The Impact of Armed Conflict on the Prevalence and Transmission Dynamics of HIV Infection in Libya

Considerable variation in the 95-95-95 targets accomplishment between children and adults might delay achievement of set targets

Despite a significant reduction in the global HIV disease prevalence in recent years, children under 15 years of age still account for 3% of people living with HIV, 9% of new incidence, and 12% of AIDS-related deaths. Although there is increased access and use of antiretroviral drugs, children under 1 year in resource-poor settings with a high HIV disease burden remain vulnerable due to poor initiation of these critical interventions impeding progress to meet the 95-95-95 targets. There are renewed efforts to ensure that exposed children under 15 years are not left behind by scaling diagnostics and clinical management in the most affected communities. However, gaps remain in the integration of these services into maternal, child, and adolescent healthcare services within these communities, resulting in only 67% of HIV-exposed infants being tested within 2 months of birth, globally in 2023. Consequently, only 29% of all exposed children under 15 years were initiated in antiretroviral treatment before their 5th birthday in 2023. There are successes for adults aged 15 years and above, but children under 15 years risk being left behind in achieving the 95-95-95 targets. In this study, we review efforts made to reduce these substantial regional variations when comparing progress made between children under 15 years and adults and highlight gaps that might impede achievement of the 95-95-95 targets among children.

Outcome of HIV patients on ART during the war and siege in a tertiary hospital in Northern Ethiopia: a cross-sectional study

The war and siege in Tigray, Ethiopia, have devastated the region's health system, critically impacting care for people living with HIV. This study aimed to assess the outcomes and factors affecting HIV patients during this crisis. An independent, repeated cross-sectional study was conducted at Ayder Comprehensive Specialized Hospital between October and November 2022. Data from prewar and during the war periods were analyzed using descriptive statistics and logistic regression. Among 440 participants (mean ages: 39 prewar and 41.2 during war), poor outcomes increased significantly during the war (28.6% prewar vs. 54.5% during war, p < 0.001). ART drug availability dropped by 68.8%, while only 10.6% and 30.7% accessed IPT and CPT, respectively. Services like CD4 and viral load determinations were severely disrupted (p < 0.001), with frequent ART switches and more missed appointments. Prewar factors associated with poor outcomes included severe malnutrition (AOR 3.98; 95% CI 1.04-15.22) and viral load > 1000 copies (AOR 6.68; 95% CI 2.91-15.32). During the crisis, significant factors included travel from distant areas (AOR 2.56; 95% CI 1.14-5.74), CD4 count > 200 cells/ml (AOR 0.27; 95% CI 0.08-0.97). The war and siege in Tigray significantly worsened HIV outcomes by disrupting care services and limiting access to essential treatments.

Rodriguez-Morales A, Furqan Ilyas M, Santos Ferreira MDN, Singh Malik Y, Kalantari R, Shahrokhabadi A, Jafari N, Shahabinejad F, Maleki Y, Montajeb S, Mehrpouya R, Ahmadi H, Vazir B, Kabir F, Rehman A, Elmi Z, Hajipour P, El-Seedi HR, Eisenreich W, Shehata AA. Migratory Wave due to Conflicts: Risk of Increased Infection From Zoonotic Diseases

Wars have devastating effects on all the components of the One Health approach: humans, animals, and ecosystems. Wars and the resulting migratory waves massively disrupt normal animal health services and surveillance. Among other consequences, they adversely impact the early detection, prevention, and control of animal diseases. Uncontrolled movement of animals or their undisposed carcasses, the destruction of wildlife habitats, and the increased interface between humans, wildlife, and domestic animals contribute to uncontrolled transmission and spread of zoonotic pathogens from animals to humans. In the last millennium, zoonotic diseases such as the "Black Death" were triggered by devastating wars and led to the deaths of a large fraction of the human population. However, also recent and ongoing wars carry the risk of an uncontrollable increase in zoonotic diseases. The most significant zoonotic diseases reported during the recent wars are African swine fever, highly pathogenic avian influenza, rabies, leptospirosis, and brucellosis, as well as foodborne and waterborne zoonotic diseases. Indeed, alarming rates of infections by antimicrobial-resistant pathogens such as Mycobacterium tuberculosis go along with wars, as seen in the current Ukraine-Russia conflict. Considering human migration, foodborne and waterborne zoonotic diseases are key health threats for refugees due to the consumption of unsafe food, lack of safe water, and disruption of the water supply and sanitation system. This review summarizes the potential factors and some data associated with the increased risk of zoonotic disease emergence and transmission during recent and ongoing conflicts.

