81 research outputs found
Excavating a Silk Road City: the Medieval Citadel of Taraz, Kazakhstan
No full textThe city of Taraz, located near the southern border with Uzbekistan, is one of the most significant historic settlements in Kazakhstan, and two seasons of fieldwork in the central market-place have revealed a substantial depth of medieval stratigraphy. Despite frequent mentions in Arabic and Chinese written sources, both the form and evolution of this important Silk Road city remain poorly understood. Evidence for a series of successive medieval buildings, including a bathhouse and a Zoroastrian flame shrine, was found in the area of the former citadel. These excavations, undertaken as a joint initiative between the Centre for Applied Archaeology and Kazakh archaeologists, were the first for 50 years in the city and form part of a wider public outreach programme
Morbidity and Mortality Weekly Report (MMWR)
No full textMorbidity and mortality weekly report. 2012 Aug 10;61(31):586-9.In the United States, an estimated 48,100 new human immunodeficiency virus (HIV) infections occurred in 2009. Of these, 27% were in heterosexual men and women who did not inject drugs, and 64% were in men who have sex with men (MSM), including 3% in MSM who inject drugs. In January 2011, following publication of evidence of safety and efficacy of daily oral tenofovir disoproxil fumarate 300 mg (TDF)/emtricitabine 200 mg (FTC) (Truvada, Gilead Sciences) as antiretroviral preexposure prophylaxis (PrEP) to reduce the risk for HIV acquisition among MSM in the iPrEx trial, CDC issued interim guidance to make available information and important initial cautions on the use of PrEP in this population. Those recommendations remain valid for MSM, including MSM who also have sex with women. Since January 2011, data from studies of PrEP among heterosexual men and women have become available, and on July 16, 2012, the Food and Drug Administration (FDA) approved a label indication for reduction of risk for sexual acquisition of HIV infection among adults, including both heterosexuals and MSM. This interim guidance includes consideration of the new information and addresses pregnancy and safety issues for heterosexually active adults at very high risk for sexual HIV acquisition that were not discussed in the previous interim guidance for the use of PrEP in MSM.Reported by DK Smith, MD, Michael C. Thigpen, MD, Steven R. Nesheim, MD, Margaret A. Lampe, MPH, Lynn A. Paxton, MD, Taraz Samandari, MD, Amy Lansky, PhD, Jonathan Mermin, MD, Kevin Fenton, MD, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
BMC Infect Dis
No full textBackgroundA positive tuberculin skin test (TST) is often defined by skin induration of \ue2\u2030\ua510\uc2\ua0mm in people who are HIV-seronegative. However, to increase sensitivity for detection of Mycobacterium tuberculosis infection in the context of impaired immune function, a revised cut-off of \ue2\u2030\ua55\uc2\ua0mm is used for people living with HIV infection. The incremental proportion of patients who are included by this revised definition and the association between this proportion and CD4+ cell count are unknown.MethodsThe literature was systematically reviewed to determine the proportion of people living with HIV (PLWH) without evidence of active tuberculosis in low and middle-income countries who tested TST-positive using cut-offs of \ue2\u2030\ua55\uc2\ua0mm and \ue2\u2030\ua510\uc2\ua0mm of induration. The difference in the proportion testing TST-positive using the two cut-off sizes was calculated for all eligible studies and was stratified by geographical region and CD4+ cell count.ResultsA total of 32 studies identified meeting criteria were identified, providing data on 10,971 PLWH from sub-Saharan Africa, Asia and the Americas. The median proportion of PLWH testing TST-positive using a cut-off of \ue2\u2030\ua55\uc2\ua0mm was 26.8% (IQR, 19.8-46.1%; range, 2.5-81.0%). Using a cut-off of \ue2\u2030\ua510\uc2\ua0mm, the median proportion of PLWH testing TST-positive was 19.6% (IQR, 13.7-36.8%; range 