (FSWs) in four Ministry of Health (MoH)-run clinics in Dakar, Senegal. We assessed uptake, retention in care, and adherence over up to 12 months of follow-up as well as HIV infection rates. Between July and November 2015, 350 individuals were approached and 324 (92.6%) were preliminarily eligible. Uptake was high, with 82.4% of eligible participants choosing to enroll and take PrEP. The mean age of those enrolled was 37.7 years (SD = 8.7), and approximately half had not attended school (41.2%). Among the 267 participants who were prescribed PrEP, 79.9 and 73.4% were retained in PrEP care at 6 and 12 months, respectively. Older age among FSWs was found to be the only significant predictor of lower discontinuation. We did not find significant differences in retention by site, education, condom use, or HIV risk perception. There were no new HIV infections at follow-up. Our results showed evidence of high interest in PrEP and very good PrEP retention rates among FSWs at 12-month follow-up when offered in MoH-run clinics, with older age as the only significant predictor of higher PrEP retention. This highlights the role that these clinics can play in expanding PrEP access nationwide.

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BackgroundAn academic safety-net hospital leveraged the federally funded state Delivery System Reform Incentive Payment programme to implement a hospital-wide initiative to reduce healthcare-associated infections (HAIs) and improve sepsis care.MethodsThe study period was from 2013 to 2017. The setting is a 770-bed urban hospital with six intensive care units and a large emergency department. Key interventions implemented were (1) awareness campaign and clinician engagement, (2) implementation of HAI and sepsis bundles, (3) education of clinical personnel using standardised curriculum on bundles, (4) training of key managers, leaders and personnel in quality improvement methods, and (5) electronic medical record-based clinical decision support. Throughout the 5-year period, staff received frequent, clear, visible and consistent messages from leadership regarding the importance of their participation in this initiative, performing hand hygiene and preventing potential regulatory failures. Several process measures including bundle compliance, hand hygiene and culture of safety were monitored. The primary outcomes were rates of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), surgical site infection (SSI) and sepsis mortality.ResultsFrom 2013 to 2017, the hospital-wide rates of HAI reduced: CLABSI from 1.6 to 0.8 per 1000 catheter-days (Poisson regression estimate: −0.19; 95% CI −0.29 to −0.09; p=0.0002), CAUTI from 4.7 to 1.3 per 1000 catheter-days (−0.34; −0.43 to −0.26; p<0.0001) and SSI after 18 types of procedures from 3.4% to 1.3% (−0.29; −0.34 to −0.24; p<0.0001). Mortality of patients presenting to emergency department with sepsis reduced from 9.4% to 2.9% (−0.42; −0.49 to −0.36; p<0.0001). Adherence to bundles of care and hand hygiene and the hospital culture of patient safety improved. Results were sustained through 2019.ConclusionA hospital-wide initiative incentivised by the Delivery System Reform Incentive Payment programme succeeded in reducing HAI and sepsis mortality over 5 years in a sustainable manner.

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Background: The global push to achieve the 90-90-90 targets designed to end the HIV epidemic has called for the removing of policy barriers to prevention and treatment, and ensuring financial sustainability of HIV programs. Universal health insurance is one tool that can be used to this end. In sub-Saharan Africa, where HIV prevalence and incidence remain high, the use of health insurance to provide comprehensive HIV care is limited. This study looked at the factors that best predict social health insurance enrollment among HIV positive pregnant women using data from the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Methods: Cross-sectional clinical encounter data were extracted from the electronic medical records (EMR) at AMPATH. We used univariate and multivariate logistic regressions to estimate the predictors of health insurance enrollment among HIV positive pregnant women. The analysis was further stratified by HIV disease severity (based on CD4 cell count <350 and 350>) to test the possibility of differential enrollment given HIV disease state. Results: Approximately 7% of HIV infected women delivering at a healthcare facility had health insurance. HIV positive pregnant women who deliver at a health facility had twice the odds of enrolling in insurance [2.46 Adjusted Odds Ratio (AOR), Confidence Interval (CI) 1.24–4.87]. They were 10 times more likely to have insurance if they were lost to follow-up to HIV care during pregnancy [9.90 AOR; CI 3.42–28.67], and three times more likely to enroll if they sought care at an urban clinic [2.50 AOR; 95% CI 1.53–4.12]. Being on HIV treatment was negatively associated with health insurance enrollment [0.22 AOR; CI 0.10–0.49]. Stratifying the analysis by HIV disease severity while statistically significant did not change these results. Conclusions: The findings indicated that health insurance enrollment among HIV positive pregnant women was low mirroring national levels. Additionally, structural factors, such as access to institutional delivery and location of healthcare facilities, increased the likelihood of health insurance enrollment within this population. However, behavioral aspects, such as being lost to follow-up to HIV care during pregnancy and being on HIV treatment, had an ambiguous effect on insurance enrollment. This may potentially be because of adverse selection and information asymmetries. Further understanding of the relationship between insurance and HIV is needed if health insurance is to be utilized for HIV treatment and prevention in limited resource settings.

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Although men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmissible infections, sexual health services for MSM in low- and middle-income countries (LMIC) remain under-resourced and are poorly understood. A scoping review of literature on MSM sexual health in LMIC was conducted in order to identify key clinical services and gaps in knowledge. Three databases were searched, in addition to hand-reviewing key journals and bulletins, to identify literature with a focus on MSM sexual health. Key services related to providing care to MSM in LMIC that emerged from our review are described. These services include creation of safe and confidential clinic environments, HIV testing services, behavioural interventions, HIV pre-exposure prophylaxis (PrEP), rapid antiretroviral therapy (ART) initiation and STI services. Compared with high-income settings, major differences in LMIC include lack of diagnostic technology, unfavourable legal environments and lack of funding for MSM health. Innovative approaches to healthcare delivery, such as harnessing mobile technology, self-testing and crowdsourcing interventions, can improve health services among MSM in LMIC. There are gaps in the evidence about how best to provide sexual health services for MSM in LMIC settings. Implementation research and scale-up of existing biomedical and behavioural interventions, such as HIV/STI testing services, PrEP and early antiretroviral initiation are urgently needed in LMIC.

