1
|
Loeb T, Willis K, Velishavo F, Lee D, Rao A, Baral S, Rucinski K. Leveraging Routinely Collected Program Data to Inform Extrapolated Size Estimates for Key Populations in Namibia: Small Area Estimation Study. JMIR Public Health Surveill 2024; 10:e48963. [PMID: 38573760 PMCID: PMC11027056 DOI: 10.2196/48963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/07/2023] [Accepted: 12/13/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Estimating the size of key populations, including female sex workers (FSW) and men who have sex with men (MSM), can inform planning and resource allocation for HIV programs at local and national levels. In geographic areas where direct population size estimates (PSEs) for key populations have not been collected, small area estimation (SAE) can help fill in gaps using supplemental data sources known as auxiliary data. However, routinely collected program data have not historically been used as auxiliary data to generate subnational estimates for key populations, including in Namibia. OBJECTIVE To systematically generate regional size estimates for FSW and MSM in Namibia, we used a consensus-informed estimation approach with local stakeholders that included the integration of routinely collected HIV program data provided by key populations' HIV service providers. METHODS We used quarterly program data reported by key population implementing partners, including counts of the number of individuals accessing HIV services over time, to weight existing PSEs collected through bio-behavioral surveys using a Bayesian triangulation approach. SAEs were generated through simple imputation, stratified imputation, and multivariable Poisson regression models. We selected final estimates using an iterative qualitative ranking process with local key population implementing partners. RESULTS Extrapolated national estimates for FSW ranged from 4777 to 13,148 across Namibia, comprising 1.5% to 3.6% of female individuals aged between 15 and 49 years. For MSM, estimates ranged from 4611 to 10,171, comprising 0.7% to 1.5% of male individuals aged between 15 and 49 years. After the inclusion of program data as priors, the estimated proportion of FSW derived from simple imputation increased from 1.9% to 2.8%, and the proportion of MSM decreased from 1.5% to 0.75%. When stratified imputation was implemented using HIV prevalence to inform strata, the inclusion of program data increased the proportion of FSW from 2.6% to 4.0% in regions with high prevalence and decreased the proportion from 1.4% to 1.2% in regions with low prevalence. When population density was used to inform strata, the inclusion of program data also increased the proportion of FSW in high-density regions (from 1.1% to 3.4%) and decreased the proportion of MSM in all regions. CONCLUSIONS Using SAE approaches, we combined epidemiologic and program data to generate subnational size estimates for key populations in Namibia. Overall, estimates were highly sensitive to the inclusion of program data. Program data represent a supplemental source of information that can be used to align PSEs with real-world HIV programs, particularly in regions where population-based data collection methods are challenging to implement. Future work is needed to determine how best to include and validate program data in target settings and in key population size estimation studies, ultimately bridging research with practice to support a more comprehensive HIV response.
Collapse
Affiliation(s)
- Talia Loeb
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kalai Willis
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Daniel Lee
- United States Agency for International Development Dominican Republic, Santo Domingo, Dominican Republic
| | - Amrita Rao
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Stefan Baral
- Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine Rucinski
- Data for Implementation (Data.FI), Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|
2
|
Grosso A, Bowring AL, Njindam IM, Decker MR, Lyons C, Rao A, Tamoufe U, Fako GH, Fouda G, Levitt D, Turpin G, Billong SC, Zoung-Kanyi Bissek AC, Njoya O, Baral S. Sexually Transmitted Infection Risks and Symptoms Heightened Among Female Sex Workers who Started Selling Sex Before the Age of 18 in Five Cities in Cameroon. AIDS Behav 2024; 28:898-906. [PMID: 37843686 PMCID: PMC10896857 DOI: 10.1007/s10461-023-04196-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Abstract
