69832 research outputs found
Sort by
Retrospective cohort analysis of antiretroviral therapy initiation timelines and clinical outcomes in adults with HIV and TB disease in KwaZulu-Natal, South Africa.
Full text linkBackgroundWe aimed to determine antiretroviral therapy (ART) initiation timing and outcomes in people living with HIV (PLHIV) receiving tuberculosis treatment in KwaZulu-Natal, South Africa.MethodsWe performed a retrospective cohort analysis of routinely collected de-identified data from 62 clinics including PLHIV not already receiving ART aged ≥16 years, starting tuberculosis treatment between October 2016-November 2019. Multivariable Poisson regression models with robust standard errors evaluated associations between timing of ART initiation (after starting tuberculosis treatment) and successful tuberculosis treatment, and 6-month HIV viral load (VL) < 50 copies/mL.ResultsAmong 5,548 PLHIV with tuberculosis, 29.8% initiated ART within 15 days ("early"), 36.2% in 16-56 days, 8.7% in 57-210 days, with 25.3% not initiating ART by 7 months. Proportions with successful tuberculosis treatment were similar comparing 16-56 and 57-210 days to early initiation, with a lower likelihood of successful tuberculosis outcome with no ART within 7 months (adjusted risk ratio [aRR] 0.81 [0.77-0.86], p < 0.001). In those with a known VL 6 months post-ART initiation (n = 2,658), initiation within 57-210 days had a lower likelihood of viral suppression (aRR 0.90 [0.82-0.99], p < 0.03).ConclusionAlthough <30% of PLHIV with tuberculosis initiated ART early, this was associated with better tuberculosis outcomes and VL suppression
Age-related disparities in viral suppression among older individuals living with HIV in rural Uganda.
Full text linkBACKGROUND: The number of people living with HIV (PLWH) in sub-Saharan Africa who are over 50 years old is increasing rapidly, and expected to triple by 2040. Yet, how older PLWH sustain access to care and viral suppression is not well known. We examined the prevalence and correlates of viral suppression in a cohort of older PLWH in Uganda. METHODS: We analyzed data from the Quality of Life and Aging with HIV in rural Uganda study, which follows PLWH over 50 years old who are in care at public HIV clinics in Uganda. Our outcome of interest was viral suppression, defined as HIV-1 RNA viral load less than 200 copies/mL. We estimated the prevalence of viral suppression and fitted multivariable log binomial regression models to identify correlates of viral suppression. RESULTS: The mean cohort age was 59.7 years (standard deviation [SD] 6) and participants had been taking HIV therapy for a mean of 13.3 years (SD 3). Viral suppression was relatively high overall (87%, 240/277). In multivariable models, people aged ≥ 60 years were less likely to be virally suppressed than those aged 50-59 years (78% vs. 93%, adjusted prevalence ratio [APR] 0.85, 95% CI: 0.76, 0.93, P = 0.001). By contrast, having one or more comorbidities was positively associated with viral suppression (APR 1.10, 95% CI: 1.01, 1.18, P = 0.021). CONCLUSION: We found a decreased prevalence of viral suppression among PLWH aged ≥ 60 years atleast in Uganda. Public health interventions that address the adherence support needs of older individuals should be evaluated and, if successful, incorporated into HIV care services, given the significant number of older people living with HIV in the region
Marketing strategies used in retail food environments in Azerbaijan, Kazakhstan, and North Macedonia
Full text linkBackground: Food retail environments are an important influence over dietary behaviours. Food retail marketing strategies that promote less healthy foods endanger the rights of children to good health. However, limited evidence exists on food retail marketing practices in Europe and Central Asia (ECA). We aimed to describe the online food retail marketing environment in three ECA countries – Azerbaijan, Kazakhstan, and North Macedonia – and explore retailer perspectives of strategies to improve the healthiness of food retail environments.
