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Call to action: building a better future together, powered by evidence, guided by collective impact
Get PDFImagine a world where every decision, whether in a government office, a community meeting, a hospital, or in response to a humanitarian crisis, is guided by timely and trusted evidence. A world where research is not locked behind paywalls or delayed by outdated systems but delivered in real time and adapted to local needs.The world in 2025 faces complex challenges, but also unprecedented opportunities to accelerate progress. The Sustainable Development Goals remind us how far we still need to go, while also highlighting the transformative power of working together in new way
“Now that I took TPT, it’s affecting my ART adherence, viral load, even my wellbeing in the community”. Exploring acceptability and experience of Tuberculosis Preventive Treatment among adolescents living with HIV in Zimbabwe
Get PDFTuberculosis preventive treatment (TPT) is increasingly offered to people living with HIV in high-burden settings, including adolescents and young people (AYPLHIV). Evidence demonstrates that AYPLHIVs’ HIV treatment engagement is improved by the provision of tailored support. How to effectively adapt this support to accommodate multimorbidity care, such as TPT alongside ART, warrants attention to deliver sustained optimal outcomes. We conducted qualitative research to better understand AYPLHIVs’ experiences when initiating TPT and their related support needs. Peer counsellors (18–24 years) who were offered TPT within routine HIV care participated in two focus groups (n = 16 participants) and in-depth interviews (n = 12) in Harare. Iterative data collection and thematic analysis was conducted September 2023 to February 2024. TPT was presented by healthcare workers as uncomplicated and routine. This contrasted with participants’ accounts of the significant disruptive and challenging experience of taking up TPT. This tension led many to stop TPT without support. Those who completed treatment were motivated by personal circumstances(e.g., recently witnessing severe TB illness, pregnancy); however, taking up and completing subsequent courses of TPT was not assured. TPT side effects and stigma led many to discontinue treatment, even when these were not personally experienced. Side effects recalled past experiences of HIV-stigma and discrimination, and undermined ART adherence, HIV viral suppression, and positive mental health. Introducing additional life-protecting treatments can have complicating biosocial effects, with consequences for individuals and public health. To support multimorbidity prevention and care, we outline five principles to guide initiating and maintaining treatment that acknowledges and responds to AYPLHIVs’ dynamic immunological and social realities: Supported and safe relationships; Tailored messaging; Adaptable support; Respect for agency and autonomy; Timing: plan, review, revise (START). START emphasises investing in consistent peer support throughout adolescence, and centring AYPLHIVs’ agency, embodied knowledge and wellbeing to ensure they are informed decision-makers about their health
“Now that I took TPT, it’s affecting my ART adherence, viral load, even my wellbeing in the community”. Exploring acceptability and experience of Tuberculosis Preventive Treatment among adolescents living with HIV in Zimbabwe
Get PDFTuberculosis preventive treatment (TPT) is increasingly offered to people living with HIV in high-burden settings, including adolescents and young people (AYPLHIV). Evidence demonstrates that AYPLHIVs’ HIV treatment engagement is improved by the provision of tailored support. How to effectively adapt this support to accommodate multimorbidity care, such as TPT alongside ART, warrants attention to deliver sustained optimal outcomes. We conducted qualitative research to better understand AYPLHIVs’ experiences when initiating TPT and their related support needs. Peer counsellors (18–24 years) who were offered TPT within routine HIV care participated in two focus groups (n = 16 participants) and in-depth interviews (n = 12) in Harare. Iterative data collection and thematic analysis was conducted September 2023 to February 2024. TPT was presented by healthcare workers as uncomplicated and routine. This contrasted with participants’ accounts of the significant disruptive and challenging experience of taking up