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Epidemiology of Hepatitis B Virus Infection and Impact of Vaccination on Disease

CLINICS IN LIVER DISEASE 2016年第4期20卷 607-+页

作者： Nelson, Noele P. Easterbrook, Philippa J. McMahon, Brian J. Ctr Dis Control & Prevent Clin Intervent Team Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven 1600 Clifton RdMS G37 Atlanta GA 30329 USA World Hlth Org HIV Dept Global Hepatitis Programme 20 Via Appia CH-1211 Geneva Switzerland Alaska Native Tribal Hlth Consortium Alaska Native Med Ctr Liver Dis & Hepatitis Program 4315 Diplomacy Dr Anchorage AK 99508 USA

Integration of hepatitis B vaccination into national immunization programs has resulted in substantial reductions of hepatitis B virus (HBV) transmission in previously high endemic countries. The key strategy for control of the HBV epidemic is birth dose and infant vaccination. Additional measures include use of hepatitis B immunoglobulin (HBIG) and diagnosis of mothers at high risk of transmitting HBV and use of antiviral agents during pregnancy to decrease maternal DNA concentrations to undetectable concentrations. Despite the substantial decrease in HBV cases since vaccination introduction, implementation of birth dose vaccination in low-income and middle-income countries and vaccination of high-risk adults remain challenging.

关键词： Hepatitis B virus Hepatitis B vaccine Birth dose Perinatal transmission Vaccine impact

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The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990-2019: Findings from the Global Burden of Disease Study 2019

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LANCET REGIONAL HEALTH-EUROPE 2022年 16卷 100341-100341页