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ObjectiveDigital innovations with internet/mobile phones offer a potential cost-saving solution for overburdened health systems with high service delivery costs to improve efficiency of HIV/STI (sexually transmitted infections) control initiatives. However, their overall evidence has not yet been appraised. We evaluated the feasibility and impact of all digital innovations for all HIV/STIs.DesignSystematic review.Setting/participantsAll settings/all participants.InterventionWe classified digital innovations into (1) mobile health-based (mHealth: SMS (short message service)/phone calls), (2) internet-based mobile and/or electronic health (mHealth/eHealth: social media, avatar-guided computer programs, websites, mobile applications, streamed soap opera videos) and (3) combined innovations (included both SMS/phone calls and internet-based mHealth/eHealth).Primary and secondary outcome measuresFeasibility, acceptability, impact.MethodsWe searched databases MEDLINE via PubMed, Embase, Cochrane CENTRAL and Web of Science, abstracted data, explored heterogeneity, performed a random effects subgroup analysis.ResultsWe reviewed 99 studies, 63 (64%) were from America/Europe, 36 (36%) from Africa/Asia; 79% (79/99) were clinical trials; 84% (83/99) evaluated impact. Of innovations, mHealth based: 70% (69/99); internet based: 21% (21/99); combined: 9% (9/99).All digital innovations were highly accepted (26/31; 84%), and feasible (20/31; 65%). Regarding impacted measures, mHealth-based innovations (SMS) significantly improved antiretroviral therapy (ART) adherence (pooled OR=2.15(95%CI: 1.18 to 3.91)) and clinic attendance rates (pooled OR=1.76(95%CI: 1.28, 2.42)); internet-based innovations improved clinic attendance (6/6), ART adherence (4/4), self-care (1/1), while reducing risk (5/5); combined innovations increased clinic attendance, ART adherence, partner notifications and self-care. Confounding (68%) and selection bias (66%) were observed in observational studies and attrition bias in 31% of clinical trials.ConclusionDigital innovations were acceptable, feasible and generated impact. A trend towards the use of internet-based and combined (internet and mobile) innovations was noted. Large scale-up studies of high quality, with new integrated impact metrics, and cost-effectiveness are needed. Findings will appeal to all stakeholders in the HIV/STI global initiatives space.

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IntroductionAchieving the Joint United Nations Programme on HIV and AIDS 90-90-90 targets requires models of HIV care that expand antiretroviral therapy (ART) coverage without overburdening health systems. Point-of-care (POC) viral load (VL) testing has the potential to efficiently monitor ART treatment, while enrolled nurses may be able to provide safe and cost-effective chronic care for stable patients with HIV. This study aims to demonstrate whether POC VL testing combined with task shifting to enrolled nurses is non-inferior and cost-effective compared with laboratory-based VL monitoring and standard HIV care.Methods and analysisThe STREAM (Simplifying HIV TREAtment and Monitoring) study is an open-label, non-inferiority, randomised controlled implementation trial. HIV-positive adults, clinically stable at 6 months after ART initiation, will be recruited in a large urban clinic in South Africa. Approximately 396 participants will be randomised 1:1 to receive POC HIV VL monitoring and potential task shifting to enrolled nurses, versus laboratory VL monitoring and standard South African HIV care. Initial clinic follow-up will be 2-monthly in both arms, with VL testing at enrolment, 6 months and 12 months. At 6 months (1 year after ART initiation), stable participants in both arms will qualify for a differentiated care model involving decentralised ART pickup at community-based pharmacies. The primary outcome is retention in care and virological suppression at 12 months from enrolment. Secondary outcomes include time to appropriate entry into the decentralised ART delivery programme, costs per virologically suppressed patient and cost-effectiveness of the intervention compared with standard care. Findings will inform the scale up of VL testing and differentiated care in HIV-endemic resource-limited settings.Ethics and disseminationEthical approval has been granted by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BFC296/16) and University of Washington Institutional Review Board (STUDY00001466). Results will be presented at international conferences and published in academic peer-reviewed journals.Trial registrationNCT03066128; Pre-results.

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Introduction Sexually transmitted infections (STIs) are common during pregnancy and can result in adverse delivery and birth outcomes. The purpose of this study was to estimate the prevalence of STIs; Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (syphilis), Trichom*onas vagin*lis (trichom*oniasis), and Human Immunodeficiency Virus (HIV) among pregnant women visiting an antenatal care center in Nepal. Materials and methods We adapted and piloted the WHO standard protocol for conducting a prevalence survey of STIs among pregnant women visiting antenatal care center of Dhulikhel Hospital, Nepal. Patient recruitment, data collection, and specimen testing took place between November 2019-March 2020. First catch urine sample was collected from each eligible woman. GeneXpert platform was used for CT and NG testing. Wet-mount microscopy of urine sample was used for detection of trichom*oniasis. Serological test for HIV was done by rapid and enzyme-linked immunosorbent assay tests. Serological test for syphilis was done using “nonspecific non-treponemal” and “specific treponemal” antibody tests. Tests for CT, NG and trichom*oniasis were done as part of the prevalence study while tests for syphilis and HIV were done as part of the routine antenatal testing. Results 672 women were approached to participate in the study, out of which 591 (87.9%) met the eligibility criteria and consented to participate. The overall prevalence of any STIs was 8.6% (51/591, 95% CI: 6.3–10.8); 1.5% (95% CI: 0.5–2.5) for CT and 7.1% (95% CI: 5.0–9.2) for trichom*oniasis infection. None of the samples tested positive for NG, HIV or syphilis. Prevalence of any STI was not significantly different among women, age ≤ 24 years (10%, 25/229) compared to women age ≥25 years (7.1%, 26/362) (p = 0.08). Conclusions The prevalence of trichom*oniasis among pregnant women in this sub-urban population of Nepal was high compared to few cases of CT and no cases of NG, syphilis, and HIV. The WHO standard protocol provided a valuable framework for conducting STI surveillance that can be adapted for other countries and populations.

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Background: Sharps injuries are accidental infiltrating wounds that are typically the consequences of utilizing hazardous equipment in the usual fast-paced, and stressful health care setting. As a result, exposure to blood-borne pathogens from sharps injury poses a significant risk to health care workers. These injuries predispose the staff to dangerous infections such as hepatitis B, C and HIV. The aim of the study was to assess the occupational exposure to sharps injuries among health care workers in King Abdulaziz University Hospital in Jeddah.Methods: A cross-sectional descriptive study was conducted. Nurses, residents, dentists, and housekeepers working in the surgical ward, obstetrics and gynaecology ward, emergency department, operation room, labor and delivery room, and dental clinics at King Abdulaziz University Hospital were included. A random sample of 161 subjects was recruited in this study using a self-administered structured questionnaire.Results: Of 161 participants, 53 (32.90%) had a history of sharps injury. Among them 25 (47.16%) were nurses, both surgical and gynaecological residents had the same result of 11 (20.76%), and 6 (11.32%) of them were dentists. Most of the injuries had occurred during the use of the suture needle; 24 (45.28%) suggested that work overload was the main reason for sharps injury occurrence.Conclusions: Among health care workers, nurses were especially at risk of exposure to sharps injury. The most important risk factors for injury occurrence include long working hours, continuous rotating shifts, and work overload. Also, not all of the health care workers knew about the hospital’s reporting system.