Methods: Online food retail marketing environments were assessed using the INFORMAS protocol for monitoring marketing practices for foods and beverages within online grocery stores. Retailers and other key informants (n = 16) were interviewed to understand their perceptions of the barriers and enablers to creating a child rights-friendly food retail (online and in-store) environment in each country.
Results: Online food retail environments are developing at different rates across the three countries. In all three countries, unhealthy foods were more frequently promoted through online marketing strategies compared to healthy products. Retailers showed some willingness and capacity to modify food retail marketing strategies to promote children's health, however cited challenges including profit-driven business models and dependence on suppliers and manufacturers.
Conclusions: Food retail environments in Azerbaijan, Kazakhstan, and North Macedonia could be modified to better support children's rights and health. Initial efforts by governments, researchers, NGOs, and UN agencies could focus on co-designing interventions with retailers that align health and profit goals. Government-led regulations may also be necessary to ensure consistent standards across retailers
Global learning opportunities within social innovation in health (GLOWS): A modified Delphi process to identify and pilot core competencies for learning.
Full text linkBACKGROUND: Social innovation in health refers to the community-engaged process that connects health improvement and social change. The aim of this study was to develop a consensus statement on core learning competencies in social innovation in health and pilot them as part of a participatory training workshop.
METHODS AND FINDINGS: A modified Delphi Process aggregating data from a scoping review, global open call, and participatory process was organized. Participants were recruited from low, middle, and high-income countries with a range of social innovation experiences. Statements focused on social innovation in health core competencies for learning. Consensus was determined using the RAND/UCLA Appropriateness method. After expressing interest in the project, 68 individuals received the survey. 46 participants completed the first survey, and 35 completed the second. All 28 statements reached consensus, and based on the results of this first survey, some statements were added, amended, and merged to reach 30 consensus statements in the second survey. Competencies were categorized into skills, mindsets, and knowledge. Twenty-five statements had a median Likert rating score of >8 indicating strong agreement. Some competencies reached higher levels of agreement. This included community engagement, which can leverage the collective knowledge and problem-solving abilities of a diverse group of individuals to tackle complex challenges; social entrepreneurship skills including business model knowledge, securing funding, team building, and knowledge of intersectional issues and health inequities. Twelve competencies were then piloted as eight one-hour online workshops, which assessed the feasibility of developing them through online open-access social innovation training sessions. Afterwards,137 participants completed a survey rating their competency on a scale from 1 (not competent) to 5 (very competent),most reported a significant 1-point improvement including in entrepreneurship and understanding intersectionality.
CONCLUSION: The results from this study will inform the development of a WHO/TDR conceptual framework which will have implications for training program design and policy
Mind the gap: A qualitative assessment of limitations in school-age immunisation programme delivery for Orthodox Jewish children in northeast London.
Full text linkINTRODUCTION: School-based vaccine programme delivery offers convenience to parents, and reduces the burden on primary care capacity. Vaccine coverage among school-age children is lower in Hackney (northeast London), and post-pandemic coverage recovery has been limited in Hackney compared to London and England. Hackney is home to the largest Orthodox Jewish (OJ) population in Europe where most children attend independent faith schools. This study aimed to assess (i): vaccine programme delivery gaps via independent OJ schools in Hackney; and (ii) the primary care catch-up and commissioning strategies undertaken to help close gaps.
METHODS: Qualitative evaluations of national incident responses for poliovirus and measles tailored to underserved communities in northeast London (2022-24). Data consisted of in-depth semi-structured interviews (n = 53) with public health professionals, healthcare practitioners, community partners, and OJ parents. Vaccine clinic visits (n = 11) were conducted in northeast London, affording additional (n = 43) focused and opportunistic interviews with OJ parents attending for catch-up.