作者： Castelpietra, Giulio Knudsen, Ann Kristin Skrindo Agardh, Emilie E. Armocida, Benedetta Beghi, Massimiliano Iburg, Kim Moesgaard Logroscino, Giancarlo Ma, Rui Starace, Fabrizio Steel, Nicholas Addolorato, Giovanni Andrei, Catalina Liliana Andrei, Tudorel Ayuso-Mateos, Jose L. Banach, Maciej Barnighausen, Till Winfried Barone-Adesi, Francesco Bhagavathula, Akshaya Srikanth Carvalho, Felix Carvalho, Marcia Chandan, Joht Singh Chattu, Vijay Kumar Couto, Rosa A. S. Cruz-Martins, Natalia Dargan, Paul, I Deuba, Keshab da Silva, Diana Dias Fagbamigbe, Adeniyi Francis Fernandes, Eduarda Ferrara, Pietro Fischer, Florian Gaal, Peter Andras Gialluisi, Alessandro Haagsma, Juanita A. Haro, Josep Maria Hasan, M. Tasdik Hasan, Syed Shahzad Hostiuc, Sorin Iacoviello, Licia Iavicoli, Ivo Jamshidi, Elham Jonas, Jost B. Joo, Tamas Jozwiak, Jacek Jerzy Katikireddi, Srinivasa Vittal Kauppila, Joonas H. Khan, Moien A. B. Kisa, Adnan Kisa, Sezer Kivimaki, Mika Koly, Kamrun Nahar Koyanagi, Ai Kumar, Manasi Lallukka, Tea Langguth, Berthold Ledda, Caterina Lee, Paul H. Lega, Ilaria Linehan, Christine Loureiro, Joana A. Madureira-Carvalho, Aurea M. Martinez-Raga, Jose Mathur, Manu Raj McGrath, John J. Mechili, Enkeleint A. Mentis, Alexios-Fotios A. Mestrovic, Tomislav Miazgowski, Bartosz Mirica, Andreea Mirijello, Antonio Moazen, Babak Mohammed, Shafiu Mulita, Francesk Nagel, Gabriele Negoi, Ionut Negoi, Ruxandra Irina Nwatah, Vincent Ebuka Padron-Monedero, Alicia Panda-Jonas, Songhomitra Pardhan, Shahina Pasovic, Maja Patel, Jay Petcu, Ionela-Roxana Pinheiro, Marina Pollok, Richard Charles G. Postma, Maarten J. Rawaf, David Laith Rawaf, Salman Romero-Rodriguez, Esperanza Ronfani, Luca Sagoe, Dominic Sanmarchi, Francesco Schaub, Michael P. Sharew, Nigussie Tadesse Shiri, Rahman Shokraneh, Farhad Sigfusdottir, Inga Dora Silva, Joao Pedro Silva, Renata Socea, Bogdan Szocska, Miklos Tabares-Seisdedos, Rafael Torrado, Marco Tovani-Palone, Marcos Roberto Vasankari, Tommi Juhani Veroux, Massimiliano Viner, Russell M. Werdecker, Andrea Winkler, A Cent Hlth Directorate Outpatient & Inpatient Care Serv I-34100 Trieste Italy Norwegian Inst Publ Hlth Ctr Dis Burden Bergen Norway Karolinska Inst Dept Global Publ Hlth Stockholm Sweden Natl Inst Hlth Dept Cardiovasc Endocrine Metab Dis & Aging Rome Italy AUSL Romagna Dept Mental Hlth Ravenna Italy Aarhus Univ Dept Publ Hlth Aarhus Denmark Univ Bari Aldo Moro Dept Basic Med Sci Neurosci & Sense Organs Bari Italy Fdn Cardinale Giovanni Panico Hosp Dept Clin Res Neurol Tricase Italy Univ Washington Inst Hlth Metr & Evaluat Dept Hlth Metr Sci Seattle WA 98195 USA AUSL Modena Dept Mental Hlth & Drug Abuse Modena Italy Univ East Anglia Dept Primary Care & Publ Hlth Norwich Norfolk England Publ Hlth England London England Univ Cattolica Sacro Cuore Dept Internal Med Rome Italy Carol Davila Univ Med & Pharm Cardiol Dept Bucharest Romania Bucharest Carol Davila Univ Econ Studies Dept Stat & Econometr Bucharest Romania Inst Hlth Carlos III CIBERSAM Madrid Spain Med Univ Lodz Dept Hypertens Lodz Poland Heidelberg Univ Heidelberg Inst Global Hlth HIGH Heidelberg Germany Harvard Univ TH Chan Sch Publ Hlth Boston MA 02115 USA Univ Piemonte Orientale Dept Translat Med Novara Italy Charles Univ Prague Dept Social & Clin Pharm Hradec Kralova Czech Republic United Arab Emirates Univ Inst Publ Hlth Al Ain U Arab Emirates Univ Porto Res Unit Appl Mol Biosci UCIBIO Porto Portugal Univ Fernando Pessoa Fac Hlth Sci Porto Portugal Univ Birmingham Inst Appl Hlth Res Birmingham W Midlands England Univ West Indies Fac Med Sci St Augustine Trinidad Tobago Univ Porto Dept Chem Sci Porto Portugal Univ Porto Dept Med Porto Portugal Inst Res & Adv Training Hlth Sci & Technol CESPU Dept Hlth Sci Famalicao Portugal Kings Coll London Fac Life Sci & Med London England Guys & St Thomas NHS Fdn Trust Dept Clin Toxicol London England Save Children Natl Ctr AIDS & STD Control Kathmandu Nepal Univ Porto Lab Toxicol Porto Portugal Univ Ibadan Epidemiol

Background Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time. Methods Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated. Findings In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 - 21,630) for MDs, 3,891 (3,020 4,905) for SUDs, and 89.1 (63.8 - 123.1) for self-harm. In terms of disability, anxiety contributed to 647.3 (432 -912.3) YLDs, while in terms of premature death, self-harm contributed to 319.6 (248.9-412.8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14.9%;9.4-20.1) and drug use disorders (16.9%;8.9-26.3), and decreased in idiopathic developmental intellectual disability (-29.1%;23.8-38.5). YLLs decreased in self-harm (-27.9%;38.3-18.7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs. Interpretation Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people. Funding The Bill and Melinda Gates Foundation Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://***/licenses/by/4.0/)

关键词： Young people Mental health Mental disorders Self-harm Substance use Europe

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Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

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LANCET GLOBAL HEALTH 2022年第12期10卷 E1715-E1743页