0\ue2\u20ac\u201c52.1%). The median difference in the proportion of PLWH testing TST-positive using the two cut-offs was 6.0% (IQR, 3.4-10.1%; range, 0\ue2\u20ac\u201c37.6%). Among those with CD4+ cell counts of <200, 200\ue2\u20ac\u201c499 and \ue2\u2030\ua5500 cells/\uce\ubcL, the proportion of positive tests defined by the \ue2\u2030\ua55\uc2\ua0mm cut-off that were between 5.0 and 9.9\uc2\ua0mm in diameter was similar (12.5%, 12.9% and 10.5%, respectively).ConclusionsThere is a small incremental yield in the proportion of PLWH who test TST-positive when using an induration cut-off size of \ue2\u2030\ua55\uc2\ua0mm compared to \ue2\u2030\ua510\uc2\ua0mm. This proportion was similar across the range of CD4+ cell strata, supporting the current standardization of this cut-off at all levels of immunodeficiency
You have to find TB to treat TB
No full textAs we commemorate Dr. Robert Koch's 1882 discovery of Mycobacterium tuberculosis, the bacteria that causes TB, we are reminded of the many advances over the past 129 years in TB control. Through the intervention efforts of CDC, USAID, WHO's Stop TB Partnership, and many others, TB death rates have fallen by 35% since 1990, and as many as 6 million lives have been saved since 1995. In spite of these successes, TB still remains a serious threat, especially for those infected with HIV. HIV is the single most powerful risk factor for TB disease and one of the leading causes of death among people infected with HIV. Among the 1.7 million lives that TB claimed in 2009, 380,000 were among people with HIV infection. While people with HIV who have TB can be effectively diagnosed and treated, more effort is needed to diagnose and treat TB promptly and effectively, and to scale-up preventive treatment for TB. World TB Day presents CDC and its partners with a prime opportunity to discuss TB/HIV-related problems and solutions while renewing our support for worldwide TB control efforts. This special session of Public Health Grand Rounds seeks to dispel myths and misconceptions about TB and HIV, discuss actions needed to reduce the spread and burden of TB, and advance our efforts in preventing deaths from TB/HIV.Title from title screen (March 26, 2011).Streaming video (1:04:57 hr. : sd., col.).Jay Varma, MD, Chief, International Emerging Infections Program-China Division of Global Disease Detection and Response, Center for Global Health, CDC [Presentation: TB and HIV: friends with(out) benefits] -- Kevin Cain, MD,Chief, TB/HIV Team, International Research and Programs Branch, Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC [Presentation: You have to find TB to treat TB] -- Taraz Samandari, MD, PhD, Chief, Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Elimination, CDC [Presentation: You have to find TB to treat TB] -- Taraz Samandari, MD, PhD, Chief, Epidemiology Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Elimination, CDC [Presentation: If finding TB is so difficult, why not just prevent it?] -- Mario Raviglione, MD, Director, STOP TB Department, World Health Organization (WHO) [Presentation: From science to policy to impact] -- Thomas R. Frieden, MD, MPH, Director, Centers for Disease Control and Prevention Administrator, Agency for Toxic Substances and Disease Registry [Presentation: Fundamentals are fundamental]Facilitated by: Dr. Tanja Popovic, Scientific Director, Public Health Grand Rounds; Shane Joiner, Communication Manager, Public Health Grand Rounds.Recorded March 24, 2011.Mode of access: World Wide Web as streaming video (197 MB, total time: 1::00:13) and as an Acrobat .pdf file ((4.8 MB, 62 p.) containing PowerPoint slides for the speakers' talks.Open-captioned
J Acquir Immune Defic Syndr