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There is a high global prevalence of HIV, sexually transmitted infections (STIs), and unplanned pregnancies. Current preventative daily oral dosing regimens can be ineffective due to low patient adherence. Sustained release delivery systems in conjunction with multipurpose prevention technologies (MPTs) can reduce high rates of HIV/STIs and unplanned pregnancies in an all-in-one efficacious, acceptable, and easily accessible technology to allow for prolonged release of antivirals and contraceptives. The concept and development of MPTs have greatly progressed over the past decade and demonstrate efficacious technologies that are user-accepted with potentially high adherence. This review gives a comprehensive overview of the latest oral, parenteral, and vagin*lly delivered MPTs in development as well as drug delivery formulations with the potential to advance as an MPT, and implementation studies regarding MPT user acceptability and adherence. Furthermore, there is a focus on MPT intravagin*l rings emphasizing injection molding and hot-melt extrusion manufacturing limitations and emerging fabrication advancements. Lastly, formulation development considerations and limitations are discussed, such as nonhormonal contraceptive considerations, challenges with achieving a stable coformulation of multiple drugs, achieving sustained and controlled drug release, limiting drug–drug interactions, and advancing past preclinical development stages. Despite the challenges in the MPT landscape, these technologies demonstrate the potential to bridge gaps in preventative sexual and reproductive health care.

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Background The burden of HIV, HBV, and HCV infections remains disproportionately high in sub-Saharan Africa, with high rates of co-infections. Multiplex rapid diagnostic tests for HIV, HBV and HCV serological testing with high analytical performances may improve the “cascade of screening” and quite possibly the linkage-to-care with reduced cost. Based on our previous field experience of HIV self-testing, we herein aimed at evaluating the practicability and acceptability of a prototype finger-stick whole-blood Triplex HIV/HCV/HBsAg self-test as a simultaneous serological screening tool for HIV, HBV, and HCV in the Democratic Republic of the Congo (DRC). Methods A cross-sectional multicentric study consisting of face-to-face, paper-based, and semi-structured questionnaires with a home-based and facility-based recruitment of untrained adult volunteers at risk of HIV, HBV, and HCV infections recruited from the general public was conducted in 2020 in urban and rural areas in the DRC. The practicability of the Triplex self-test was assessed by 3 substudies on the observation of self-test manipulation including the understanding of the instructions for use (IFU), on the interpretation of Triplex self-test results and on its acceptability. Results A total of 251 volunteers (mean age, 28 years; range, 18–49; 154 males) were included, from urban [160 (63.7%)] and rural [91 (36.3%)] areas. Overall, 242 (96.4%) participants performed the Triplex self-test and succeeded in obtaining a valid test result with an overall usability index of 89.2%. The correct use of the Triplex self-test was higher in urban areas than rural areas (51.2% versus 16.5%; aOR: 6.9). The use of video IFU in addition to paper-based IFU increased the correct manipulation and interpretation of the Triplex self-test. A total of 197 (78.5%) participants correctly interpreted the Triplex self-test results, whereas 54 (21.5%) misinterpreted their results, mainly the positive test results harboring low-intensity band (30/251; 12.0%), and preferentially the HBsAg band (12/44; 27.3%). The rates of acceptability of reuse, distribution of the Triplex self-test to third parties (partner, friend, or family member), linkage to the health care facility for confirmation of results and treatment, and confidence in the self-test results were very high, especially among participants from urban areas. Conclusions This pilot study shows evidence for the first time in sub-Saharan Africa on good practicability and high acceptability of a prototype Triplex HIV/HCV/HBsAg self-test for simultaneous diagnosis of three highly prevalent chronic viral infections, providing the rational basis of using self-test harboring four bands of interest, i.e. the control, HIV, HCV, and HBsAg bands. The relatively frequent misinterpretation of the Triplex self-test points however the necessity to improve the delivery of this prototype Triplex self-test probably in a supervised setting. Finally, these observations lay the foundations for the potential large-scale use of the Triplex self-test in populations living in sub-Saharan Africa at high risk for HIV, HBV, and HCV infections.

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Background Sexual well-being is fundamental to physical and emotional health, and the ability to achieve it depends on access to comprehensive sexuality information and high-quality sexual health care from evidence-informed, nonjudgmental providers. Adequate and timely delivery of these components to individuals who are at high risk for sexually transmitted infections (STIs), including HIV, and unintended pregnancies promotes sexual health and mitigates consequences arising from risky sexual behavior. Brief interventions that allow health care providers to improve the information available to clients and motivate and help them to develop risk-reduction skills are seen as efficient ways to improve knowledge, change client behavior, and reduce provider stigma regarding sexual health. Objective The aim of the study is to evaluate five aspects of feasibility (acceptability, willingness, safety, satisfaction, and process) of a brief sexuality-related communication (BSC) intervention based on motivational interviewing and behavior change techniques in primary health care settings in low- and middle-income countries (LMICs). Methods This protocol outlines a multisite, multiphase study of feasibility of a BSC intervention in primary health care settings in LMICs that will be examined across four phases of the study. Phases I through III involve the collection of formative, qualitative data to examine provider and client perceptions of the feasibility of the intervention, adaptation of the intervention guide, and training providers on how to implement the final version of the BSC intervention. During phase IV, the feasibility of the intervention will be tested in a nonrandomized pre-post test trial where providers and clients will be followed for 6 months and participate in multiphase data collection. Results Phase I is currently underway in Moldova, and phases I and II were completed in Peru in late 2019. Results are expected for the feasibility study in 2021. Conclusions This feasibility study will determine whether the implementation of brief intervention programs aimed at improving sexual health outcomes is possible in the constraints of LMIC health systems and will add to our understanding of factors shaping clinical practice among primary care providers. International Registered Report Identifier (IRRID) DERR1-10.2196/15569