作者： Lozano, Rafael Haakenstad, Annie Yearwood, Jamal Akeem Fullman, Nancy Bintz, Corinne Bienhoff, Kelly Weaver, Marcia R. Nandakumar, Vishnu Joffe, Jonah N. LeGrand, Kate E. Knight, Megan Abbafati, Cristiana Abbasi-Kangevari, Mohsen Abdoli, Amir Abeldano Zuniga, Roberto Ariel Adedeji, Isaac Akinkunmi Adekanmbi, Victor Adetokunboh, Olatunji O. Afzal, Muhammad Sohail Afzal, Saira Agudelo-Botero, Marcela Ahinkorah, Bright Opoku Ahmad, Sajjad Ahmadi, Ali Ahmadi, Sepideh Ahmed, Ali Rashid, Tarik Ahmed Aji, Budi Akande-Sholabi, Wuraola Alam, Khurshid Al Hamad, Hanadi Alhassan, Robert Kaba Ali, Liaqat Alipour, Vahid Aljunid, Syed Mohamed Ameyaw, Edward Kwabena Amin, Tarek Tawfik Amu, Hubert Amugsi, Dickson A. Ancuceanu, Robert Andrade, Pedro Prata Anjum, Afifa Arabloo, Jalal Arab-Zozani, Morteza Ariffin, Hany Arulappan, Judie Aryan, Zahra Ashraf, Tahira Atnafu, Desta Debalkie Atreya, Alok Ausloos, Marcel Avila-Burgos, Leticia Ayano, Getinet Ayanore, Martin Amogre Azari, Samad Badiye, Ashish D. Baig, Atif Amin Bairwa, Mohan Bakkannavar, Shankar M. Baliga, Shrikala Banik, Palash Chandra Baernighausen, Till Winfried Barra, Fabio Barrow, Amadou Basu, Sanjay Bayati, Mohsen Belete, Rebuma Bell, Arielle Wilder Bhagat, Devidas S. Bhagavathula, Akshaya Srikanth Bhardwaj, Pankaj Bhardwaj, Nikha Bhaskar, Sonu Bhattacharyya, Krittika Bhutta, Zulfiqar A. Bibi, Sadia Bijani, Ali Bikbov, Boris Biondi, Antonio Bolarinwa, Obasanjo Afolabi Bonny, Aime Brenner, Hermann Buonsenso, Danilo Burkart, Katrin Busse, Reinhard Butt, Zahid A. Butt, Nadeem Shafique Caetano dos Santos, Florentino Luciano Cahuana-Hurtado, Lucero Alberto Camera, Luis Cardenas, Rosario Carneiro, Vera L. A. Catala-Lopez, Ferran Chandan, Joht Singh Charan, Jaykaran Chavan, Prachi P. Chen, Simiao Chen, Shu Choudhari, Sonali Gajanan Chowdhury, Enayet Karim Chowdhury, Mohiuddin Ahsanul Kabir Cirillo, Massimo Corso, Barbara Dadras, Omid Dahlawi, Saad M. A. Dai, Xiaochen Dandona, Lalit Dandona, Rakhi Dangel, William James Alberto Davila-Cervantes, Claudio Davletov, Kairat Deuba, Univ Washington Inst Hlth Metr & Evaluat Seattle WA 98195 USA Univ Washington Sch Med Dept Hlth Metr Sci Seattle WA USA Univ Washington Div Allergy & Infect Dis Seattle WA 98195 USA Univ Washington Dept Anesthesiol & Pain Med Seattle WA 98195 USA Harvard Univ Dept Global Hlth & Populat Boston MA 02115 USA Harvard Univ Brigham & Womens Hosp Boston MA 02115 USA Harvard Univ TH Chan Sch Publ Hlth Boston MA 02115 USA Harvard Univ Ctr Primary Care Boston MA 02115 USA Harvard Univ Dept Global Hlth & Social Med Boston MA 02115 USA Harvard Univ Div Cardiol Boston MA 02115 USA Harvard Univ Div Gen Internal Med Boston MA 02115 USA Gates Ventures Dept Nutr Seattle WA USA Univ Roma La Sapienza Dept Jurid & Econ Studies Rome Italy Univ Tehran Med Sci Noncommunicable Dis Res Ctr Tehran Iran Univ Tehran Med Sci Natl Inst Hlth Res Tehran Iran Univ Tehran Med Sci Multiple Sclerosis Res Ctr Tehran Iran Univ Tehran Med Sci Students Sci Res Ctr SSRC Tehran Iran Univ Tehran Med Sci Digest Dis Res Inst Tehran Iran Univ Tehran Med Sci Dept Epidemiol & Biostat Tehran Iran Univ Tehran Med Sci Sina Trauma & Surg Res Ctr Tehran Iran Jahrom Univ Med Sci Zoonoses Res Ctr Jahrom Iran Univ Sierra Sur Postgrad Dept Miahuatlan De Porfirio D Mexico Natl Res Council Mexico Mexico City DF Mexico Olabisi Onabanjo Univ Dept Sociol Ago Iwoye Nigeria Univ Texas Galveston Dept Obstet & Gynecol Galveston TX USA Univ Texas Galveston Off Hlth Policy & Legislat Affairs Galveston TX USA Stellenbosch Univ DSI NRF Ctr Excellence Epidemiol Modelling & Anal Stellenbosch South Africa Stellenbosch Univ Div Epidemiol & Biostat Cape Town South Africa Univ Management & Technol Dept Life Sci Lahore Pakistan King Edward Mem Hosp Dept Community Med Lahore Pakistan Inst Publ Hlth Dept Publ Hlth Lahore Pakistan Univ Nacl Autonoma Mexico Ctr Policy Populat & Hlth Res Mexico City DF Mexico Univ Nacl Autonoma Mexico Hlth Policy & Populat Res Ctr CIPPS Mexico City DF Mexico U