TPT. This tension led many to stop TPT without support. Those who completed treatment were motivated by personal circumstances(e.g., recently witnessing severe TB illness, pregnancy); however, taking up and completing subsequent courses of TPT was not assured. TPT side effects and stigma led many to discontinue treatment, even when these were not personally experienced. Side effects recalled past experiences of HIV-stigma and discrimination, and undermined ART adherence, HIV viral suppression, and positive mental health. Introducing additional life-protecting treatments can have complicating biosocial effects, with consequences for individuals and public health. To support multimorbidity prevention and care, we outline five principles to guide initiating and maintaining treatment that acknowledges and responds to AYPLHIVs’ dynamic immunological and social realities: Supported and safe relationships; Tailored messaging; Adaptable support; Respect for agency and autonomy; Timing: plan, review, revise (START). START emphasises investing in consistent peer support throughout adolescence, and centring AYPLHIVs’ agency, embodied knowledge and wellbeing to ensure they are informed decision-makers about their health
The prenatal anxiety trajectory and its correlation with stress and psychological flexibility: a longitudinal study
Get PDFBackground: Several investigations have delved into the heterogeneity of anxiety symptom trajectories throughout pregnancy. However, the causal relationships between prenatal anxiety, stress, and psychological flexibility remain unclear. This study endeavored to identify distinct trajectory groups and influencing factors for anxiety symptoms in pregnant women, and explore the relationship between stress, psychological flexibility, and anxiety during this period. Methods: Pregnant women were recruited from March to May 2022 at a hospital in Xi’an City, Shaanxi Province, China. Structured questionnaire surveys were conducted through a WeChat applet at five time points (12, 20, 26, 32, and 37 weeks), collecting information on basic demographics, stress, psychological flexibility, and anxiety throughout their pregnancies. The latent class growth model was employed to identify potential trajectory groups of prenatal anxiety, logistic regression was utilized to analyze the factors associated with these groups, and a linear mixed model was implemented to investigate the relationship between stress, psychological flexibility, and anxiety. Results: Three distinct anxiety trajectory groups were identified. Unplanned pregnancy (OR = 1.76, 95% CI: 1.08–2.87, P = 0.024) and a history of spontaneous abortion (OR = 1.75, 95% CI: 1.10–2.79, P = 0.018) were significantly associated with a heightened risk of developing an anxiety trajectory group. Higher stress at 12 (β = 0.229, 95% CI: 0.187–0.271), 20 (β = 0.249, 95% CI: 0.211–0.287), 26 (β = 0.255, 95% CI: 0.213–0.296), and 32 weeks(β = 0.278, 95% CI: 0.241–0.315) significantly predicted elevated anxiety in late pregnancy (all P < 0.001). While higher psychological flexibility at the same time points predicted lower anxiety (βs from − 0.074 to − 0.099; all P < 0.001). Conclusions: The trajectories of prenatal anxiety symptoms are dynamic and heterogeneous, with stress and psychological flexibility emerging as significant predictive factors. This study offers critical insights into the characteristics of pregnant women in high-risk trajectory groups, highlighting the potential for early intervention to mitigate worsening symptoms. Trial registration: The study was approved by the Ethical Committee of Health Science Center, Xi’an Jiaotong University in accordance with the Declaration of Helsinki (Registration number: 2022 − 1436, date:2022.7.4).</p
The prenatal anxiety trajectory and its correlation with stress and psychological flexibility: a longitudinal study