No full textObjectiveIn Botswana, a 36-month course of isoniazid treatment of latent tuberculosis (TB) infection [isoniazid preventive therapy (IPT)] was superior to 6-month IPT in reducing TB and death in persons living with HIV (PLHIV), having positive tuberculin skin tests (TSTs) but not in those with negative TST. We examined the cost-effectiveness of IPT in Botswana, where antiretroviral therapy (ART) is widely available.DesignUsing a decision-analytic model, we determined the incremental cost-effectiveness of strategies for reducing TB and death in 10,000 PLHIV over 36 months.MethodsIPT for 6 months and provision of ART if CD4+ lymphocyte count <250 cells per microliter (2011 Botswana policy) was compared with 6 alternative strategies that varied the use of IPT, TST, and ART for CD4+ count thresholds, including CD4+ <350 and <500 cells per microliter.ResultsBotswana policy, 2011 was dominated by most other strategies. IPT of 36 months for TST-positive PLHIV with ART for CD4+ <250 cells per microliter resulted in 120 fewer TB cases for an additional cost of 2418 per death averted compared with provision of 6-month IPT to TST-positive PLHIV who received ART for CD4+ <250 cells per microliter, the next most effective strategy. Alternative strategies offered lower incremental effectiveness at higher cost. These findings remained consistent in sensitivity analyses.ConclusionsA strategy of treating PLHIV who have positive TST with 36-month IPT is more cost effective for reducing both TB and death compared with providing IPT without a TST, providing only 6-month IPT, or expanding ART eligibility without IPT.CC999999/Intramural CDC HHS/United State
Infect Dis Obstet Gynecol
No full textWhile 6- to 12-month courses of isoniazid for tuberculosis prevention are considered safe in pregnant women, the effects of longer-term isoniazid prophylaxis or isoniazid in combination with antiretroviral therapy (ART) are not established in human-immunodeficiency-virus-(HIV-) infected women who experience pregnancy during the course of therapy.|Nested study of pregnancy outcomes among HIV-infected women participating in a placebo-controlled, TB-prevention trial using 36 months daily isoniazid. Pregnancy outcomes were collected by interview and record review.|Among 196 pregnant women, 103 (52.6%) were exposed to isoniazid during pregnancy; all were exposed to antiretroviral drugs. Prior to pregnancy they had received a median of 341 days (range 1-1095) of isoniazid. We observed no isoniazid-associated hepatitis or other severe isoniazid-associated adverse events in the 103 women. Pregnancy outcomes were 132 term live births, 42 premature births, 11 stillbirths, 8 low birth weight, 6 spontaneous abortions, 4 neonatal deaths, and 1 congenital abnormality. In a multivariable model, neither isoniazid nor ART exposure during pregnancy was significantly associated with adverse pregnancy outcome (adjusted odds ratios 0.6, 95% CI: 0.3-1.1 and 1.8, 95% CI 0.9-3.6, resp.).|Long-term isoniazid prophylaxis was not associated with adverse pregnancy outcomes, such as preterm delivery, even in the context of ART exposure
Prev Med
No full textHIV disproportionately affects persons in Southeast United States. Primary care providers (PCPs) are vital for HIV prevention. Data are limited about their prescribing of antiretrovirals (ARVs) for prevention, including non-occupational post-exposure prophylaxis (nPEP), pre-exposure prophylaxis (PrEP), and antiretroviral therapy (ART). We examined these practices to assess gaps. During April-August 2017, we conducted an online survey of PCPs in Atlanta, Baltimore, Baton Rouge, Miami, New Orleans, and Washington, DC to assess HIV-related knowledge, attitudes and practices. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were used to estimate correlates of nPEP, PrEP and ART prescribing practices. Adjusting for MSA and specialty, the weighted sample (n\u202f=\u202f820, 29.6% adjusted response rate) comprised 60.2% white and 59.4% females. PCPs reported ever prescribing nPEP (31.0%), PrEP (18.1%), and ART (27.2%). Prescribing nPEP was associated with nPEP familiarity (aPR\u202f=\u202f2.63, 95% CI 1.59, 4.35) and prescribing PrEP (aPR\u202f=\u202f3.57, 95% CI 2.78, 4.55). Prescribing PrEP was associated with PrEP familiarity (aPR\u202f=\u202f4.35, 95% CI 2.63, 7.14), prescribing nPEP (aPR\u202f=\u202f5.00, 95% CI 2.00, 12.50), and providing care for persons with HIV (aPR\u202f=\u202f1.56, 95% CI 1.06, 2.27). Prescribing ART was associated with nPEP familiarity (aPR\u202f=\u202f1.89, 95% CI 1.27, 2.78) and practicing in outpatient public practice versus hospital-based facilities (aPR\u202f=\u202f2.14 95% CI 1.51, 3.04), and inversely associated with collaborations involving specialists (aPR\u202f=\u202f0.60, 95% CI 0.42, 0.86). A minority of PCPs surveyed from the Southeast report ever prescribing ARVs for prevention. Future efforts should include enhancing HIV care coordination and developing strategies to increase use of biomedical tools.CC999999/ImCDC/Intramural CDC HHSUnited States
PLoS One
No full textBackgroundParticipant non-adherence and loss to follow-up can compromise the validity of clinical trial results. An assessment of these issues was made in a 3-year tuberculosis prevention trial among HIV-infected adults in Botswana.Methods and FindingsBetween 11/2004\u201307/2006, 1995 participants were enrolled at eight public health clinics. They returned monthly to receive bottles of medication and were expected to take daily tablets of isoniazid or placebo for three years. Non-adherence was defined as refusing tablet ingestion but agreeing to quarterly physical examinations. Loss to follow-up was defined as not having returned for appointments in 6560 days. Between 10/2008\u201304/2009, survey interviews were conducted with 83 participants identified as lost to follow-up and 127 identified as non-adherent. As a comparison, 252 randomly selected adherent participants were also surveyed. Multivariate logistic regression analysis was used to identify associations with selected risk factors. Men had higher odds of being non-adherent (adjusted odds ratio (AOR), 2.24; 95% confidence interval [95%CI] 1.24\u20134.04) and lost to follow-up (AOR 3.08; 95%CI 1.50\u20136.33). Non-adherent participants had higher odds of reporting difficulties taking the regimen or not knowing if they had difficulties (AOR 3.40; 95%CI 1.75\u20136.60) and lower odds associated with each year of age (AOR 0.95; 95%CI 0.91\u20130.98), but other variables such as employment, distance from clinic, alcohol use, and understanding study requirements were not significantly different than controls. Among participants who were non-adherent or lost to follow-up, 40/210 (19.0%) reported that they stopped the medication because of work commitments and 33/210 (15.7%) said they thought they had completed the study.ConclusionsMen had higher odds of non-adherence and loss to follow-up than women. Potential interventions that might improve adherence in trial participants may include:targeting health education for men, reducing barriers, clarifying study expectations, educating employers about HIV/AIDS to help reduce stigma in the workplace, and encouraging employers to support employee health.Trial RegistrationClinicalTrials.gov NCT0016428120111023
Am J Public Health
No full textCC999999/Intramural CDC HHS/United States2018-10-01T00:00:00Z28902548PMC5607687vault:3059
Adaptation to climate change: historical evidence from the Indian monsoon
No full textAbstractEstimating the potential impacts of climate change requires understanding the ability of agents to adapt to changes in their climate. This paper uses panel data from India spanning from 1956 to 1999 to investigate the ability of farmers to adapt. To identify adaptation, the author exploits persistent, multidecadal monsoon regimes during which droughts or floods are more common. These regimes generate medium-run variation in average rainfall, and there is spatial variation in the timing of the regimes. Using a fixed-effects strategy, she tests whether farmers have adapted to the medium-run rainfall variation induced by the monsoon regimes. The author finds evidence that farmers adjust their irrigation investments and their crop portfolios in response to the medium-run rainfall variation. However, adaptation only recovers a small fraction of the profits farmers have lost due to adverse climate variation.</jats:p
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