Background: The number of cases of gonorrhoea in the USA and worldwide caused by Neisseria gonorrhoeae is increasing (555 608 reported US cases in 2017, and 87 million cases worldwide in 2016). Many countries report d...
Background: The number of cases of gonorrhoea in the USA and worldwide caused by Neisseria gonorrhoeae is increasing (555 608 reported US cases in 2017, and 87 million cases worldwide in 2016). Many countries report declining in vitro susceptibility of azithromycin, which is a concern because azithromycin and ceftriaxone are the recommended dual treatment in many countries. We aimed to identify strain types associated with decreased susceptibility to azithromycin. Methods: We did a genomic analysis of N gonorrhoeae isolates obtained by the US Gonococcal Isolate Surveillance Project. Isolates were whole-genome sequenced based on decreased susceptibility to azithromycin (minimal inhibitory concentration [MIC] ≥2 μg/mL, using agar dilution antibiotic susceptibility testing) and geographical representation. Bioinformatic analyses established genomic diversity, strain population dynamics, and antimicrobial resistance profiles. Findings: 410 isolates were sorted into more than 20 unique phylogenetic clades. One predominant persistent clade (consisting of 97 isolates) included the most isolates with azithromycin MICs of 2 μg/mL or higher (61 of 97 [63%] vs 59 of 311 [19%];p<0·0001) and carried a mosaic mtr (multiple transferable resistance) locus (68 of 97 [70%] vs two of 313 [1%];p<0·0001). Of the remaining 313 isolates, 57 (18%) had decreased susceptibility to azithromycin (MIC ≥4 μg/mL), which was attributed to 23S rRNA variants (56 of 57 [98%]) and formed phylogenetically diverse clades, showing various levels of clonal expansion. Interpretation: Reduced azithromycin susceptibility was associated with expanding and persistent clades harbouring two well described resistance mechanisms, mosaic mtr locus and 23S rRNA variants. Understanding the role of recombination, particularly within the mtr locus, on the fitness and expansion of strains with decreased susceptibility has important implications for the public health response to minimise gonorrhoea transmission. Funding:
In this Review, we summarise outputs from a multidisciplinary consultation convened by WHO between July 11 and 13, 2023, to discuss hepatitis B virus (HBV) drug resistance (HBVDR). Treatment of chronic HBV infection w...
BackgroundSince 2014, the Thailand National Guidelines have recommended pre-exposure prophylaxis (PrEP) to prevent hiv among persons at risk. In March 2016, Silom Community Clinic (SCC) began PrEP provision to men who...
Background
Since 2014, the Thailand National Guidelines have recommended pre-exposure prophylaxis (PrEP) to prevent hiv among persons at risk. In March 2016, Silom Community Clinic (SCC) began PrEP provision to men who have sex with men (MSM) and transgender women (TGW) in Bangkok, Thailand.
Methods
SCC staff routinely counseled MSM and TGW attending hiv voluntary counseling and testing about PrEP. If clients believed that they were at substantial risk of hiv and were interested in PrEP, they could receive PrEP after screening that included hiv and renal function testing. Eligible clients received a 30-day supply of daily oral tenofovir-emtricitabine costing 800 Baht (30 USD), and completed a baseline computer-assisted self-interview (CASI) on knowledge and behaviors. At every 3-month follow-up, PrEP clients had a CASI on adherence; if they were interested in discontinuation of PrEP, they completed a CASI that included reasons for discontinuation. We conducted a descriptive analysis of baseline and follow-up CASI results.
Results
From March 2016 to February 2018, 192 clients were prescribed PrEP, and 80 (42%) continued PrEP for at least 6 months. The median age of clients starting PrEP was 31 years (range, 17–67 years), and 98% were MSM. Overall, most (77%) reported at least 1 of four risk behaviors in the last 3 months; among the 148, 120 (81%) had a sex partner with unknown or positive hiv status, 99 (67%) had anal sex without a condom, 22 (15%) reported an STI, and 16 (11%) received money or goods in exchange for sex. Among the 166 clients who returned for at least one follow-up visit, 135 (81%) completed the CASI at the last follow-up visit; of those, 106 (78%) reported 100% adherence to daily PrEP in the last 7 days, and 126 (93%) reported ≥80% adherence in the last 30 days. Of the 36 clients who discontinued PrEP and completed CASI, 33% reported the reason for discontinuation was no current hiv risk (33%); most (69%) reported that they would consider PrEP in t
Background: The sustainable development goals (SDGs) aim to end hiv/AIDS as a public health threat by 2030. Understanding the current state of the hiv epidemic and its change over time is essential to this effort. Thi...
Background: The sustainable development goals (SDGs) aim to end hiv/AIDS as a public health threat by 2030. Understanding the current state of the hiv epidemic and its change over time is essential to this effort. This study assesses the current sex-specific hiv burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific hiv-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with hiv (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with hiv worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with hiv in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was
A1 What does an ABI look like when delivered in the prison setting: perspectives and experiences of male remand prisoners and relevant stakeholders Aisha S. Holloway1, Jennifer Ferguson2, Sarah Landale3, Laura Cariola...
A1 What does an ABI look like when delivered in the prison setting: perspectives and experiences of male remand prisoners and relevant stakeholders Aisha S. Holloway1, Jennifer Ferguson2, Sarah Landale3, Laura Cariola3, Dorothy Newbury-Birch2 1Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK; 2Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, UK; 3School of Health in Social Science, The University of Edinburgh, Edinburgh, UK Correspondence: Aisha Holloway - ***@*** Addiction Science & Clinical Practice 2017, 12(Suppl 1): A1 Background: Addressing alcohol harm in prisons can potentially reduce the risk of re-offending, and costs to society, whilst tackling health inequalities. Health savings of £4.3 m and crime savings of £100 m per year can be a result of appropriate alcohol interventions. Prison therefore offers an opportunity for the identification, response and/or referral to treatment for those male remand prisoners who are consuming alcohol above recommended levels. There is however, limited evidence for the effectiveness, optimum timing of delivery, recommended length, content, implementation and economic benefit of Alcohol Brief Interventions (ABI) in the prison setting for male remand prisoners. As part of the PRISM-A study, we aimed to explore the ‘elements’ of an acceptable ABI for delivery, experiences of engagement with services/health professionals about alcohol use, alongside barriers and facilitators to implementation within the prison setting for male remand prisoners. Materials and methods: Twenty-four in-depth interviews were conducted with adult male remand prisoners at one Scottish prison (n = 12) and one English prison (n = 12). A focus group at each of the prison sites was held with key stakeholders (e.g. prison nurses, prison officers, voluntary alcohol/addiction services, health service managers and commissioners).
Purpose. To examine perceptions of phase-I human immunodeficiency virus (hiv) vaccine trial participation among African-Americans and Hispanics in San Francisco, California.;Design. Qualitative, semistructured intervi...
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