Background Health-care needs change throughout the life course. It is thus crucial to assess whether health systems provide access to quality health care for all ages. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we measured the Healthcare Access and Quality (HAQ) Index overall and for select age groups in 204 locations from 1990 to 2019. Methods We distinguished the overall HAQ Index (ages 0-74 years) from scores for select age groups: the young (ages 0-14 years), working (ages 15-64 years), and post-working (ages 65-74 years) groups. For GBD 2019, HAQ Index construction methods were updated to use the arithmetic mean of scaled mortality-to-incidence ratios (MIRs) and risk-standardised death rates (RSDRs) for 32 causes of death that should not occur in the presence of timely, quality health care. Across locations and years, MIRs and RSDRs were scaled from 0 (worst) to 100 (best) separately, putting the HAQ Index on a different relative scale for each age group. We estimated absolute convergence for each group on the basis of whether the HAQ Index grew faster in absolute terms between 1990 and 2019 in countries with lower 1990 HAQ Index scores than countries with higher 1990 HAQ Index scores and by Socio-demographic Index (SDI) quintile. SDI is a summary metric of overall development. Findings Between 1990 and 2019, the HAQ Index increased overall (by 19.6 points, 95% uncertainty interval 17.9-21.3), as well as among the young (22.5, 19.9-24.7), working (17.2, 15.2-19.1), and post-working (15.1, 13.2-17.0) age groups. Large differences in HAQ Index scores were present across SDI levels in 2019, with the overall index ranging from 30.7 (28.6-33.0) on average in low-SDI countries to 83.4 (82.4-84.3) on average in highSDI countries. Similarly large ranges between low-SDI and high-SDI countries, respectively, were estimated in the HAQ Index for the young (40.4-89.0), working (33.8-82.8), and post-working (30.4-79.1) group

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Awareness and attitudes towards HIV/aids among residents of Kandy, Sri Lanka

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aids CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF aids/HIV 2015年第3期27卷 387-391页

作者： Navaratna, Samidi Kanda, Koji Dharmaratne, Samath D. Tennakoon, Sampath Jayasinghe, Ananda Jayasekara, Niroshan Nagano, Katsutoshi Obayashi, Yoshihide Arai, Asuna Tamashiro, Hiko Univ Peradeniya Fac Med Dept Community Med Peradeniya Sri Lanka Hokkaido Univ Grad Sch Med Dept Global Hlth & Epidemiol Sapporo Hokkaido Japan Natl STD AIDS Control Programme Colombo Sri Lanka