Disruptions to HIV Prevention During Armed Conflict in Ukraine and Other Settings

PURPOSE OF REVIEW

This review evaluates recent literature to understand the ways in which war disrupts HIV prevention and creates conditions for HIV outbreaks, with a focus on Ukraine. We also examine potential responses that can be deployed to sustain HIV prevention services amid ongoing conflict.

RECENT FINDINGS

Recent studies and frameworks suggest that disruptions caused during war are comparable to other emergencies, like natural disasters. The most important disruptions included health system/infrastructure destabilization, displacement, and psychological and financial challenges for individuals in key populations. Wars in most settings, as exemplified by the recent war in Ukraine, demonstrate that these disruptions can be tempered through a coordinated, rapid response. Lesson learned from Ukraine show that adequate preparation and a rapid, collaborative response by providers is needed to ensure HIV prevention during war. Future research should develop comprehensive frameworks outlining how to facilitate this response.

The impact of conflict on infectious disease: a systematic literature review

BACKGROUND

Conflict situations, armed or not, have been associated with emergence and transmission of infectious diseases. This review aims to identify the pathways through which infectious diseases emerge within conflict situations and to outline appropriate infectious disease preparedness and response strategies.

METHODS

A systematic review was performed representing published evidence from January 2000 to October 2023. Ovid Medline and Embase were utilised to obtain literature on infectious diseases in any conflict settings. The systematic review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis). No geographical restrictions were imposed.

FINDINGS

Our review identified 51 studies covering AIDS, Hepatitis B, Tuberculosis, Cholera, Coronavirus 2, Ebola, Poliomyelitis, Malaria, Leishmaniasis, Measles, Diphtheria, Dengue and Acute Bacterial Meningitis within conflict settings in Europe, Middle East, Asia, and Africa since October 2023. Key factors contributing to disease emergence and transmission in conflict situations included population displacement, destruction of vital infrastructure, reduction in functioning healthcare systems and healthcare personnel, disruption of disease control programmes (including reduced surveillance, diagnostic delays, and interrupted vaccinations), reduced access by healthcare providers to populations within areas of active conflict, increased population vulnerability due to limited access to healthcare services, and disruptions in the supply chain of safe water, food, and medication. To mitigate these infectious disease risks reported preparedness and response strategies included both disease-specific intervention strategies as well as broader concepts such as the education of conflict-affected populations through infectious disease awareness programmes, investing in and enabling health care in locations with displaced populations, intensifying immunisation campaigns, and ensuring political commitment and intersectoral collaborations between governments and international organisations.

CONCLUSION

Conflict plays a direct and indirect role in the transmission and propagation of infectious diseases. The findings from this review can assist decision-makers in the development of evidence-based preparedness and response strategies for the timely and effective containment of infectious disease outbreaks in conflict zones and amongst conflict-driven displaced populations.

FUNDING

European Centre for Disease Prevention and Control under specific contract No. 22 ECD.13,154 within Framework contract ECDC/2019/001 Lot 1B.

Impact of war-associated factors on spread of sexually transmitted infections: a systemic review

Introduction

Statistical data indicate a link between war and the spread of sexually transmitted infections (STIs), then it is necessary to carefully analyze the factors that directly affect the identified pattern in order to overcome this problem. Therefore, the purpose of the study was to systematically analyze the factors that influence the spread of STIs during war.

Methods

The study included all original research articles and meta-analyses on the impact of war on the spread of sexually transmitted infections that met the following eligibility criteria: (1) articles published exclusively in English; (2) articles published in the period 2013-2023; (3) studies with quantitative, qualitative or mixed design. The search for relevant literature was conducted using four databases: PubMed, Embase, Web of Science, and Ebsco.

Results

The articles selected for our systematic review had different research designs and were mainly published as original studies (n = 8) and literature reviews (n = 6). As a result of the evaluation of the selected articles for the systematic review, the authors identified migration, a decrease in access to health care, difficult access to contraception, sexual violence as the most frequent factors directly affecting the spread of STIs during the war.

Conclusion

This systematic review systematizes data on the impact of hostilities on the spread of STIs and outlines the main factors that contribute to the dissemination of pathogens far beyond the territory at the epicenter of the conflict.Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023479808, CRD42023479808.