Get PDFBackground: Several investigations have delved into the heterogeneity of anxiety symptom trajectories throughout pregnancy. However, the causal relationships between prenatal anxiety, stress, and psychological flexibility remain unclear. This study endeavored to identify distinct trajectory groups and influencing factors for anxiety symptoms in pregnant women, and explore the relationship between stress, psychological flexibility, and anxiety during this period. Methods: Pregnant women were recruited from March to May 2022 at a hospital in Xi’an City, Shaanxi Province, China. Structured questionnaire surveys were conducted through a WeChat applet at five time points (12, 20, 26, 32, and 37 weeks), collecting information on basic demographics, stress, psychological flexibility, and anxiety throughout their pregnancies. The latent class growth model was employed to identify potential trajectory groups of prenatal anxiety, logistic regression was utilized to analyze the factors associated with these groups, and a linear mixed model was implemented to investigate the relationship between stress, psychological flexibility, and anxiety. Results: Three distinct anxiety trajectory groups were identified. Unplanned pregnancy (OR = 1.76, 95% CI: 1.08–2.87, P = 0.024) and a history of spontaneous abortion (OR = 1.75, 95% CI: 1.10–2.79, P = 0.018) were significantly associated with a heightened risk of developing an anxiety trajectory group. Higher stress at 12 (β = 0.229, 95% CI: 0.187–0.271), 20 (β = 0.249, 95% CI: 0.211–0.287), 26 (β = 0.255, 95% CI: 0.213–0.296), and 32 weeks(β = 0.278, 95% CI: 0.241–0.315) significantly predicted elevated anxiety in late pregnancy (all P < 0.001). While higher psychological flexibility at the same time points predicted lower anxiety (βs from − 0.074 to − 0.099; all P < 0.001). Conclusions: The trajectories of prenatal anxiety symptoms are dynamic and heterogeneous, with stress and psychological flexibility emerging as significant predictive factors. This study offers critical insights into the characteristics of pregnant women in high-risk trajectory groups, highlighting the potential for early intervention to mitigate worsening symptoms. Trial registration: The study was approved by the Ethical Committee of Health Science Center, Xi’an Jiaotong University in accordance with the Declaration of Helsinki (Registration number: 2022 − 1436, date:2022.7.4).</p
Evaluation of the diagnostic accuracy of Xpert® Mpox and STANDARD™ M10 MPX/OPX for the detection of monkeypox virus
Get PDFObjectivesEvaluation of diagnostic accuracy of two point-of-care (POC) molecular diagnostic tests for the detection of monkeypox virus (MPXV): Xpert® Mpox (Cepheid, Inc., USA) and STANDARD™ M10 MPX/OPX (SD Biosensor, Inc., Korea).MethodsDiagnostic accuracy of both POC platforms was evaluated using 53 upper-respiratory swabs (URS) and 32 skin lesions swabs (SS) collected from mpox and COVID-19 patients in the UK against the Sansure (Sansure Biotech Inc.) and CDC reference qPCR tests. The analytical sensitivity of both platforms was assessed using a viral isolate from II, B.1 lineage.ResultsThe overall sensitivity and specificity of the Xpert® Mpox was 97.67% [95% CI 87.71–99.94%] and 88.57% [95% CI 73.26–96.80%] and 97.44% [95% CI 86.52–99.94%] and 74.42% [95% CI 58.83–86.48%] comparing the Sansure and CDC qPCR, respectively and for the M10 MPX/OPX was 87.80% [95% CI 73.80–95.92%] and 76.60% [95% CI 61.97–87.70%] and 94.29% [95% CI 80.84–99.30%] and 86.67% [95% CI 73.21–94.95%] with the Sansure and CDC qPCR.ConclusionThe Xpert® Mpox had good diagnostic accuracy for both sample types while the M10 MPX/OPX clinical accuracy was deficient with URS. Our data supports the use of URS during the first 3 days of symptoms onset for mpox diagnosis.</p
Co-creation of a gender responsive TB intervention in Nigeria: a researcher-led collaborative study
Get PDFBackgroundIn Nigeria, men constitute over half of the people notified with tuberculosis (TB), experience longer delays before reaching care, and are estimated to account for two thirds of people who miss out on care. The higher TB risk and burden in men has implications for the whole population and reaching them earlier with TB services will reduce onward transmission in households, communities, and workplaces. The absence of a comprehensive guidance and the lack of substantial empirical evidence on TB care approaches that are responsive to the needs of men in Nigeria exacerbates this problem. Therefore, this research aimed to co-create a gender-responsive intervention for men in peri-urban communities in Nigeria.MethodsOur study utilised a researcher-led collaborative approach to engage local TB stakeholders including communities adversely affected by the disease to co-create a gender-responsive TB intervention. Between March and November 2022, we engaged 13 local TB stakeholders in a three-phase participatory intervention design process. This engagement involved two iterative cycles of Delphi research online, and an