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Background: The treatment of HIV disease is made more complex by rapid changes in disease management. Two primary objectives of this study were to evaluate the continuing education (CE) needs and preferences of pharmacists and to utilize this information to develop CE HIV disease management strategies. Our hypothesis was that current knowledge of HIV disease management is outdated and that CE related to HIV should be delivered in ways that meet the preferences of pharmacists. Methods: A 14-page needs assessment (NA) was developed to assess the CE needs and preferences of Newfoundland and Labrador (NL) pharmacists and their knowledge of HIV disease management. The NA was validated by pharmacists, physicians, nurses, and social workers from Memorial University of Newfoundland and the Health Care Corporation of St. John's. Respondents' answers were scored using a six-point Likert scale. Space was available for respondents to provide open answers and opinions related to the questionnaire, CE, and HIV. Piloting and feedback suggested the NA could be completed in 20–30 minutes. The NA was mailed to 470 pharmacists. Results: Thirty percent of the pharmacists returned a completed questionnaire. Mean scores (MS) were calculated for specific CE topics. The top three CE topics were: update professional skills (MS = 4.46); current standards of care (MS = 3.9); and professional practice standards (MS = 3.85). CE topics for clinical skills were also highlighted and included pharmacology and therapeutics, infectious disease, and patient education. CE topics specific to HIV included drug interactions, resistance, management of adverse events, opportunistic infections, alternative therapies, HAART therapy, post-exposure prophylaxis, and pregnancy in HIV/AIDS. Most pharmacists (81%) had access to Internet and e-mail (76%). Few respondents had access to teleconference (19%) and videoconference (11%). Pharmacists' preferences for CE delivery times were workday evenings (2–3 hours), weekend half-day, and workday half-day. Conferences, correspondences courses, structured courses, and seminars were the preferred delivery modes. Conclusions/Implications: Pharmacists in NL appear to have specific educational needs. Although the study achieved a lower-than-expected response rate, perhaps partly due to its length, most respondents indicated that computer-based technology could enhance the delivery of CE. Continuous, discipline-specific, real-time assessment of educational needs may be essential for optimum management of patients with HIV. It is likely the findings reflect the needs of pharmacists across the country, especially those outside urban areas. The preferences identified in this study could apply to delivering CE for a variety of diseases.

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Abstract Background Inappropriate prescription of antibiotics for respiratory tract infections (RTIs) in ambulatory care settings is common, increasing the risk of adverse health outcomes. Behavioral and educational interventions targeting primary care providers (PCPs) have shown promise in reducing inappropriate antibiotic prescribing for RTIs. While one perceived barrier to such interventions is the concern that these adversely impact patient satisfaction, few data exist in this area. Here, we examine whether a recent PCP-targeted intervention that significantly reduced antibiotic prescribing for RTIs was associated with a change in patient satisfaction. Methods The PCP-targeted intervention involved monthly education sessions and peer benchmarking reports delivered to 31 clinics within an academic health system, and was previously shown to reduce antibiotic prescribing. Here, we performed a retrospective, secondary analysis of Press Ganey (PG) surveys associated with the outpatient encounters in the pre- and post-intervention periods. We evaluated the impact on patient perceptions of PCPs based on provider exposure to the intervention using a mixed effects logistic regression model. Results There were 17,416 out of 197,744 encounters (8.8%) with associated PG surveys for the study time period (July 2016 to September 2018). In the multivariate model, patient satisfaction with PCPs was most strongly associated with patient-level characteristics (age, race, health status, education status) and survey-level characteristics (survey response time, patient’s usual provider) (Figure 1). Satisfaction with PCPs did not change following delivery of the provider-based intervention even after adjusting for patient- and survey-level characteristics [adjusted odds ratio (95% CI): 1.005 (0.928, 1.087)]. However, a small increase in satisfaction associated with receiving antibiotics during the entire study period was seen [adjusted odds ratio (95% CI): 1.146 (1.06, 1.244)]. Figure 1: Association of a provider-targeted intervention as well as patient, provider, and practice characteristics with patient satisfaction in a multivariable mixed effects logistic regression model Conclusion Patient perceptions of PCPs remain unchanged following the delivery of a behavioral and educational intervention to primary care providers that resulted in observable decreases in antibiotic prescribing practices for RTIs. Disclosures All Authors: No reported disclosures

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Abstract Background Women account for 25 % of HIV infections nationally, and African American (AA) women are disproportionately affected. We report important gender differences observed in an expanded HIV testing and linkage to care (X-TLC) program conducted on the South and West Sides of Chicago. Methods X-TLC is funded by CDPH with CDC prevention B funds. X-TLC has expanded from 3 sites to 14 sites, including acute care hospitals (academic, community), community health centers (CHCs), and family planning clinics. We report descriptive stats, group comparisons by Chi-square, and multivariate analyses adjusted for demographics. Results Since 2011, X-TLC has conducted 308,038 HIV screens, and 63.7 % of those tested were women. Overall seroprevalence for HIV was 0.56 %, and 30.5 % of HIV patients identified were cis-gender women (seroprevalence 0.15 %). The seroprevalence for women testing in EDs was higher (0.44 %). Similar to men, only 52.9 % of HIV positive women were new diagnoses. Women accounted for 28.5 % of all new diagnoses, compared with 15.4 % for Chicago overall. In 2016 X-TLC screened 91,865 persons for HIV, and 65.2 % of those tested were women. There were 193 new diagnosis and 32.1 % (62) were women, 85.7 % AA. In comparison, in 2015 there were 139 women with a new HIV diagnosis for all of Chicago. Women newly diagnosed were less likely to be linked to care (adjusted odds ratio, aOR, 0.54, 0.35–0.85). Linkage was lower for women diagnosed at CHCs (84.6 % vs. 76.3 %, P = 0.02). Most CHCs did not have on site HIV providers. At our site, however, women linked to care were more likely to be retained in care (aOR 0.58, 0.43–0.78). We also conduct targeted outreach testing, partner services (PS) testing, and social network strategy (SNS) testing, but women are not identified by these programs (16/171 tested women, 8 new diagnoses were men for PS; 507 tested, 471 men and 36 trans-gender women, 38 new positives, 0 cis-gender women for SNS). Conclusion More women than men were offered and/or accept HIV screening in healthcare settings. The proportion of seropositive women identified was higher than the national average. X-TLC is reaching a large proportional of AA women with HIV unaware of their status. Other testing strategies will rarely identify cis-gender women with HIV infection. Gender differences in linkage to and retention in care will require strategies targeted at women. Disclosures J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; N. Glick, Gilead FOCUS: Grant Investigator, Grant recipient; D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient

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Background: Safe blood transfusion to the people is essential requirement of health care delivery system. Despite the mandatory screening of blood with newest, very sensitive serological test, considerable risk remains for transfusion transmission of virus due to window period infections. Study was aimed to analyze the efficacy of Mini pool Nucleic Acid Amplification Testing as additional donor screening program and its role in improving blood safety in the high prevalence population. Material and Methods: Study was performed at a tertiary-care, accreditated hospital from June 2013 to December 2015 All negative cases for anti-HIV, anti-HCV and HBsAg by ELISA were subjected to MP-NAT to detect HIV-1, HIV-2 and HCV-RNA with HBV DNA.Results: In 31 months, 20470 donations were received of which whole blood donations were 16997 (83.03%) and 3473 (16.97%) apheresis. Out of 16997 donations, 446 (2.61%) were seroreactive. Out of 16551 sero-negative donors subjected to MP-NAT testing, 17 (0.10%) were NAT reactive (NAT yield -1 in 974). Out of 17 cases, 12 were HBV (1 in 1379), four HCV (1 in 4138) and one HIV NAT reactive (1 in 16551). Conclusion: NAT has improvised the blood safety by detecting the virus in the pre-seroconversion, window period thereby providing much higher sensitivity as compared to newest generation serological tests. In countries with high incidence of infection with significant number of window period donations, NAT can serve as a valuable tool along with other serological testing in high prevalence, resource constrained countries to achieve the goal of zero risk of blood.