Political instability and hiv/aids response in the south west and north west regions of Cameroon: a qualitative study

BACKGROUND

Politically motivated violence and insecurity continue to be a major threat to progress in HIV epidemic control and a significant contributor to health inequality. Despite a decreasing HIV/AIDS disease burden, the Republic of Cameroon in West Africa is experiencing ongoing political instability in her North and South West Regions. Our study used qualitative methods to better understand key frontline health care providers' (fHCP) perceptions of the effects of political instability on HIV/AIDS response gains in Cameroon since 2018, as well as lessons learned for overcoming them.

METHODS

Between July and August 2022, semi-structured, in-depth key informant interviews involving 10 purposively selected participants were conducted in the two regions. Interviews were recorded and transcribed verbatim, coded thematically, and analyzed manually.

RESULTS

Six overarching themes emerged from the transcribed key informant interviews. They were as follows: Challenge with access to and availability of health care services (HIV care, commodity supply chain) in the smaller communities; Impact on continuity of treatment; Increased risk of new HIV infections; The socioeconomic impact of the crisis on the quality of life; The impact of the crisis on fHCPs' physical and mental health and the health system'; and Coping mechanisms.

CONCLUSIONS

Frontline healthcare workers have acknowledged the significant impact the current political instability has had in hindering the development and advancement of a successful local response to HIV/AIDS in the two impacted regions of Cameroon. Coordinated efforts must be made to strengthen the health sector in areas such as HIV healthcare decentralization, supply chain, and protecting frontline healthcare workers from political quagmires in order to lessen the impact of the nation's socio-political crisis on the HIV/AIDS response and, more generally, on the entire health sector.

Impact of armed conflicts on HIV treatment outcomes in sub-Saharan Africa: protocol for a systematic review and meta-analysis

INTRODUCTION

Armed conflicts have significant negative impacts on the entire healthcare system in general and HIV care system in particular. Sub-Saharan Africa is suffering from a disproportionate double burden of armed conflict and HIV infection. Nevertheless, the impact of the armed conflict on the HIV treatment outcomes in conflict settings in sub-Saharan Africa has not been thoroughly and systematically synthesised. This protocol outlines a review that aims to summarise the available evidence on the impact of armed conflict on HIV treatment outcomes in sub-Saharan Africa.

METHODS AND ANALYSIS

A systematic review of all quantitative studies that assess the impact of armed conflicts on HIV treatment outcomes will be conducted. The systematic search will start with a preliminary search of Google Scholar, followed by implementation of the full search strategy across five databases (MEDLINE, PubMed, CINAHL, SCOPUS and Web of Science) and the screening of titles and abstracts then relevant full texts. Bibliographies will be reviewed to identify additional relevant studies. We will include studies conducted in sub-Saharan Africa that were published in English between 1 January 2002 and 31 December 2022. Methodological validity of the included studies will be assessed using standardised critical appraisal instruments from the Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument. Data will be extracted using standardised JBI instruments and analysed through narrative synthesis, and meta-analyses and regression. Heterogeneity will be assessed using I2 and Χ2 tests.

ETHICS AND DISSEMINATION

Since this study will not involve gathering primary data, formal ethical approval is not required. Journal publications, conference presentations and a media release will be used to share the study findings.

PROSPERO REGISTRATION NUMBER

CRD42022361924.

Status of the HIV epidemic in key populations in the Middle East and north Africa: knowns and unknowns

The Middle East and north Africa is one of only two world regions where HIV incidence is on the rise, with most infections occurring among key populations: people who inject drugs, men who have sex with men, and female sex workers. In this Review, we show a trend of increasing HIV prevalence among the three key populations in the Middle East and north Africa. Although the epidemic continues at a low level in some countries or localities within a country, there is evidence for concentrated epidemics, with sustained transmission at considerable HIV prevalence among people who inject drugs and men who have sex with men in over half of countries in the region with data, and among female sex workers in several countries. Most epidemics emerged around 2003 or thereafter. The status of the epidemic among key populations remains unknown in several countries due to persistent data gaps. The HIV response in Middle East and north Africa remains far below global targets for prevention, testing, and treatment. It is hindered by underfunding, poor surveillance, and stigma, all of which are compounded by widespread conflict and humanitarian crises, and most recently, the advent of COVID-19. Investment is needed to put the region on track towards the target of eliminating HIV/AIDS as a global health threat by 2030. Reaching this target will not be possible without tailoring the response to the needs of key populations, while addressing, to the extent possible, the complex structural and operational barriers to success.