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Does washing insecticide-treated nets 20 times for experimental hut evaluations provide a suitable proxy for their end-of-life performance under household conditions?
Get PDFBACKGROUND: Insecticide-treated nets (ITNs) are washed 20 times as part of experimental hut trials to simulate the loss of active ingredient (AI) occurring over their intended 3-year lifespan and estimate insecticidal durability. The ability of the 20-wash method to predict the end-of-life performance of ITNs has not been empirically validated. METHODS: We performed an experimental hut trial to compare the efficacy of new ITNs unwashed and washed 20 times to field-aged ITNs withdrawn from households 3 years post-distribution against a pyrethroid-resistant vector population in Covè, Benin. Four products from pyrethroid-only (Interceptor®), pyrethroid-piperonyl butoxide (PermaNet® 3.0), pyrethroid-pyriproxyfen (Royal Guard®) and pyrethroid-chlorfenapyr (Interceptor® G2) ITN types were tested. Net pieces were tested in bioassays and sent for chemical analysis to assess differences in surface AI bioavailability and total chemical content between washed and field-aged nets. Susceptibility bioassays were also performed to assess insecticide resistance in the Covè vector population. RESULTS: Mosquito mortality in experimental huts was similar or slightly higher with field-aged nets than washed nets with Interceptor® (11% vs. 10%, p = 0.339, OR = 1.19, 95% CIs [0.84, 1.69]), PermaNet® 3.0 (12% vs. 18%, p < 0.001, OR = 1.78, 95% CIs [1.34, 2.38]) and Royal Guard® (9% vs. 14%, p = 0.076, OR = 1.33, 95% CIs: [0.97, 1.83]). Likewise, field-aged Royal Guard® induced a similar reduction in fertility to washed Royal Guard® (22% vs. 29%, p = 0.066). In contrast, mortality was significantly lower with field-aged nets Interceptor® G2 compared to washed nets (54% vs. 19%, p < 0.001, OR = 0.18, 95% CIs [0.14, 0.24]). Blood-feeding inhibition was higher with field-aged nets than washed nets across all ITN types. Retention of non-pyrethroid AIs was lower than for the pyrethroid, particularly with field-aged nets (PermaNet® 3.0 (roof): 25% vs. 68%, p < 0.001, Royal Guard®: 27% vs. 53%, p < 0.001, Interceptor® G2: 14% vs. 39%, p < 0.001). CONCLUSIONS: In this setting, the 20-wash method provided a suitable proxy for the end-of-life killing and sterilising performance of Interceptor®, PermaNet® 3.0 and Royal Guard® in experimental huts. In contrast, washing overestimated the end-of-life performance of Interceptor® G2 for mortality and underestimated the personal protection of all field-aged ITNs
Risk of hepatocellular carcinoma after direct-acting antiviral treatment for hepatitis C virus infection in people with HIV
Get PDFBACKGROUND: To inform hepatocellular carcinoma (HCC) surveillance after hepatitis C virus (HCV) cure with direct-acting antivirals (DAA), we estimated HCC risk post-DAA in people with HIV with advanced liver fibrosis or cirrhosis under universal DAA.
METHODS: We used data from HepCAUSAL, a collaboration of cohorts of HIV-HCV co-infection from Europe and North America. Eligibility criteria were HIV-HCV co-infection, advanced liver fibrosis or cirrhosis, DAA naïve, HIV-RNA<50 copies/mL, on antiretroviral therapy, no HBV co-infection, no prior HCC diagnosis or liver transplant. Follow-up started when eligibility was met and ended at HCC diagnosis, death, loss to follow-up, six years, or database closure, whichever came first. We estimated the 6-year risk and annual probability of HCC if all eligible individuals had initiated DAA at baseline using a weighted pooled logistic model for the monthly HCC risk among DAA initiators.
RESULTS: Of 3,824 eligible individuals (92% males, median age 60 years [IQR: 54,64]), 2,373 (62%) who initiated DAA, 43 had an HCC diagnosis during follow-up. The estimated 6-year HCC risk (95% CI) under universal DAA was 2.5% (1.6,3.9). Annual HCC probability was: 0.81% (0.34,1.54) between baseline and month 12 after DAA initiation, 0.64% (0.28,1.19) between year 1-2, 0.50% (0.27,0.84) between year 2-3, 0.34% (0.13,0.63) between year 3-4, 0.19% (0.07,0.33) between year 4-5, and 0.10% (0.01,0.24) between year 5-6.
CONCLUSION: An estimated 2.5% of people with HIV and advanced liver fibrosis or cirrhosis are diagnosed with HCC by 6 years post-DAA. Annual probability of HCC declines over time and falls below 0.4% after 3 years
Institutionalising community participation in decision-making in maternal and newborn health services in low-and middle-income countries: An analysis from 102 national health ministries.