in-person workshop. In the first and second phases, participants described the potential impact of 15 listed interventions and prioritised combinations of nine interventions deemed to be effective in overcoming identified gendered barriers. Responses were analysed using a combination of qualitative framework approach, content analysis, and summary descriptive statistics assisted by NVivo software. Stakeholder consensus on a preferred intervention package was reached during the participatory workshop.ResultsOverall, participants prioritised approaches that sought to actively find and systematically screen men for TB including awareness creation as a crucial component. The stakeholders placed significant considerations on the synergy between interventions and their programmatic sustainability when making their final choices. Consequently, a complex intervention package comprising three components was developed. These included targeted awareness creation among men in communities; TB screening in male-dominated socio-cultural congregate settings; and the use of digital chest X-ray screening. Anticipated early outputs of this intervention included improved TB knowledge, increased care-seeking, reduced TB-related costs and TB stigma, and accelerated early diagnosis among men in Nigeria.ConclusionLeveraging the insights and experiences of local stakeholders through iterative engagements yielded consensus on a viable gender-responsive TB intervention.</p
The Association Between Egg and Egg-Derived Cholesterol Consumption, and Their Change Trajectories, with Obesity Among Chinese Adults: Results from the China Health and Nutrition Survey
Get PDFBackground/Objectives: As a widely consumed, nutritious, and affordable food, eggs and their derivatives’ impacts on obesity remain inconclusive. In this study, we aimed to determine the association between egg and egg-derived cholesterol consumption, and their change trajectories, with obesity among Chinese adults. Methods: Longitudinal data collected by the China Health and Nutrition Survey from 1997 to 2015 were analyzed. The latent growth mixture model was used to identify eggs and egg-derived cholesterol consumption trajectories. Cox proportional hazard models with shared frailty were used to analyze the association between egg and egg-derived cholesterol consumption, and their change trajectories, with obesity. Results: Data from 10,971 and 9483 participants aged ≥18 years old were used for the analyses of general obesity and central obesity, respectively. Compared to participants with an average egg intake of 0.1–50.0 g/d during the follow-up period, adults who never consumed eggs or those with an average egg intake of 50.1–100.0 g/d and >100.0 g/d had a higher risk of general obesity, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.31 (1.08, 1.58), 1.30 (1.07, 1.60), and 1.98 (1.17, 3.35), respectively, and had a higher risk of central obesity, with HRs (95% CIs) of 1.17 (1.04, 1.31), 1.31 (1.14, 1.50), and 1.64 (1.15, 2.36), respectively. Participants with a “Baseline Low-Significant Rising Pattern” or a “Baseline High-Rising then Falling Pattern” of egg consumption trajectories during the follow-up period had a higher risk of general obesity, with HRs (95% CIs) of 1.56 (1.25, 1.93) and 1.38 (1.13, 1.69), respectively, and central obesity, with HRs (95% CIs) of 1.47 (1.29, 1.68) and 1.52 (1.34, 1.72), respectively. Compared to the second quartile (Q2) group of the average egg-derived cholesterol intake during the follow-up period, Q1, Q3, and Q4 groups had a higher risk of general obesity, with HRs (95% CIs) of 1.28 (1.06,1.54), 1.21 (1.02, 1.44), and 1.43 (1.19, 1.71), respectively, and a higher risk of central obesity, with HRs (95% CIs) of 1.20 (1.08, 1.33), 1.11 (1.01, 1.23), and 1.32 (1.19, 1.46), respectively. Participants with a “Baseline Low-Significant Rising Pattern” or with a “Baseline High-Rising then Falling Pattern” of egg-derived cholesterol consumption during the follow-up period had a higher risk of general obesity, with HRs (95% CIs) of 1.54 (1.25, 1.92) and 1.37 (1.15, 1.64), respectively, and a higher risk of central obesity, with HRs (95% CIs) of 1.46 (1.28, 1.68) and 1.47 (1.32, 1.64), respectively. Conclusions: Both the insufficient and excessive intake of eggs and egg-derived cholesterol tended to be associated with a higher risk of general and central obesity. Suddenly increasing or consistently high levels of egg and egg-derived cholesterol intake seemed to be associated with a higher risk of obesity. To prevent obesity, people should consume a moderate amount of eggs and egg-derived cholesterol.</p