RESULTS: Evaluating the delivery of routine and outbreak vaccination campaigns to school-age children demonstrates that independent OJ schools in Hackney are a key programme delivery gap, directly impacting access to catch-up and routine adolescent programmes. OJ parents reported that they did not receive relevant vaccine programme information and invitations for school-age children via independent faith schools. Primary care-led outreach clinics were hosted to offer school-age immunisations to OJ adolescents, but did not offer HPV vaccines. Sub-commissioning community organisations to liaise with independent schools may be a strategy to help resolve this delivery gap, but would require responsibilities within school-age immunisation partnerships to be clearly assigned.
CONCLUSION: Limitations in vaccine programme delivery via independent faith schools in northeast London may play a role in suboptimal vaccination coverage. Programme gaps must be addressed to help ensure that every eligible child is invited for, and can access, routine vaccination via accessible pathways
Health inequalities among people with disabilities: an umbrella review and evidence synthesis.
Full text linkBACKGROUND: People with disabilities frequently experience poorer health than others in the population, yet the extent of this health gap is unknown. We undertook an umbrella review of meta-analyses to assess the amount, strength and quality of the evidence of the association between disability and a broad range of health outcomes. METHODS: We searched Cochrane Library, EMBASE, Medline, PsycINFO and Health Evidence to identify meta-analyses of quantitative studies, published January 1, 2000 to February 3, 2025, in any language. We included systematic reviews with meta-analyses that compared health outcomes between people with and without disabilities, across all study settings and geographical locations. Two reviewers assessed study eligibility and extracted data. We assessed risk of bias using the AMSTAR2 tool and evaluated the strength of evidence for each meta-analysis according to the Fusar-Poli and Radua criteria. We narratively described the association between disability and health outcomes, categorised according to ICD-11 categories. This study is registered with PROSPERO, CRD42025645729. FINDINGS: The search generated 11,221 unique records, of which 58 systematic reviews that included meta-analyses were included. Together, these reviews drew on 1409 primary studies from 77 countries and produced 132 separate meta-analyses that evaluated 16 health outcomes. Overall, most systematic reviews were of moderate to low quality. Intellectual and developmental disabilities accounted for the largest share of the meta-analyses (n = 60, 45%). One-third of associations (n = 45, 34%) showed convincing or highly suggestive evidence linking disability to adverse health outcomes. The majority of meta-analyses (n = 113, 86%) found statistically significant and positive associations. No studies that examined disability in relation to diseases of the blood, diseases of the immune system, diseases of the musculoskeletal system or conditions related to sexual health were identified. INTERPRETATION: People with disabilities are a diverse group, yet share the common experience of markedly worse health than their peers without disabilities. The evidence base is constrained by limited measurement of subjective health outcomes and definitions of disability that may not capture contextual factors. Consequently, the true association of disability and poor health outcomes may be underestimated. Health inequities experienced by people with disabilities necessitate health system reforms with efforts to embed inclusion and address social determinants of health. FUNDING: The National Institute for Health and Care Research, the Programme for Evidence to Inform Disability Action grant from the Foreign, Commonwealth and Development Office, the Conrad N. Hilton Foundation
Decolonising implementation science: a call for methodological pluralism.
No full textIn this Viewpoint, we argue that the project to decolonise implementation science is an important and much needed endeavour, but should move beyond a focus on equity to a more disruptive decolonial approach that interrogates the field's methodological and epistemological foundations. Methodological pluralism in implementation science-one that integrates diverse ways of knowing-is not only more just, but also more effective and scientifically robust. Achieving this requires uncomfortable confrontation with the colonial architecture of academic research and accepted ways of knowing
Non-Vaccine Serotype Replacement and Subdominant Persistence of Vaccine Types in Nepalese Infants Following PCV10 Introduction.
