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Advances in HIV Treatment and Vaccine Development: Emerging Therapies and Breakthrough Strategies for Long-Term Control.
Get PDFSince its identification in 1981, HIV has posed a global public health challenge, witnessing transformative advancements in treatment and prevention. This review summarizes recent novel therapeutic and preventive approaches for long-term HIV control, management, and elimination, and how global collaboration and technological innovations may advance HIV control efforts. This study highlights the progress and challenges in HIV treatment, emphasizing the effectiveness of current antiretroviral therapy (ART) in suppressing viral replication, reducing transmission, and preventing end-organ damage. However, adherence remains a significant barrier due to pill burden, side effects, and psychosocial factors affecting patients. ART-related toxicities include neuropathy, hepatotoxicity, metabolic disorders, and neuropsychiatric effects. Long-acting ART (LA-ART) offers a promising alternative to daily dosing; however, challenges such as injection site reactions persist. Broadly neutralizing antibodies (bNAbs) have shown enhanced efficacy in viral suppression and immune response activation, offering potential for treatment and vaccine design. Innovative gene-editing tools, such as CRISPR-Cas systems, are being explored for their ability to excise or silence proviral DNA; however, their clinical application is limited by off-target effects and delivery challenges. Latency-targeting strategies like "shock and kill" and "block and lock" remain experimental with limited clinical success, and nanotechnology-based drug delivery systems offer targeted, sustained, and less toxic treatment options. Despite the challenges posed by the virus's rapid mutation rate and immune evasion mechanisms, novel vaccine approaches, such as mRNA technology, vector-based platforms, and epitope-targeting strategies, are being explored. In addition, artificial intelligence and machine learning are enhancing the design of vaccines, predictive modeling, and fast-tracking progress in this area. Socio-economic bottlenecks in HIV control, such as stigma, gender disparities, and inequitable healthcare access, exacerbate the epidemic, particularly in sub-Saharan Africa. Enhancing global collaboration, providing sustainable funding, and integrating emerging and innovative technologies are critical for advancing HIV prevention and management. Achieving an AIDS-free generation and ultimately eliminating the epidemic will depend on effectively addressing the social, structural, and scientific barriers that hinder progress in this regard.
Trial Registration: ClinicalTrials.gov identifier: NCT02120352, NCT02938520, NCT03639311, NCT03497676, NCT03635788
A qualitative process evaluation of group problem management plus for distressed Syrian refugees in Türkiye.
Get PDFSyrian refugees in Türkiye show a high prevalence of mental health problems but encounter barriers to accessing mental health services. Group Problem Management Plus (gPM+), developed by the World Health Organization, is a low-intensity psychological intervention delivered by nonspecialist facilitators. This qualitative process evaluation explores the acceptability, feasibility and perceived effectiveness of gPM+ for Syrian refugees resettled in Türkiye, as well as facilitating factors and barriers to its implementation. Twenty-three semi-structured interviews were conducted with gPM+ participants, facilitators, drop-outs, relatives of participants and key informants. Findings showed that gPM+ was well-received for its group-based format, which participants felt fostered social support, and for its content, which they reported may have led to improvements in coping skills and family relationships. Facilitators viewed the intervention as feasible to implement. However, barriers such as participants' economic struggles, practical challenges (e.g., childcare and transportation difficulties) and low mental health literacy impeded engagement. Adapting gPM+ to address social determinants like poverty may be beneficial. The need for booster sessions was emphasized to maintain long-term change and provide deeper learning of the strategies. For sustainable scaling up gPM+ within primary health care, key informants highlighted the importance of training and supervising nonprofessional facilitators and securing governmental support
Broiler farming and antibiotic use through an agency theory lens. A case study from West Bengal, India.