Currently, interventions for HIV/aids control in Sri Lanka are only carried out among the most-at-risk populations. This study was conducted to identify the level of awareness and stigma-related attitudes among the general population of Sri Lanka. A cross-sectional study was carried out among 869 residents of 18-64 years of age in Kandy, Sri Lanka. A self-administered questionnaire was utilised to obtain information about stigma, discrimination and HIV/aids-related knowledge. Chi-square test and multivariate analysis were applied to find possible associations between HIV-related variables and socio-demographic indicators. Response rate was 82.0%. Overall, 93.5% of the participants have heard of HIV/aids but the knowledge on HIV/aids was low with an average score of 51.7%, no statistically significant difference between genders (p = 0.352). Only 58.1% were aware that a condom was an effective tool for its prevention. There were many misconceptions related to epidemiology of HIV/aids. The participants showed more positive attitudes towards HIV/aids and people living with HIV/aids (PLHIV) for all questionnaire items except for those listed under shame and blame. Positive attitudes towards PLHIV were observed to be greater among those with a better HIV/aids-related knowledge score. There was no significant association between the attitudes towards PLHIV and socio-demographic characteristics such as ethnicity and religion. There is a greater need of making attempts towards educating the public regarding HIV/aids to eliminate misconceptions prevalent in the society. Stigma-related attitudes are mainly due to shame and blame associated with the disease. As the attitudes towards PLHIV were more positive among those with a better HIV/aids-related knowledge score, targeted HIV/aids-related health education interventions maybe recommended in this regard.

关键词： general population attitudes: stigma Sri Lanka awareness

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Delivering Prevention Interventions to People Living with HIV in Clinical Care Settings: Results of a Cluster Randomized Trial in Kenya, Namibia, and Tanzania

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aids AND BEHAVIOR 2016年第9期20卷 2110-2118页

作者： Bachanas, Pamela Kidder, Daniel Medley, Amy Pals, Sherri L. Carpenter, Deborah Howard, Andrea Antelman, Gretchen DeLuca, Nicolas Muhenje, Odylia Sheriff, Muhsin Somi, Geoffrey Katuta, Frieda Cherutich, Peter Moore, Janet US Ctr Dis Control & Prevent Div Global HIV AIDS 1600 Clifton RdMS E04 Atlanta GA 30333 USA US Ctr Dis Control & Prevent Div Global HIV AIDS Dar Es Salaam Tanzania Columbia Univ ICAP New York NY USA Columbia Univ ICAP Tanzania Dar Es Salaam Tanzania US Ctr Dis Control & Prevent Div Global HIV AIDS Windhoek Namibia US Ctr Dis Control & Prevent Div Global HIV AIDS Nairobi Kenya Columbia Univ ICAP Kenya Nairobi Kenya Minist Hlth & Social Welf Dar Es Salaam Tanzania Minist Hlth & Social Serv Windhoek Namibia Natl AIDS STD Control Programme NASCOP Nairobi Kenya

We conducted a group randomized trial to assess the feasibility and effectiveness of a multi-component, clinic-based HIV prevention intervention for HIV-positive patients attending clinical care in Namibia, Kenya, and Tanzania. Eighteen HIV care and treatment clinics (six per country) were randomly assigned to intervention or control arms. Approximately 200 sexually active clients from each clinic were enrolled and interviewed at baseline and 6- and 12-months post-intervention. Mixed model logistic regression with random effects for clinic and participant was used to assess the effectiveness of the intervention. Of 3522 HIV-positive patients enrolled, 3034 (86 %) completed a 12-month follow-up interview. Intervention participants were significantly more likely to report receiving provider-delivered messages on disclosure, partner testing, family planning, alcohol reduction, and consistent condom use compared to participants in comparison clinics. Participants in intervention clinics were less likely to report unprotected sex in the past 2 weeks (OR = 0.56, 95 % CI 0.32, 0.99) compared to participants in comparison clinics. In Tanzania, a higher percentage of participants in intervention clinics (17 %) reported using a highly effective method of contraception compared to participants in comparison clinics (10 %, OR = 2.25, 95 % CI 1.24, 4.10). This effect was not observed in Kenya or Namibia. HIV prevention services are feasible to implement as part of routine care and are associated with a self-reported decrease in unprotected sex. Further operational research is needed to identify strategies to address common operational challenges including staff turnover and large patient volumes.