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Abstract Background Infectious complications in children treated for cancer contribute to their morbidity and mortality. There is a paucity of studies on the incidence, microbiological etiology, risk factors, and outcome of serious bacterial infections in African children treated for cancer. Aim The aim of the study was to delineate the epidemiology of infectious morbidity and mortality in South African children with cancer. Methods This prospective, single-center, longitudinal-cohort study enrolled children one-19 years old hospitalized for cancer treatment at the Paediatric Oncology Unit, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. Children were investigated for infection as part of the standard of care. Results In total, 169 children were enrolled, 82 with hematological malignancy (HM), 87 with a solid tumor (ST), median age was 68.5 months and 10.7% were living with HIV. The incidence (per 100 child-years) of septic episodes (SE) and microbiologically confirmed SE (MSCE) was 101 (138 vs. 70, P &lt; 0.001) and 70.9 (99.1 vs. 47.3; P &lt; 0.001), respectively; higher in children with HM than ST. The incidence of MCSE in children with high-risk HM (137.7) was 4.32-fold greater compared with those with medium-risk HM (30.3; P &lt; 0.001). Children with metastatic ST had a higher incidence (84.4) of MSCE than those with localized ST (33.6; aOR: 2.52; P &lt; 0.001). The presence of an indwelling catheter was 3-fold (P &lt; 0.001) more likely to be associated with MCSE compared with those without. There was no association for age group, nutritional status or HIV-status, and incidence of MCSE. The incidence of gram-positive (GPB) and gram-negative (GNB) SEs was 48.5 and 37.6, respectively, and higher in children with an HM. The most commonly identified GPB were Coagulase-negative Staphylococci, Streptococcus viridans and Enterococcus faecium; while the most common GNB were Escherichia coli, Acinetobacter baumannii, and Pseudomonas species. The median CRP was higher in children with MSCE compared with those with culture-negative SE (CNSE) (116.5 vs. 92; P &lt; 0.001) in both HM (132.5 vs. 117; P &lt; 0.001) and ST (87.5 vs. 46; P &lt; 0.001). The procalcitonin was higher in those with MSCE compared with those with CNSE (2.30 vs. 1.40; P &lt; 0.001) in both HM (2.95 vs. 1.60; P = 0.002) and ST (2.10 vs. 1.20; P &lt; 0.001). The case fatality risk was 40.4%; 80% was attributed to sepsis. Of these, 35 (72.92%) had HM and 34 of the 35 (97.14%) had HR-HM. Children with HM had an overall sepsis CFR of 42.68%. Four (30.77%) of the 13 sepsis-related deaths in STs had metastatic disease and 8 (16.67%) of the total number of sepsis-related deaths were in children living with HIV. There was no association between malnutrition or HIV-positivity and death. The odds of dying from sepsis were higher in children with profound (aOR 3.96; P = 0.004) and prolonged (aOR 3.71; P = 0.011) neutropenia. Pneumonia (58.85% vs. 29.23%; aOR 2.38; P = 0.025) and tuberculosis (70.83% vs. 34.91%; aOR 4.3; P = 0.005) were independently associated with a higher CFR. Conclusion The current study emphasizes the high burden of sepsis in African children treated for cancer, and especially HM, and highlights the association of tuberculosis and pneumonia as independent predictors of death in children with cancer.

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Abstract Background Childhood trauma has long-lasting implications for adult health as prior work in the general population linked ≥4 adverse childhood experiences (ACEs) to multiple negative health outcomes in adulthood. History of childhood trauma is prevalent in people living with HIV (PLWH); however, screening for history of childhood trauma is not routinely performed in HIV clinical care. Methods We conducted a single-center, cross-sectional quality improvement pilot project to (1) define the prevalence of ACEs in PLWH engaged in care and (2) improve linkage with mental health resources. We hypothesized the prevalence of ≥4 ACEs in PLWH would be >21%, the prevalence previously reported in the local, general population. Patients were approached in the course of routine clinical care at an urban, academic HIV outpatient clinic between October 2018 and April 2019 and offered screening for ACEs, depression, and post-traumatic stress disorder (PTSD) using previously validated tools. Results Forty-nine patients completed the screening. Median age was 48 years [IQR: 37–55]; 69% were male and 53% were gay or bisexual. Most patients identified as black/African American (75%) and white (12%). Median ACEs score was 4 [IQR 1–6], with 51% (95% CI: 36–66%) reporting ≥4 ACEs (Figure 1), and most common ACE being guardian substance abuse (57%) (Figure 2). When compared with men, women had a higher median ACEs score (5 vs. 3, P = 0.04), history of childhood sexual abuse (67% vs. 26%, P <0.001), parent incarceration (53% vs. 24%, P = 0.04), and parental divorce or separation (73% vs. 41%, P = 0.04). Patients with ≥4 ACEs were more likely to have positive PTSD screens (56% vs. 21%, P = 0.02), moderate depression or greater (37% vs. 11%, P = 0.002), and were more likely to accept on-site mental health referral after screening (36% vs. 8%, P = 0.04). Acceptability of screening was deemed “very good” by patients, with median acceptability score 5 [IQR: 4–5] on a 5-point scale. Conclusion Over half of HIV+ patients screened in our clinic reported ≥4 ACEs, more than twice the prevalence of the general population. ACEs screening facilitated linkage of patients with high ACEs scores to mental healthcare. These results highlight the potential value of routine ACEs screening to enhance delivery of trauma-informed HIV primary care. Disclosures All authors: No reported disclosures.