Get PDFChicken meat (broiler) production is a rapidly growing livestock sector in India, and one dominated by contract farming. Studies have reported high levels of antibiotic use in Indian broiler farms which is concerning given this is one of the driving forces for the development of antibiotic resistance. This study used the economic lens of agency theory to examine strategic decisions which occur during contract broiler production and their potential impact on antibiotic use, using West Bengal as a case study. Agency theory focuses on the informational asymmetry and opportunism between service providers and seekers and the subsequent agency cost needed to avoid aberrant outcomes. Interviews were conducted with key informants (n = 6) and stakeholders (n = 20) associated with broiler production, and broiler farmers (17 contract and four non-contract), using online and face-to-face interviews. Data were analysed descriptively using manifest content analysis and interpretatively using reflexive thematic analysis. Contract farming in West Bengal exists within a series of inter-dependent relationships, many of which contain information asymmetry and can be subject to opportunism. Positioning contract companies as principals seeking labour from agents, we see how out-sourcing of production to distal farms led to antibiotics being used as a risk mitigation strategy. This was further compounded by concerns about the Mycoplasma status of breeding stock, and a perception that broiler day old chicks were infected, resulting in use of antibiotics belonging to classes deemed critically important for human health. While antibiotic use decisions were predominately made by contract companies, they were dependent on the decisions farmers and breeding companies made concerning biosecurity and production practices. In turn, farmers' decisions were shaped by factors such as access to financial and social capital. Thus, efforts to reduce antibiotic use in West Bengal's broilers must not just focus on changing the prescribing behavior of individuals but more broadly consider the environment within which contracting exists
Controversies, Consensuses, and Guidelines on Preventing, Diagnosing and Managing Acute-onset Bacterial Endophthalmitis after Cataract Surgery by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), the Asia-Pacific Vitreo-retina Society (APVRS), and the Asia-Pacific Society of Ocular Inflammation and Infection (APSOII).
Get PDFBACKGROUND: Postcataract surgery endophthalmitis is a serious but largely preventable clinical entity. The implementation of uniform preoperative, intraoperative, and postoperative protocols is essential to reduce its incidence. METHODS: In light of emerging evidence and considerable variability in clinical practices, a panel of international experts from the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), the Asia-Pacific Vitreo-retina Society (APVRS), and the Asia-Pacific Society of Ocular Inflammation and Infection (APSOII) convened to develop evidence-based guidelines addressing all phases of cataract surgery. This consensus manuscript is the product of a systematic review of the current literature, informed by the collective experience and expertise of the panel members. The panel engaged in structured discussions, critical evaluation of clinical data, and formal voting to establish agreement across three key domains: (1) preoperative and intraoperative prophylactic strategies, (2) diagnostic approaches for early postoperative acute bacterial endophthalmitis, and (3) standardized management protocols. Voting on each proposed statement was conducted using a 5-point Likert scale (strongly agree, agree, neutral, disagree, strongly disagree). Consensus was defined as ≥75% of experts voting either "strongly agree" or "agree." RESULTS: A total of 45 consensus statements were evaluated, of which 21 (46.6%) achieved the predefined level of consensus. CONCLUSIONS: This document aims to establish standardized guidelines to improve cataract surgery outcomes by minimizing the risk of postoperative endophthalmitis. For areas where consensus was not achieved, the panel recommends further investigation and continued research to guide future updates to clinical practice
The overlapping global distribution of dengue, chikungunya, Zika and yellow fever.
Get PDFArboviruses transmitted mainly by Aedes (Stegomyia) aegypti and Ae. albopictus, including dengue, chikungunya, and Zika viruses, and yellow fever virus in urban settings, pose an escalating global threat. Existing risk maps, often hampered by surveillance biases, may underestimate or misrepresent the true distribution of these diseases and do not incorporate epidemiological similarities despite shared vector species. We address this by generating new global environmental suitability maps for Aedes-borne arboviruses using a multi-disease ecological niche model with a nested surveillance model fit to a dataset of over 21,000 occurrence points. This reveals a convergence in suitability around a common global distribution with recent spread of chikungunya and Zika closely aligning with areas suitable for dengue. We estimate that 5.66 (95% confidence interval 5.64-5.68) billion people live in areas suitable for dengue, chikungunya and Zika and 1.54 (1.53-1.54) billion people for yellow fever. We find large national and subnational differences in surveillance capabilities with higher income more accessible areas more likely to detect, diagnose and report viral diseases, which may have led to overestimation of risk in the United States and Europe. When combined with estimates of uncertainty, these suitability maps can be used by ministries of health to target limited surveillance and intervention resources in new strategies against these emerging threats
Effects of community-based rehabilitation on caregivers of people with schizophrenia in Ethiopia in the RISE trial.