关键词： HIV/aids Sub-Saharan Africa HIV prevention People living with HIV

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HIV and STI Prevalence and Injection Behaviors Among People Who Inject Drugs in Nairobi: Results from a 2011 Bio-behavioral Study Using Respondent-Driven Sampling

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aids AND BEHAVIOR 2015年第1期19卷 S24-S35页

作者： Tun, Waimar Sheehy, Meredith Broz, Dita Okal, Jerry Muraguri, Nicholas Raymond, H. Fisher Musyoki, Helgar Kim, Andrea A. Muthui, Mercy Geibel, Scott Populat Council HIV & AIDS Program Washington DC 20008 USA Populat Council New York NY 10021 USA Ctr Dis Control & Prevent HHS Div Global HIV AIDS Ctr Global Hlth Atlanta GA USA Ctr Global Hlth Div Global HIV AIDS Atlanta GA USA Populat Council Nairobi Kenya Natl AIDS & STD Control Programme Nairobi Kenya San Francisco Dept Hlth San Francisco CA USA Ctr Dis Control & Prevent HHS Div Global HIV AIDS Ctr Global Hlth Nairobi Kenya Ctr Global Hlth Div Global HIV AIDS Nairobi Kenya

There is a dearth of evidence on injection drug use and associated HIV infections in Kenya. To generate population-based estimates of characteristics and HIV/STI prevalence among people who inject drugs (PWID) in Nairobi, a cross-sectional study was conducted with 269 PWID using respondent-driven sampling. PWID were predominantly male (92.5 %). An estimated 67.3 % engaged in at least one risky injection practice in a typical month. HIV prevalence was 18.7 % (95 % CI 12.3-26.7), while STI prevalence was lower [syphilis: 1.7 % (95 % CI 0.2-6.0);gonorrhea: 1.5 % (95 % CI 0.1-4.9);and Chlamydia: 4.2 % (95 % CI 1.2-7.8)]. HIV infection was associated with being female (aOR, 3.5;p = 0.048), having first injected drugs 5 or more years ago (aOR, 4.3;p = 0.002), and ever having practiced receptive syringe sharing (aOR, 6.2;p = 0.001). Comprehensive harm reduction programs tailored toward PWID and their sex partners must be fully implemented as part of Kenya's national HIV prevention strategy.

关键词： HIV prevalence STI prevalence People who inject drugs Kenya Integrated biobehavioral Surveillance survey Respondent-driven sampling

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Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention

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LANCET 2014年第9939期384卷 272-279页

作者： Jones, Alexandra Cremin, Ide Abdullah, Fareed Idoko, John Cherutich, Peter Kilonzo, Nduku Rees, Helen Hallett, Timothy O'Reilly, Kevin Koechlin, Florence Schwartlander, Bernhard de Zalduondo, Barbara Kim, Susan Jay, Jonathan Huh, Jacqueline Piot, Peter Dybul, Mark Georgetown Univ Ctr Law ONeill Inst Natl & Global Hlth Law Washington DC USA Univ London Imperial Coll Sci Technol & Med Sch Publ Hlth London England SANAC Pretoria South Africa Natl Agcy Control AIDS Abuja Nigeria Natl AIDS STD Control Programme NASCOP Nairobi Kenya Liverpool Voluntary Counselling & Testing Care & Nairobi Kenya Univ Witwatersrand Wits Reprod Hlth & HIV Inst ZA-2050 Johannesburg South Africa WHO Dept HIV AIDS CH-1211 Geneva Switzerland UNAIDS Dept Evidence Strategy & Results Geneva Switzerland UNAIDS Off Deputy Execut Director Programme Geneva Switzerland London Sch Hyg & Trop Med Directors Off London WC1 England Global Fund Fight AIDS TB & Malaria Geneva Switzerland