Many adolescents under 18 years old who sell sex are at elevated risk for sexually transmitted infection (STI) acquisition, which may persist into adulthood. There has been limited study of the burden of the risks and vulnerabilities among women who started selling sex as adolescents across Sub-Saharan Africa. In this study, a Adult female sex workers (FSW) recruited through respondent-driven sampling in five cities in Cameroon from December 2015 to October 2016 completed a questionnaire and human immunodeficiency virus (HIV) and syphilis testing. Multivariable logistic regression analysis controlling for age was used to identify factors associated with reporting selling sex before age 18. Selling sex before age 18 was reported by 11.5% (256/2,220) of FSW. Initiation of selling sex as an adolescent was positively associated with experiencing dysuria (adjusted odds ratio [aOR]:1.50, 95% confidence interval [CI]:1.08-2.10) or genital warts (aOR:1.78, 95% CI:1.08-2.94) and negatively associated with prior recent testing for HIV (aOR:0.71, 95% CI:0.53-0.96) or STIs (aOR:0.65, 95% CI:0.44-0.96). Consistent condom use with clients was negatively associated with early initiation of selling sex (aOR:0.58, 95% CI:0.42-0.80), while experience of recent sexual violence was positively associated with early initiation (aOR:1.74, 95% CI:1.15-2.63). There were no independent significant differences in HIV (24.5%) or syphilis (8.3%) prevalence. Given the limited use of HIV and STI testing services by women who sold sex as adolescents, the prevalence of forced sex, condomless sex, and STI symptoms were high. Programs serving FSW should more vigorously aim to serve adolescents and adults who began selling sex early.
Collapse
Affiliation(s)
- Ashley Grosso
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ, 08901, USA.
| | - Anna L Bowring
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
- Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | | | - Michele R Decker
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, 615 N Wolfe St Baltimore, MD, Baltimore, 21205, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
| | - Ubald Tamoufe
- Metabiota, Avenue Mvog-Fouda Ada, Av 1.085, Carrefour Intendance BP, Yaoundé, 15939, Cameroon
| | - Guy H Fako
- Care and Health Program, Yaoundé, Cameroon
| | - Ghislaine Fouda
- CARE Cameroon, Villa La Rose (3è étage, Av. Churchill, Yaoundé, Cameroon
| | - Daniel Levitt
- CARE USA, 115 Broadway, 5th floor, New York, NY, 10006, USA
- FHI 360, New York, United States
| | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
| | - Serge C Billong
- Groupe Technique Central, CNLS, Rue Henri Dunant, Yaoundé, Cameroon
| | | | - Oudou Njoya
- Department of Internal Medicine, Yaoundé University Hospital Center, Joseph Tchooungui Akoa, Yaoundé, Cameroon
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, 615 N Wolfe , MD, Baltimore, 21205, USA
| |
Collapse
|
3
|
Suprabha BS, Shenoy R, Mahabala KY, Nayak AP, Rao A, D'Souza V. Early Childhood Caries and Dental Care Utilization in Mangalore, India: Parents' Perceptions. JDR Clin Trans Res 2024:23800844231225193. [PMID: 38389414 DOI: 10.1177/23800844231225193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Parents often underuse dental care services for their children with early childhood caries (ECC), resulting in a high burden of untreated dental caries. AIM To describe parental perceptions and challenges in dental care utilization for their children with ECC. DESIGN A descriptive qualitative study was conducted with parents of children with ECC seeking dental care in Mangalore, India. Data were collected through focus group discussions using an interview guide. Manual line-by-line coding and content analysis methods were used for data analysis. RESULTS Three categories were generated from data obtained through 5 focus groups of 27 participants: dental care visiting patterns, the significance of dental visits, and challenges to dental care utilization. Parents would only visit the dentist when they perceived their children's tooth problems. The challenges faced include time constraints, misinformation, lack of awareness and motivation, costs, fear, and anxiety of the children and the parents themselves. Parents perceived improvements in the awareness of their children's oral health and quality of life after dental visits. CONCLUSION Attending dental services to treat their children's tooth problems was the primary way of attaining awareness about prevention among the parents of children with ECC. Increased oral health awareness and improved quality of life can motivate parents to seek further dental care for their children. Collaboration with multidisciplinary stakeholders is required to improve oral health awareness among parents of children with ECC. KNOWLEDGE TRANSFER STATEMENT The study's results will help plan targeted preventive programs for children with ECC. The study suggests dental care utilization by children with ECC is based on parental perceptions of their children's tooth problems. It outlines the challenges that affect dental visits of children with ECC and the role of multidisciplinary stakeholders. Improved oral health awareness and quality of life following dental treatment can facilitate further dental visits.