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A assistência às pessoas vivendo com Vírus da Imunodeficiência Humana/Síndrome da Imunodeficiência Adquirida sugere investimentos na prática interdisciplinar, substituindo a concepção fragmentária pela compreensão integral da saúde. Assim, objetivou-se conhecer a percepção das pessoas que vivem com síndrome da imunodeficiência adquirida sobre a assistência recebida pela equipe multiprofissional na perspectiva da integralidade da atenção. Trata-se de um estudo qualitativo, exploratório, fundamentado na teoria da integralidade em saúde. Participaram da pesquisa 18 pessoas que vivem com síndrome da imunodeficiência adquirida acompanhadas no serviço de assistência especializada. Os dados foram coletados mediante entrevista semiestruturada, e submetidos à análise de conteúdo segundo Bardin. Emergiram as categorias: “Percepção da assistência à saúde como modo de acolher o usuário”, “Percepção da assistência às necessidades de saúde como garantia de acesso a procedimentos e serviços” e “A assistência à saúde centrada na figura de um único profissional”. Constatou-se que a assistência da equipe multiprofissional é pouco perceptível pelos usuários, que reconhecem apenas um profissional como responsável pelo cuidado.Descritores: Infecções por HIV, Assistência à Saúde, Equipe de Assistência ao Paciente, Integralidade em Saúde. Performance of the multiprofessional team in specialized care in HIV/AIDSAbstract: Assistance to people living with HIV/AIDS suggests investments in interdisciplinary practice, replacing the fragmentary conception with a comprehensive understanding of health. Thus, the objective was to know the perception of people living with HIV/AIDS on the assistance received by the multidisciplinary team in the perspective of comprehensive care. It is a qualitative, exploratory study, based on the theory of integrality in health. The study included 18 people living with HIV/AIDS accompanied by the specialized assistance service. Data were collected through semi-structured interviews, and submitted to content analysis according to Bardin. The categories emerged: “Perception of health care as a way of welcoming the user”, “Perception of assistance to health needs as a guarantee of access to procedures and services” and “Health care centered on the figure of a single professional”. It was found that the assistance of the multidisciplinary team is barely noticeable by users, who recognize only one professional as responsible for care.Descriptors: HIV Infections, Delivery of Health Care, Patient Care Team, Integrality in Health. Desempeño del equipo multiprofesional en atención especializada en VIH/SIDAResumen: La asistencia a las personas que viven con el VIH/SIDA sugiere inversiones en la práctica interdisciplinaria, reemplazando el concepto fragmentario con una comprensión integral de la salud. Por lo tanto, el objetivo era conocer la percepción de las personas que viven con el VIH/SIDA sobre la asistencia recibida por el equipo multidisciplinario en la perspectiva de la atención integral. Este es un estudio cualitativo, exploratorio, basado en la teoría de la integralidad en salud. El estudio incluyó a 18 personas que viven con VIH/SIDA acompañadas por el servicio de asistencia especializada. Los datos se recopilaron a través de entrevistas semiestructuradas y se sometieron a análisis de contenido según Bardin. Surgieron las categorías: “Percepción de la atención médica como una forma de acoger al usuario”, “Percepción de la asistencia a las necesidades de salud como garantía de acceso a procedimientos y servicios” y “Atención médica centrada en la figura de un solo profesional”. Se descubrió que la asistencia del equipo multidisciplinario apenas se nota por los usuarios, que reconocen a un solo profesional como responsable de la atención.Descriptores: Infecciones por VIH, Prestación de Atención de Salud, Grupo de Atención al Paciente, Integralidad en Salud.

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Background: Candidemia is a leading cause of bloodstream infections (BSIs), and community-onset candidemia is being recognized as a public health problem. In the era of electronic health records (EHRs), we can use machine learning to detect patterns in patient data that may predict infections. Objective: We aimed to predict community-onset candidemia in patients admitted to the University of Iowa Hospital & Clinics (UIHC) using machine-learning algorithms. Methods: We retrospectively reviewed data for patients admitted to UIHC during 2015–2018. All adult inpatients who had a requested blood culture were included. Candidemia was defined as a blood culture positive for Candida within 48 hours after admission. Variables of interest were extracted from the EHR: age, sex, body mass index, and month of admission. We also included comorbidities upon admission defined by the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM): cardiovascular diseases, neurological disorders, chronic pulmonary disease, dementia, rheumatoid disease, peptic ulcer disease, liver disease, diabetes mellitus, hypothyroidism, renal failure, coagulopathy, obesity, weight loss, fluid and electrolyte disorders, anemia, alcohol abuse, drug abuse, psychiatric diseases, malignancy, and HIV/AIDS. We calculated Charlson and Elixhauser scores based on ICD-10-CM codes. We also included prehospitalization conditions (90 days before admission): Candida-positive cultures from sites other than blood, antibiotics/antifungals, hemodialysis, central lines, corticosteroids, surgeries, and intensive care unit (ICU) admissions. Mode and median imputation were used for missing information. Random forests with resampled training sets were used for prediction, and results were evaluated using 10-fold cross validation. Results: In total, 30,528 adult admissions were extracted; 73 admissions had an episode of candidemia (<1%). Median admission age was 61 years, and nearly half of admissions were female patients (44.7%). Mean BMI was 27.67. The most admissions occurred during the months of March, August, and November. The 3 most common ICD-10-CM codes were diabetes mellitus, hypertension, and cancer. Median Charlson and Elixhauser scores were 1 and 2, respectively. The model used 103 variables. The 3 most predictive variables were Elixhauser score on admission, and characteristics in the 90 days prior to admission were Candida from sites other than blood, use of a central line, and recent use of antibiotics/antifungals. The model’s area under the receiver operating characteristic curve was 0.72. Conclusions: Preadmission patient characteristics predicted community-onset candidemia. Machine-learning models may help detect patients eligible for screening for candidemia and prompt empiric antifungal therapy in high-risk patients in the first 48 hours of their admission.Funding: NoneDisclosures: None

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Abstract Background Well-trained and dedicated personnel for infection care and prevention is essential for optimal care in pediatric oncology centers. Feedback from global collaborators consistently identifies education and training as a priority. We collaboratively designed and implemented a blended methodology training course focused on four essential themes: infectious complications in pediatric cancer; quality in infection care; quality in infection prevention; and, sustainability, research, and dissemination. Methods Using our team’s subject matter expertise and experience developing training materials, we designed the training seminar comprising two components: (1) an 8-week distance-learning segment delivered online through our free, education website (www.Cure4Kids.org) which focuses on building foundational knowledge in the identified essential themes of infection diseases; and, (2) a 2-week residential training seminar delivered face-to-face at St. Jude Children’s Hospital, which consolidates training through interactive lectures, workshops, clinical and research area tours, and research project presentations. Results The initial launch in 2017 trained 22 healthcare providers from 17 healthcare institutions in 10 countries. Knowledge gain from pretest to posttest for each module was significant (P &lt; 0.001). Satisfaction with course delivery was high; most participants (93–100%) found each module’s content relevant to their daily practice. For residential training, participants rated each day as either good (median: 10%; range: 5–25%) or outstanding (median: 90%; range: 75–95%). Individual research projects developed by course participants focused on bloodstream infections, febrile neutropenia, multi-drug-resistant organisms, fungal infections, hand hygiene, antibiotic prophylaxis, and infection prevention. After the course conclusion, nearly half (n = 9) implemented their project idea in their clinical practice or prepared it for submission as academic merit or to a scientific conference. Now in its fourth year, the course has also incorporated training in leadership and quality. As of December 2019, this Infectious Diseases Training Seminar has trained 145 participants from 102 institutions in 48 countries. Graduates of the course formed two professional networks, one in Latin America and another in the Asia Pacific region. Members of the network participate in local capacity building, research, quality improvement, and education in infection care and prevention. Conclusions The course has and continues to meet the verbalized need for education and training opportunities in infection care and prevention for the pediatric cancer patient population. Our experience models how targeted training efforts can strengthen the quality of the healthcare workforce for improving outcomes in pediatric cancer care globally.