Large declines in HIV incidence have been reported since 2001, and scientific advances in HIV prevention provide strong hope to reduce incidence further. Now is the time to replace the quest for so-called silver bullets with a public health approach to combination prevention that understands that risk is not evenly distributed and that effective interventions can vary by risk profile. Different countries have different microepidemics, with very different levels of transmission and risk groups, changing over time. Therefore, focus should be on high-transmission geographies, people at highest risk for HIV, and the package of interventions that are most likely to have the largest effect in each different microepidemic. Building on the backbone of behaviour change, condom use, and medical male circumcision, as well as expanded use of antiretroviral drugs for infected people and pre-exposure prophylaxis for uninfected people at high risk of infection, it is now possible to consider the prospect of what would be one of the most remarkable achievements in the history of public health: reduction of HIV transmission from a pandemic to low-level endemicity.

关键词： Epidemic infection risk aids prevention Population at Risk HIV Persons Pre-Exposure Prophylaxis Pandemics Public Health Circumcision, Male

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Alcohol use and its association with HIV risk behaviors among a cohort of patients attending HIV clinical care in Tanzania, Kenya, and Namibia

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aids CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF aids/HIV 2014年第10期26卷 1288-1297页

作者： Medley, Amy Seth, Puja Pathak, Sonal Howard, Andrea A. DeLuca, Nickolas Matiko, Eva Mwinyi, Abubakari Katuta, Frieda Sheriff, Mushin Makyao, Neema Wanjiku, Lucy Ngare, Carol Bachanas, Pamela US Ctr Dis Control & Prevent Div Global HIV AIDS Atlanta GA 30333 USA ICF Int Atlanta GA USA Columbia Univ Int Ctr AIDS Care & Treatment Programs ICAP New York NY USA US Ctr Dis Control & Prevent Dar Es Salaam Tanzania Columbia Univ Int Ctr AIDS Care & Treatment Programs ICAP Dar Es Salaam Tanzania Minist Hlth & Social Serv Windhoek Namibia Columbia Univ Int Ctr AIDS Care & Treatment Programs ICAP Nairobi Kenya Minist Hlth & Social Welf Dar Es Salaam Tanzania US Ctr Dis Control & Prevent Nairobi Kenya Natl AIDS STD Control Programme NASCOP Nairobi Kenya

This article describes the frequency of alcohol use among HIV-positive patients attending clinical care in sub-Saharan Africa and explores the association between alcohol use, medication adherence, and sexual risk behavior. Data from 3538 patients attending an HIV clinic in Kenya, Tanzania, or Namibia were captured through interview and medical record abstraction. Participants were categorized into three drinking categories: nondrinkers, nonharmful drinkers, and harmful/likely dependent drinkers. A proportional odds model was used to identify correlates associated with categories of alcohol use. Overall, 20% of participants reported alcohol use in the past 6 months;15% were categorized as nonharmful drinkers and 5% as harmful/likely dependent drinkers. Participants who reported missing a dose of their HIV medications [adjusted odds ratio (AOR): 2.04, 95% confidence interval (CI): 1.67, 2.49];inconsistent condom use (AOR: 1.49, 95% CI: 1.23, 1.79);exchanging sex for food, money, gifts, or a place to stay (AOR: 1.57, 95% CI: 1.06, 2.32);and having a sexually transmitted infection symptom (AOR: 1.40, 95% CI: 1.10, 1.77) were more likely to be categorized in the higher risk drinking categories. This research highlights the need to integrate alcohol screening and counseling into the adherence and risk reduction counseling offered to HIV-positive patients as part of their routine care. Moreover, given the numerous intersections between alcohol and HIV, policies that focus on reducing alcohol consumption and alcohol-related risk behavior should be integrated into HIV prevention, care, and treatment strategies.