Get PDFIn 2024, 194 countries endorsed World Health Assembly Resolution (WHA77.2) to strengthen participation in health-related decision-making. Achieving this requires strong leadership to institutionalise community participation by embedding it into health system functions. However, efforts are often fragmented and short-term, hindering both sustainability and scalability. There is limited understanding of how well countries have institutionalised community participation in decision-making for quality maternal and newborn health services. A secondary analysis of maternal and newborn health survey data was conducted using responses from 102 Ministries of Health in low-and middle-income countries. The analysis assessed progress in adopting and implementing maternal and newborn health recommendations on community participation. A descriptive approach was used to summarise the frequency of reported community participation activities. Percentages were applied to describe the data, which was disaggregated by 2024-2025 World Bank classifications for income level, and fragile and conflict-affected settings. Country responses were categorised using Lasswell's Policy Cycle heuristic. The findings indicate substantial gaps in institutionalising community participation in maternal and newborn health. Only half of countries reported integrating participation into national plans, and just one-third into implementation. In 90% of countries, parent groups were reported to be either absent or lacking influence on policymaking. National research on community participation, essential for evidence-based decision-making, was rarely reported. Across all regions, countries had varied progress, reflecting a diverse and uneven landscape of community participation. Stronger efforts are required to institutionalise community participation across the maternal and newborn health policy cycle. Strengthening this integration will require clear metrics to track implementation, enabling more accurate assessments of progress and accountability. Identifying countries where institutionalisation is advancing can surface positive deviance cases. Studying these in-depth may reveal drivers and effective strategies for fostering community participation to guide the adaption and integration of successful approaches into national health systems
'I Think From the Beginning, the Ambitions Were Compromised': A Case Study of COVAX as Vaccine Equity Policy Operationalisation.
Get PDFBACKGROUND: COVAX was designed to support the discovery, development, and distribution of COVID-19 vaccines globally, at scale and pace. This article examines how COVAX promoted vaccine equity and what lessons can be learnt. METHODS: Informed by a scoping review of lessons learnt from GHPs, we reviewed 109 documents related to COVAX and other GHPs and conducted 23 key informant interviews with representatives from GHPs, civil society, academia, and the private sector. Data were synthesised thematically using Rushton and Williams's framework. RESULTS: Data showed how the global health policy context shaped COVAX, with experience with Gavi and CEPI influencing its governance structure. We highlighted weaknesses in transparency and accountability, limited engagement with civil society organisations [CSO] and LMIC stakeholders, contested policy debates (e.g., different framing) and paradigms (e.g., prioritising technical and financial over political solutions). CONCLUSIONS: COVAX largely replicated existing GHP approaches, subsidising research and development and then paying for resulting discoveries. While recognising how this reflects global power structures, in the inevitable next global health crisis, the international health community must advocate for greater LMIC and CSO involvement in decision-making, sharing of intellectual property and technology transfer, and rebalancing of flows of innovation costs and benefits to a broader range of actors across public and private sectors
Unmet healthcare needs, out-of-pocket payments and catastrophic health expenditures among hypertensive adults in Bangladesh.
Get PDFBACKGROUND: This study aims to examine unmet healthcare needs and the burden of out-of-pocket (OOP) payments in Bangladesh among hypertensive adults using the most recent survey data. METHODS: A total of 5086 hypertensive patients aged 18 to 80 were recruited from 75 pharmacies in Bangladesh in 2023, 35 being located in urban areas and 40 in rural areas. Unmet healthcare needs was the primary outcome variable, while the incidence of catastrophic health expenditures (CHE) was the secondary outcome variable. A multilevel logistic regression model was performed to identify factors associated with unmet healthcare needs and CHE. A multilevel Tobit regression model was used to identify the determinants of OOP health expenditures. RESULTS: The study indicated that the prevalence of unmet healthcare needs among hypertensive adults was around 26% and incidence of CHE was 46% at 10% threshold of total consumption in Bangladesh. The most common reason for unmet healthcare needs was affordability, long waiting times, lack of availability, and transportation issues etc. Unmet healthcare needs were more prevalent among men, individuals with no education, divorced/separated, non-Muslims and poor population. Regression models suggested that older people, men, those with higher education, Muslim, married people, larger household, overweight and obese people, and rural residents were more likely to burden of OOP expenses. CONCLUSIONS: High unmet needs and CHE prevalence in Bangladesh reveal inadequate health risk protection. Prioritizing affordability, addressing disparities, and strengthening financial risk protection can improve access and outcomes for hypertensive adults
Delivering high-quality biometry in low-resource settings: a practical guide
Get PDFAccurate biometry is possible in any setting when a small, well-trained team follows a standardised protocol, audits its results, and keeps its equipment calibrated and well maintained
Closing the gap: New report estimates the resources required to eliminate trachoma
Get PDFInvestment will lift the social and financial burden of trachoma
Remote cognitive tests predict neurodegenerative biomarkers in the Insight 46 cohort.