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Aim. The article addresses the progress in elimination of mother-to-child transmission of HIV in the Russian Federation. The authors reviewed the available data on the current situation and identified opportunities to reduce the risk of mother-to-child transmission of HIV. Materials and methods. The basic HIV statistics for 2017 from the federal public health watchdog Rospotrebnadzor and the Russia's ministry of health were analysed. The findings included several important aspects. Results. In 2017, women constituted a substantial proportion of population living with HIV, both among all cases and among new HIV infections (37%-38%). The number of new HIV cases among women was growing every year and by 2017 increased 62% compared to 2010. In 28 regions of the Russian Federation, more than 1% of pregnant women were HIV positive. Across the whole monitoring period (from 1987), 177,663 pregnancies complicated by HIV infection and ended in delivery were registered in Russia by the end of 2017, including 14,969 such pregnancies in 2017 alone. In 2017, 91.0% of pregnant women living with HIV took ART during pregnancy, 94.7% received it in labour. 98.7% of new-borns were given antiretroviral therapy as prevention. However, a three-stage chemoprophylaxis was provided to only 89.1% of mother-child pairs. It was revealed that 1,635 motherchild pairs (10.9%) missed at least one of prevention stages. The main reason for incomplete prevention was the late diagnosis of HIV infection in mothers. The viral load before delivery was not suppressed in 25.8% of HIV-positive pregnant women whose pregnancies were completed in 2017 (2,527 women were tested for viral load and 1,342 did not take antiretroviral drugs during pregnancy). 708 children born to HIV-positive mothers were diagnosed HIV positive in 2017 of whom, however, only 235 were born that year. Calculations showed that in 2017 the risk of vertical HIV transmission amounted to 2.3%, which were 348 new-born babies. A significant number of children (35,579 born in different years) did not undergo a final HIV test. 3.9% of all HIV-infected children born to HIV-positive women had contracted HIV through breastfeeding. There was also a trend towards increasing the number of HIV transmissions this way. The article reveals that in the cohort of children born women, the death rate is higher. So in 2017 mortality among infants born to HIV-positive mothers was 1.5 times higher, while perinatal mortality was twice as high as in the general population. Conclusion. The study showed that in order to improve the situation concerning vertical transmission of HIV, it is necessary to solve a number of tasks related to low threshold programmes aimed at access to surveillance, treatment and retention in care for women, especially those of at-risk of HIV. The ways to achieve the goal are early infant HIV diagnosis in first two months of new-borns' life, urgent final laboratory examination of older children exposed to HIV at birth, determination and elimination of factors leading to increased infant mortality, breast-feeding counselling, as well as improvements in statistical methods.

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Learning outcomes For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector. Case overview/synopsis South Africa’s primary health outcomes do not correspond to the country’s spending on public health, with South Africa ranking among the worst globally in the incidence of tuberculosis, HIV prevalence, infant mortality and life expectancy. In part, this poor outcome can be explained by high inequality in access to healthcare, which reflects South Africa’s grossly skewed income and wealth distributions, with the bulk of the country’s population reliant upon an underfunded, inefficient and poorly managed public health system. This substandard service for the working poor in South Africa’s townships with high population densities offered a profitable entrepreneurial opportunity to provide affordable and effective primary care with vast gains in quality and outcomes improved dignity for patients. After receiving her MBA, physician and entrepreneur Dr Nthabiseng Legoete self-funded the launch of Quali Health in 2017. The business model set out to disrupt healthcare delivery for South Africa’s poorest citizens. Drawing patients from the working poor in Diepsloot, Quali Health’s inaugural site was cash flow positive within five months when the facility hit only 30% of installed service capacity. With quick success, Dr Legoete faced the strategic question of how fast to scale and finance the expansion. She also considered a new micro-insurance product for her clientele. Complexity academic level For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector. Supplementary materials Teaching notes are available for educators only. Subject code CSS: 3 Entrepreneurship.

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Background Young men who have sex with men have a high HIV incidence, and a substantial proportion of incident infections occur in the context of main partnerships. However, romantic relationships also provide numerous benefits to individual health and wellbeing. 2GETHER is a relationship education and HIV prevention program for young male couples, and the 2GETHER USA randomized controlled trial (RCT) was launched to establish the efficacy of an online version of 2GETHER. Objective The objective of 2GETHER is to optimize relationship functioning in young male couples as a method to improve communication about sexual risk behaviors and reduce HIV transmission. In the 2GETHER USA study, 2GETHER was adapted for online administration to couples across the United States via videoconferencing. The intervention in question aims to address the unique needs of couples from varied racial/ethnic backgrounds and geographic regions. Methods This is a comparative effectiveness RCT of 2GETHER USA relative to existing public health practice (control). 2GETHER USA is a hybrid group- and individual-level intervention that delivers three weekly online group discussion sessions for skills delivery, followed by two individualized couple sessions that focus on skills implementation in each couple. The control condition differs by participant HIV status: (1) the Testing Together protocol for concordant HIV-negative couples; (2) medication adherence and risk reduction counseling for concordant HIV-positive couples; or (3) both protocols for serodiscordant couples. Follow-up assessments are delivered at 3-, 6-, 9-, and 12-months post-intervention in both conditions. Testing for rectal and urethral Chlamydia and Gonorrhea occurs at baseline and 12-month follow-up. The primary behavioral outcome is condomless anal sex with serodiscordant serious partners or any casual partners. The primary biomedical outcome is sexually transmitted infection incidence at a 12-month follow-up. Results As of October 11, 2019, the trial has enrolled and randomized 140 dyads (Individual N=280). Enrollment will continue until we randomize 200 dyads (N=400). Assessment of intervention outcomes at 3-, 6-, 9-, and 12-months is ongoing. Conclusions 2GETHER is innovative in that it integrates relationship education and HIV prevention for optimizing the health and wellbeing of young male couples. The 2GETHER USA online adaptation has the potential to reach couples across the United States and reduce barriers to accessing health care services that are affirming of sexual minority identities for those who live in rural or under-resourced areas. Trial Registration ClinicalTrials.gov NCT03284541; https://clinicaltrials.gov/ct2/show/NCT03284541 International Registered Report Identifier (IRRID) DERR1-10.2196/15883