Get PDFBACKGROUND: Schizophrenia is a severe mental health condition with high impact on those affected and their families. Community-based rehabilitation (CBR) is a recommended treatment component for schizophrenia in low- and middle-income countries (LMIC), as it seeks to address complex social, health and economic needs. There is little evidence on the effects of CBR on caregivers of people with schizophrenia. RISE, conducted in Ethiopia, was the first randomised controlled trial of CBR for schizophrenia in a low-income country. In this paper, we extend our previous examination of caregiver impact by (1) investigating the impact of CBR on caregiver stigma and burden, (2) assessing effect modification of outcomes, and (3) determining predictors of caregiver outcomes at 12 months. METHODS: Data are from the cluster-randomised controlled RISE trial, which investigated CBR and facility-based care versus facility-based care alone among 166 people with schizophrenia and 166 linked caregivers in 48 sub-districts in Ethiopia. We analyse the effect of CBR on caregiver stigma, unemployment and burden measured with the WHO Family Interview Schedule-Impact at 6 and 12 months; and caregiver depression, reduction in work due to caregiving and caregiver burden measured with the Involvement Evaluation Questionnaire at 6 months. Logistic and linear regression models adjusted for clustering by sub-district and health centre were used for binary and continuous outcomes respectively. Effect modification by caregiver sex, age, baseline of the outcome, and baseline disability were assessed. Baseline factors associated with caregiver outcomes across the whole cohort at 12 months were investigated using hierarchal regression modelling. RESULTS: Data were available for 112 caregivers at 6 months (67%), and 149 caregivers at 12 months (90%). There was evidence that CBR was associated with greater tendency to reduce work due to caregiving at 6 months (OR:2.40, 95%CI:1.06-5.45). No evidence of an intervention effect was found on unemployment, depression, stigma or other aspects of caregiver burden. There was no evidence for effect modification. Higher baseline disability was independently associated with greater caregiving burden at 12 months (β:0.26, 95%CI:0.14-0.37). CONCLUSIONS: There appeared to be no positive intervention effect of CBR on caregiver stigma, unemployment and burden in this analysis. Improving the outcomes of caregivers of people with schizophrenia in LMIC requires interventions and research addressing the needs of caregivers, for instance by integrating social and livelihoods interventions. TRIAL REGISTRATION: Clinical Trials.gov Identifier NCT02160249. Registered on 3 June 2014
A Multi-Valent Hantavirus Vaccine Based on Recombinant Modified Vaccinia Ankara Reduces Viral Load in a Mouse Infection Model
Get PDFBackground: Old World orthohantaviruses are the aetiological agent of Haemorrhagic Fever with Renal Syndrome (HFRS) disease. Worldwide, the two most prominent pathogens of HFRS are Seoul orthohantavirus (SEOV) and Hantaan orthohantavirus (HTNV). There is currently no specific treatment nor widely licensed vaccine form hantaviruses. Methods: This study developed a virus-vectored vaccine approach using modified vaccinia Ankara (MVA) incorporating a SEOV-HTNV chimeric nucleoprotein antigen. Results: The vaccine demonstrated the induction of humoral and cellular immunity. In the absence of a disease model, a reduction in the viral load of a susceptible mouse strain with type-I interferon receptor deficiency (A129) was used to ascertain protective effects after challenge with SEOV. Results demonstrated a significant reduction in and/or clearance of viral RNA in immunised animals. Conclusions: An MVA viral vector vaccine incorporating the nucleoprotein as antigen offers a promising approach for Hantavirus vaccine development
Participant experiences with Supporting Addiction Affected Families Effectively (SAFE): a qualitative study of the 5-Step method in Goa, India
Get PDFBackground: Harmful use of alcohol has demonstrated negative effects on not only the individual engaging in the use, but also their family members. The Supporting Addiction Affected Families Effectively (SAFE) Project aimed to systematically adapt the 5-Step Method, an existing evidence-based intervention intended to support affected family members (AFMs) by focusing on their concerns, coping responses, social supports, to the Indian context with delivery by lay counsellors. The aim of this study was to examine AFM experiences with the SAFE intervention to understand its acceptability in this context as well as how AFMs perceived the impact of the intervention on their lives. Methods: We conducted in-depth interviews with 30 adult family members affected by their relative’s problematic drinking who had received the SAFE intervention. We applied an interpretivist theoretical framework to the analysis and used thematic analysis to synthesize the data. Results: The participants largely reported positive interactions with the counsellors delivering the intervention, appreciated the flexibility of scheduling the sessions according to their availability, and approved of the content of the sessions. Many participants reported a positive impact of the intervention citing feelings of relief, reduced fights as a result of new coping strategies, increased social support, and reduced stress. However, some AFMs reported little or no benefit, citing a lack of changes in their relative’s drinking behaviours, a lack of adequate external support, or the experience ongoing domestic violence, or a combination of these factors. Conclusion: While there was evidence of intervention acceptability, SAFE will require further contextually-informed adaptations to enhance its relevance and make it responsive to the contextual reality to have sustained impact for AFMs in this setting
"I just wanted to be like everyone else…": Qualitative exploration of women's perspectives on female genital mutilation/cutting and its potential abandonment in Somalia.