Compliance with transmission-based precautions, and associated factors among healthcare providers in Cameroon: a cross-sectional study
Get PDFBackgroundTransmission-based precautions (TBP) and the proper use of personal protective equipment (PPE) are essential in preventing hospital-acquired infections (HAIs) and in controlling the emergence and spread of antimicrobial resistance (AMR). This study, therefore, aimed to determine healthcare providers’ compliance with TBP and its determinants in healthcare settings to help curb the burden of HAIs and AMR.MethodThis study was a cross-sectional, hospital-based research conducted among healthcare providers at four health facilities in the Fako division of Cameroon, from January 1 to May 31, 2024. A standardized observation form, adapted from the World Health Organization’s checklist for hand hygiene practices, was used to assess compliance with Transmission-Based Precautions (TBP) among healthcare providers when interacting with patients known or suspected of having infectious pathogens. Multivariable logistic regression analysis was performed to identify factors independently associated with TBP compliance, with significance set at a p-value of less than 0.05.ResultsThe proportion of participants with good TBP compliance was 75.4% (95%CI: 67.4–82.2). Contact precaution compliance was 94.2%, while that for droplet /airborne was 12.8%. Factors independently associated with good TBP compliance were healthcare providers trained in IPC (aOR: 2.89, 95%CI: 1.16—7.22), the availability of PPE in the facility’s departments (aOR: 6.00, 95%CI: 1.24–29.17), and working in the facility; Mount Mary Hospital (aOR: 22.47, 95%CI: 2.21–228.08).ConclusionCompliance with transmission-based precautions was suboptimal. The determinants of good compliance with TBP among healthcare providers were making PPE available in the facility and training healthcare providers on IPC. Tailored public health measures should be implemented to improve and sustain healthcare providers’ compliance with TBP.</p
Vertical transmission of hepatitis B virus in the WHO African region: a systematic review and meta-analysis.
Get PDFMore new infections with hepatitis B virus (HBV) occur annually in the WHO African region than in the rest of the world combined. We did a systematic review and meta-analysis to estimate the prevalence of hepatitis B surface antigen (HBsAg) in pregnant women and vertical transmission events in the region. In this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, Africa Index Medicus, and Africa Journals Online for publications between Jan 1, 1992, and Jan 7, 2024, with no language restrictions. HBsAg prevalence and vertical transmission (HBsAg positivity in children aged 6-12 months) were estimated with the use of binomial mixed models with logit links, stratified by infant vaccination status. We estimated HBsAg prevalence for subregions of Africa and for the WHO African region by weighting by estimated livebirths for each subregion. We estimated transmission events using WHO and UNICEF vaccine coverage data and UN population estimates. We included 113 studies reporting on HBsAg prevalence from 190 983 pregnant women and 11 studies reporting on vertical transmission. HBsAg prevalence in women receiving antenatal care in the WHO African region (based on 2014-23 data) was 6·2% (95% CI 5·3-7·2). No relationship between risk of bias and HBsAg prevalence was observed. In 2022, an estimated 172 000 vertical transmission events (95% CI 82 000-383 000) occurred (0·4% of livebirths), a fall from a peak of 339 000 (149 000-634 000; 1·2% of all livebirths) in 2001. Increasing birth dose vaccination coverage to the WHO target of 90% could reduce vertical transmission by 43·7% (95% CI 11·6-78·0) to 97 000 events per year (95% CI 58 000-160 000). Adding maternal antiviral prophylaxis with 90% coverage could reduce transmission by 86·3% (95% CI 78·4-94·6) to 24 000 events per year (95% CI 14 000-39 000; 0·06% of livebirths) and achieve WHO elimination targets. Vertical transmission is an important contributor to HBV transmission in the WHO African region. Scaling up of hepatitis B birth dose vaccination and antiviral prophylaxis is urgently needed, which could achieve elimination of vertical transmission.</p