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Background Men who have sex with men (MSM), including both gay and bisexual men, have a high prevalence of HIV and sexually transmitted infections (STIs) in China. However, healthcare seeking behaviors and engagement in clinical services among MSM are often suboptimal. Global evidence shows that embedding online HIV or sexual health services into gay social networking applications holds promise for facilitating higher rates of healthcare utilization among MSM. We developed a prototype of a gay-friendly health services platform, designed for integration within a popular gay social networking app (Blued) in China. Objective The purpose of this study was to evaluate the acceptability of the platform and ask for user feedback through focus group interviews with young MSM in Guangzhou and Shenzhen, cities in Southern China. Methods The prototype was developed through an open, national crowdsourcing contest. Open crowdsourcing contests solicit community input on a topic in order to identify potential improvements and implement creative solutions. The prototype included a local, gay-friendly, STI physician finder tool and online psychological consulting services. Semistructured focus group discussions were conducted with MSM to ask for their feedback on the platform, and a short survey was administered following discussions. Thematic analysis was used to analyze the data in NVivo, and we developed a codebook based on the first interview. Double coding was conducted, and discrepancies were discussed with a third individual until consensus was reached. We then carried out descriptive analysis of the survey data. Results A total of 34 participants attended four focus group discussions. The mean age was 27.3 years old (SD 4.6). A total of 32 (94%) participants obtained at least university education, and 29 (85%) men had seen a doctor at least once before. Our survey results showed that 24 (71%) participants had interest in using the online health services platform and 25 (74%) thought that the system was easy to use. Qualitative data also revealed that there was a high demand for gay-friendly healthcare services which could help with care seeking. Men felt that the platform could bridge gaps in the existing HIV or STI service delivery system, specifically by identifying local gay-friendly physicians and counselors, providing access to online physician consultation and psychological counseling services, creating space for peer support, and distributing pre-exposure prophylaxis and sexual health education. Conclusions Crowdsourcing can help develop a community-centered online platform linking MSM to local gay-friendly HIV or STI services. Further research on developing social media–based platforms for MSM and evaluating the effectiveness of such platforms may be useful for improving sexual health outcomes.

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Abstract Background Pregnant people who inject drugs (PWID) and their infants are unique populations that have emerged from the opioid epidemic. Numerous studies have evaluated vertical transmission of HIV, HCV, sequelae of neonatal abstinence syndrome, and maternal and fetal mortality in these mother-infant dyads; however there still remains a large knowledge gap regarding how serious infections in pregnant PWID affect more proximal outcomes such as fetal and maternal distress leading to preterm delivery, risk of neonatal sepsis, need for invasive diagnostic procedures to rule-out neonatal sepsis such as lumbar puncture, neonatal intensive care unit (NICU) admission, and potential consequences of prolonged intrauterine antibiotic exposure. Methods We identified pregnant PWID ≥18 years old with serious infectious complications (defined as (sepsis, endocarditis, osteomyelitis, epidural abscesses, septic arthritis/bursitis, thrombophlebitis, and skin and soft tissue infections requiring IV antibiotics) admitted between 2017–2018 to the University of Kentucky Medical Center and their neonates treated at Kentucky Children’s Hospital. Patients were identified using positive urine or serum pregnancy test results, IVDU-associated ICD9/10 codes, infectious disease, neonatology, and obstetrics notes. Results 261 women with infectious complications from IVDU were identified, 25 were pregnant and 16 dyads were able to be matched with identification of 14 viable neonates born at the University of Kentucky. Mean maternal age was 31 years and median 30 years. Mean gestational age (GA) at time of admission was 25 weeks with median 29 weeks. Sepsis was the most common complication reported 18 (72%) followed by endocarditis 11 (44%). Staphylococcus aureus was the most isolated organism (16) 64% with 12 (48%) of isolates identified as MRSA and MSSA comprising 4 (16%). 96% were screened for HCV, with 72% HCV antibody positive and 32% with detectable viral load. There was 1 reported maternal death, 1 spontaneous abortion and 2 intrauterine fetal demises (IUFD) in the 3rd trimester and no neonatal deaths. Average GA at time of delivery was 33 weeks with median 36 weeks. 6 (42%) were routine deliveries with 3 (22%) deliveries for emergent maternal indications and 5 emergent deliveries for fetal indications (36%). 12 neonates (86%) required NICU admission with average length of stay 17 days and median 10 days. 10 (71%) underwent limited sepsis screen with 9 (64%) receiving at least 48 hours of antibiotics and 3 (22%) receiving an extended course. However none of the blood cultures yielded any organisms. All passed their hearing screening and had no evidence of renal dysfunction or cytopenias. Conclusions Pregnant PWID dyads may be at increased risk for morbidity and mortality secondary to infectious complications of IVDU. The majority of neonates were delivered early for either fetal distress or maternal distress. 2 mothers suffered IUFD in the 3rd trimester and the majority of the neonates required NICU admission (86%) due to prematurity-related factors, concern for neonatal abstinence syndrome or concern for infectious complications. Over half received 48+ hours of antibiotics in the NICU however none of the neonatal blood cultures yielded an organism. Larger cohort studies are needed to better ascertain risk in these expanding populations.

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Approximately 85% of tuberculosis (TB) related deaths occur in low- and middle-income countries where health resources are scarce. Effective priority setting is required to maximise the impact of limited budgets. The Optima TB tool has been developed to support analytical capacity and inform evidence-based priority setting processes for TB health benefits package design. This paper outlines the Optima TB framework and how it was applied in Belarus, an upper-middle income country in Eastern Europe with a relatively high burden of TB. Optima TB is a population-based disease transmission model, with programmatic cost functions and an optimisation algorithm. Modelled populations include age-differentiated general populations and higher-risk populations such as people living with HIV. Populations and prospective interventions are defined in consultation with local stakeholders. In partnership with the latter, demographic, epidemiological, programmatic, as well as cost and spending data for these populations and interventions are then collated. An optimisation analysis of TB spending was conducted in Belarus, using program objectives and constraints defined in collaboration with local stakeholders, which included experts, decision makers, funders and organisations involved in service delivery, support and technical assistance. These analyses show that it is possible to improve health impact by redistributing current TB spending in Belarus. Specifically, shifting funding from inpatient- to outpatient-focused care models, and from mass screening to active case finding strategies, could reduce TB prevalence and mortality by up to 45% and 50%, respectively, by 2035. In addition, an optimised allocation of TB spending could lead to a reduction in drug-resistant TB infections by 40% over this period. This would support progress towards national TB targets without additional financial resources. The case study in Belarus demonstrates how reallocations of spending across existing and new interventions could have a substantial impact on TB outcomes. This highlights the potential for Optima TB and similar modelling tools to support evidence-based priority setting.