关键词： alcohol use HIV/aids HIV risk behavior sub-Saharan Africa

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Collaborative Effort for a Centralized Worldwide Tuberculosis Relational Sequencing Data Platform

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CLINICAL INFECTIOUS DISEASES 2015年第Sup3期61卷 S141-S146页

作者： Starks, Angela M. Aviles, Enrique Cirillo, Daniela M. Denkinger, Claudia M. Dolinger, David L. Emerson, Claudia Gallarda, Jim Hanna, Debra Kim, Peter S. Liwski, Richard Miotto, Paolo Schito, Marco Zignol, Matteo Ctr Dis Control & Prevent Div TB Eliminat Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA 30329 USA Crit Path Inst Tucson AZ USA Ist Sci San Raffaele Ist Ricovero & Cura Carattere Sci I-20132 Milan Italy Fdn Innovat New Diagnost Geneva Switzerland St Michaels Hosp Li Ka Shing Knowledge Inst Ctr Eth Social & Cultural Risk Toronto ON M5B 1W8 Canada Bill & Melinda Gates Fdn Seattle WA USA NIAID Div AIDS NIH Bethesda MD 20892 USA WHO TB Monitoring & Evaluat Global TB Programme CH-1211 Geneva Switzerland

Continued progress in addressing challenges associated with detection and management of tuberculosis requires new diagnostic tools. These tools must be able to provide rapid and accurate information for detecting resistance to guide selection of the treatment regimen for each patient. To achieve this goal, globally representative genotypic, phenotypic, and clinical data are needed in a standardized and curated data platform. A global partnership of academic institutions, public health agencies, and nongovernmental organizations has been established to develop a tuberculosis relational sequencing data platform (ReSeqTB) that seeks to increase understanding of the genetic basis of resistance by correlating molecular data with results from drug susceptibility testing and, optimally, associated patient outcomes. These data will inform development of new diagnostics, facilitate clinical decision making, and improve surveillance for drug resistance. ReSeqTB offers an opportunity for collaboration to achieve improved patient outcomes and to advance efforts to prevent and control this devastating disease.

关键词： Mycobacterium tuberculosis drug resistance database

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Exploring the use of mobile phone technology for the enhancement of the prevention of mother-to-child transmission of HIV program in Nyanza, Kenya: a qualitative study

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BMC PUBLIC HEALTH 2013年第1期13卷 1-9页

作者： Jennings, Larissa Ong'ech, John Simiyu, Rogers Sirengo, Martin Kassaye, Seble Elizabeth Glaser Pediat AIDS Fdn Res Unit Washington DC 20036 USA Johns Hopkins Bloomberg Sch Publ Hlth Dept Int Hlth Social & Behav Intervent Baltimore MD 21205 USA Elizabeth Glaser Pediat AIDS Fdn Nairobi Kenya Univ Nairobi Kenyatta Natl Hosp Nairobi Kenya Minist Hlth Natl AIDS STD Control Programme Nairobi Kenya Georgetown Univ Div Infect Dis Dept Med Washington DC 20007 USA

Background: Community-based mobile phone programs can complement gaps in clinical services for prevention of mother-to-child transmission (PMTCT) of HIV in areas with poor infrastructure and personnel shortages. However, community and health worker perceptions on optimal mobile phone communication for PMTCT are underexplored. This study examined what specific content and forms of mobile communication are acceptable to support PMTCT. Methods: Qualitative methods using focus groups and in-depth interviews were conducted in two district hospitals in Nyanza Province, Kenya. A total of 45 participants were purposefully selected, including HIV-positive women enrolled in PMTCT, their male partners, community health workers, and nurses. Semi-structured discussion guides were used to elicit participants' current mobile phone uses for PMTCT and their perceived benefits and challenges. We also examined participants' views on platform design and gender-tailored short message service (SMS) messages designed to improve PMTCT communication and male involvement. Results: Most participants had access to a mobile phone and prior experience receiving and sending SMS, although phone sharing was common among couples. Mobile phones were used for several health-related purposes, primarily as voice calls rather than texts. The perceived benefits of mobile phones for PMTCT included linking with health workers, protecting confidentiality, and receiving information and reminders. Men and women considered the gender-tailored SMS as a catalyst for improving PMTCT male involvement and couples' communication. However, informative messaging relayed safely to the intended recipient was critical. In addition, health workers emphasized the continual need for in-person counseling coupled with, rather than replaced by, mobile phone reinforcement. For all participants, integrated and neutral text messaging provided antenatally and postnatally was most preferred, although not all topics or text formats w

关键词： Mobile phone mHealth Short message service SMS HIV Prevention of mother-to-child transmission PMTCT Male involvement

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