Full text linkBackground:Streptococcus pneumoniae is a leading cause of child mortality in Nepal despite the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10). Vaccine effectiveness is threatened by the emergence of non-vaccine serotypes (NVTs) and the multiple serotypes carriage which often fail to be detected by traditional methods. We aimed to study changes in serotype distribution before and after PCV10 immunization among infants, including serotype dominance in Nepalese infants in the post-vaccine era. Methods: We enrolled infants in a longitudinal cohort study (2020-2022) conducted in Bhaktapur, Nepal. Nasopharyngeal swabs were collected before PCV10 dose 1 (6 weeks) and at 9 and 12 months post-immunization. We used a sensitive nanofluidic qPCR platform to detect multiple serotypes and establish their hierarchy by quantifying the bacterial load of each strain. Inverse Probability Weighting (IPW) adjusted risk factor analysis was used to account for loss to follow-up. Results: PCV10 successfully reduced vaccine-type (VT) carriage, declining sharply from 32.8% at 6 weeks to 4.8% at 12 months. VTs were pushed from being the dominant strain to occupying subdominant roles in co-colonization. Conversely, NVTs rapidly filled the vacated niche, showing a significant increase in their dominant status (p < 0.001). The most common replacing NVTs that rose to dominance were 35B, 19A, 6C/6D, and 15B/15C. Significant risk factors for carriage included older infancy (aOR 3.4, 95%CI: 2.6-4.5 at 9 months), a household kitchen in the living area (aOR 1.4, 95%CI: 1.0-1.9), and winter (aOR 1.7, 95%CI: 1.5-2.7) and pre-monsoon seasons (aOR 2.0, 95%CI: 1.5-2.8). Conclusions: While PCV10 reduced overall VT circulation, the persistence of VTs in subdominant niches creates a continuous reservoir for potential re-emergence and antibiotic resistance. This clear hierarchical shift in dominance towards NVTs underscores the urgent need for a public health strategy that includes the adoption of a higher-valent PCV to provide broader protection, and interventions targeting environmental risk factors are essential to sustain long-term reductions in pneumococcal colonization
PurFect timing: revisiting purine metabolism for tuberculosis treatment.
Full text linkEradication of tuberculosis requires new drugs targeting novel pathways. Although purine metabolism represents an essential antitubercular target, concerns about host nucleobase rescue limited its exploration. New data demonstrate that nucleobase levels in human lung tissue are insufficient to confer rescue, renewing interest in this pathway for tuberculosis drug discovery
Evaluation of the diagnostic performance of the Eazyplex platform for detection of Chlamydia trachomatis and Neisseria gonorrhoeae among women in Zimbabwe.
Full text linkBACKGROUND: Gaps in sexually transmitted infection (STI) diagnosis hinder effective STI control particularly in low-resource settings where syndromic management is often the standard of care. Rapid and affordable point-of-care (POC) diagnostics for STIs such as Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are needed. This study evaluated the diagnostic performance of Eazyplex (a point-of-care test (POCT)) to screen CT and NG among sexually active women in Zimbabwe. METHODS: We enrolled 220 sexually active women aged 18-35 (median 28 years) years attending a family planning clinic in Zimbabwe. Samples collected from vaginal swabs were tested for CT and NG using Eazyplex, GeneXpert and PRESTO CT/NG. Diagnostic performance metrics (sensitivity, specificity, positive predictive value and negative predictive value) were calculated against GeneXpert, PRESTO CT/NG and a GeneXpert+PRESTO CT/NG combined reference standard. For the combined reference standard, a participant was categorised as having a positive result for CT or NG if either of the two tests yielded a positive result. RESULTS: Overall, Eazyplex reported high specificity and low sensitivity. CT results demonstrated sensitivities of 60.9%, 76.2% and 64.0% compared with GeneXpert, PRESTO CT/NG and GeneXpert+PRESTO CT/NG combined, respectively. NG results demonstrated sensitivities of 57.1%, 66.7% and 66.7% compared with GeneXpert, PRESTO CT/NG and GeneXpert+PRESTO CT/NG combined, respectively. All results had specificity ≥98.5%. CONCLUSION: Eazyplex was highly specific but moderately sensitive in detecting NG and CT. While not suitable as a standalone screening tool, its rapid turnaround gives it potential for use as near POCT in low-resource settings