Get PDFBACKGROUND: Alzheimer's disease-related biomarkers detect pathology years before symptoms emerge, when disease-modifying therapies might be most beneficial. Remote cognitive testing provides a means of assessing early cognitive changes. We explored the relationship between neurodegenerative biomarkers and cognition in cognitively normal individuals. METHODS: We remotely deployed 13 computerized Cognitron tasks in 255 Insight 46 participants. We generated amyloid load and positivity, white matter hyperintensity volume (WMHV), whole brain and hippocampal volumes at age 73, plus rates of change over 2 years. We examined the relationship between Cognitron, biomarkers, and standard neuropsychological tests. RESULTS: Slower response time on a delayed recognition task predicted amyloid positivity (odds ratio [OR] = 1.79, confidence interval [CI]: 1.15, 2.95), and WMHV (1.23, CI: 1.00, 1.56). Brain and hippocampal atrophy rates correlated with poorer visuospatial performance (b = -0.42, CI: -0.80, -0.05) and accuracy on immediate recognition (b = -0.01, CI: -0.012, -0.001), respectively. Standard tests correlated with Cognitron composites (rho = 0.50, p < 0.001). DISCUSSION: Remote computerized testing correlates with standard supervised assessments and holds potential for studying early cognitive changes associated with neurodegeneration. HIGHLIGHTS: 70% of the Online 46 cohort performed a set of remote online cognitive tasks. Response time and accuracy on a memory task predicted amyloid status and load (SUVR). Accuracy on memory and spatial span tasks correlated with longitudinal atrophy rate. The Cognitron tasks correlated with standard supervised cognitive tests. Online cognitive testing can help identify early AD-related memory deficits
Mixed-methods study to develop extensions to the SPIRIT and CONSORT statements for factorial randomised trials: the Reporting Factorial Trials (RAFT) study.
Get PDFBACKGROUND: Extensions to Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and Consolidated Standards of Reporting Trials (CONSORT) reporting recommendations specifically for factorial trials have been developed by the Reporting Factorial Trials (RAFT) study group. This article describes the processes and methods used to develop the extensions. OBJECTIVE: To develop SPIRIT and CONSORT extensions for factorial trials. DESIGN AND PARTICIPANTS: A four-phase, consensus-based approach was used: phase 1: scoping review, phase 2: Delphi survey (n=104 respondents in round 1), phase 3: consensus meeting (n=15 members) and phase 4: checklist finalisation. RESULTS: In phase 1, the scoping review identified 31 reporting recommendations, which formed a long list of 50 concepts (19 applied to the SPIRIT extension and 31 applied to the CONSORT extension) to include in the guideline development. In phase 2, a three-round Delphi survey resulted in two new concepts being added and ended with 49 concepts (19 applied to SPIRIT and 30 applied to CONSORT) reaching consensus to remain, with only three concepts meeting the exclusion criteria. In phase 3, the concepts were further refined and translated into specific extension item wording, through an extensive review process conducted by the core RAFT team and leading trial experts, who attended a 2-day hybrid meeting. The resulting 9 SPIRIT items and 17 CONSORT items were further evaluated and developed through an iterative process in phase 4, to promote user acceptance and uptake. CONCLUSION: Uptake of the CONSORT and SPIRIT extensions will improve the conduct of factorial trials, as well as understanding and interpretation of such trials. By reporting on how these extensions were developed, we promote transparency of this process and share learning experiences to develop best practice when developing reporting guidelines
Specimen and data sharing to advance research and development on Zika virus.
Get PDFFor diseases with epidemic potential, specimen and data sharing is crucial for sustained research and development of medical countermeasures such as diagnostics, therapeutics, and vaccines. In the case of Zika virus, although a global framework for specimen and data sharing to advance research and development is highly desirable, challenges related to legal, ethical, and intellectual property issues persist. Since the 2015-16 Zika virus outbreak, regional laboratory networks and research partnerships have made some progress in specimen and data sharing among some Zika virus-endemic countries. Pragmatic steps such as securing funds for augmenting laboratory capacity, building biobanks within public health laboratory infrastructures in low-income and middle-income countries, clearly defining the specimens and data that need to be collected, developing standardised protocols, harmonising data system interoperability to facilitate sharing, and defining mechanisms for benefit sharing will pave the way for timely development and deployment of medical countermeasures in public health emergencies