Get PDFSomalia has the highest estimated prevalence of female genital mutilation/cutting (FGM/C) globally. However, significant literature gaps exist on associated knowledge and contextual factors within the country, particularly among affected women. This study thus aimed to explore Somali women's perspectives about FGM/C and its potential abandonment in Somalia. We conducted an exploratory qualitative study, informed by critical feminist and social norms theories. Data from 20 semi-structured remote interviews with women in Somalia were analysed thematically using abductive coding. We generated three themes of normative expectations and social control, patriarchal influence and gendered power, and FGM/C support and abandonment. Women demonstrated detailed knowledge of FGM/C procedures and consequences, sharing personal experiences of living with the effects of FGM/C on their physical, mental, and sexual health. Most supported continuation of "milder" 'gudniinka sunnah' FGM/C, rather than abandoning the tradition. However, 'gudniinka sunnah' described several types of cutting, some which fit the World Health Organization typology of Type-IV (pricking, scraping) and others Type-I (removing part/all of the external clitoris), while 'gudniinka fircooniga' (Type-III) - though still occurring - was universally described negatively. While acknowledging potential harms, women expressed the need for more religious and scientific clarity before changing their generally supportive opinions of 'sunnah' FGM/C. Discussing socio-cultural and religious reasons for this preference, women described social norms of femininity and how awareness interventions affected their understanding of 'severe' FGM/C and could help responses against FGM/C in Somalia. While all FGM/C types are negatively associated with women's health and wellbeing, Type-IV is least understood. Although women opposed Type-III, they supported continuing Type-I/Type-IV as 'sunnah' FGM/C. Reasons for this practice are rooted deeply in Somali culture and require active engagement of a range of community stakeholders to enact meaningful changes. Health education can contribute to changing attitudes towards FGM/C in Somalia but is insufficient on its own, potentially benefitting from interventions to change social norms
Implementing patient reported outcomes in cancer care: Lessons and strategies from a large UK Cancer Centre.
Get PDFBACKGROUND: Patient-reported outcome measures (PROMs) are valuable for advancing patient-centred cancer care by capturing patients' views on their health, quality of life, and symptoms. However, routine PROM collection remains difficult to implement in clinical settings. This study evaluated a PROM pilot in the prostate cancer radiotherapy setting at Guy's Cancer Centre, identifying multi-level barriers and facilitators to routine implementation. METHODS: A mixed-methods design was used, comprising qualitative interviews with healthcare professionals and a quantitative questionnaire for patients. The interview guide was informed by the Consolidated Framework for Implementation Research (CFIR). Fourteen healthcare professionals (including clinicians, radiographers, and managers) took part in interviews, and ten of twenty prostate cancer patients completed the evaluative questionnaire. RESULTS: Key patient-level challenges included digital literacy gaps, limited access to technology, and low understanding of PROMs. Provider-level barriers involved limited PROM training, staff turnover, and concerns about added workload. Administrative issues included funding limitations and logistical complexity across multiple care sites. System-level barriers centred on poor integration between PROM platforms and electronic health record (EHR) systems. CONCLUSIONS: To support sustainable and scalable PROM use, several strategies are proposed: developing patient education tools, setting thresholds for clinically meaningful PROM changes, appointing administrative staff to reduce provider burden, and offering PROM access via devices such as iPads in waiting rooms. Policy recommendations include resourcing PROM-dedicated staff, enabling flexible training for clinical teams, and introducing support mechanisms to reduce inequities in PROM completion. These approaches aim to embed PROMs into routine cancer care, improving clinical outcomes and patient engagement. Future work should explore the scalability of these strategies across other tumour types and settings, ensuring PROMs can inform value-based, equitable cancer care delivery. POLICY SUMMARY: This paper seeks to influence policies that promote patient-centred care in oncology, particularly by enhancing the routine collection and integration of PROMs within cancer treatment pathways. It advocates for policies that allocate resources to support sustainable PROM collection, including dedicated staff roles, infrastructure for technological integration, and patient education resources. Additionally, it highlights the need for policy improvements that address health inequities by providing targeted support for populations facing digital literacy and accessibility challenges. By addressing these policy areas, the paper aims to advance frameworks that improve patient engagement, data-informed clinical decision-making, and equitable access to supportive care in oncology