Collapse
Affiliation(s)
- B S Suprabha
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, KA, India
| | - R Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, KA, India
| | - K Y Mahabala
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, KA, India
| | - A P Nayak
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, KA, India
| | - A Rao
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, KA, India
| | - V D'Souza
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
4
|
Rao A, Mhlophe H, Pretorius A, Mcingana M, Mcloughlin J, Shipp L, Baral S, Hausler H, Schwartz S, Lesko C. Effect of implementation strategies on pre-exposure prophylaxis persistence among female sex workers in South Africa: an interrupted time series study. Lancet HIV 2023; 10:e807-e815. [PMID: 38040479 PMCID: PMC10771038 DOI: 10.1016/s2352-3018(23)00262-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND A disproportionate number of new HIV infections in South Africa are among female sex workers; pre-exposure prophylaxis (PrEP) for HIV prevention is freely available to female sex workers in the country, but unique barriers challenge PrEP persistence. TB HIV Care, a large South African non-profit organisation that provides daily oral PrEP (tenofovir disoproxil fumarate and emtricitabine), has implemented multiple strategies to improve PrEP persistence. We aimed to evaluate the effect of different implementation strategies on PrEP persistence in a large-scale real-world setting. METHODS In this interrupted time series study, we estimated level changes in 1-month oral PrEP persistence associated with roll-out of various implementation strategies among female sex workers across nine districts in South Africa. We used routinely collected data from TB HIV Care programme files from June 7, 2016, to April 30, 2021. Poisson regression of 1-month persistence was used to assess the effect of these strategies. In secondary analyses, we tested the association between each of the strategies and 4-month persistence. FINDINGS The median 1-month PrEP persistence for female sex workers was 33% (IQR 27-40). SMS support and refill reminders were associated with an 11% relative increase in 1-month persistence (risk ratio [RR] 1·11, 95% CI 1·02-1·26) and clinical mentoring for PrEP providers was associated with a 127% relative increase (RR 2·27, 95% CI 1·94-2·66) among female sex workers. The loyalty rewards programme was negatively associated with 1-month persistence (RR 0·71, 95% CI 0·67-0·83). Although clinical mentoring improved 4-month persistence, SMS support text messages had no significant effect. INTERPRETATION Identification and subsequent use of clinical mentoring for PrEP providers and SMS support and refill reminders might improve the usefulness of PrEP overall to prevent new HIV infections among female sex workers. PrEP persistence remains an important issue, and strategies to build on our findings are needed. FUNDING National Institute of Mental Health and National Institute of Allergy and Infectious Diseases.
Collapse
Affiliation(s)
- Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | | | | | - Lillian Shipp
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
5
|
Pawar P, Gokavi J, Wakhare S, Bagul R, Ghule U, Khan I, Ganu V, Mukherjee A, Shete A, Rao A, Saxena V. MiR-155 Negatively Regulates Anti-Viral Innate Responses among HIV-Infected Progressors. Viruses 2023; 15:2206. [PMID: 38005883 PMCID: PMC10675553 DOI: 10.3390/v15112206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 11/26/2023] Open
Abstract
HIV infection impairs host immunity, leading to progressive disease. An anti-retroviral treatment efficiently controls viremia but cannot completely restore the immune dysfunction in HIV-infected individuals. Both host and viral factors determine the rate of disease progression. Among the host factors, innate immunity plays a critical role; however, the mechanism(s) associated with dysfunctional innate responses are poorly understood among HIV disease progressors, which was investigated here. The gene expression profiles of TLRs and innate cytokines in HIV-infected (LTNPs and progressors) and HIV-uninfected individuals were examined. Since the progressors showed a dysregulated TLR-mediated innate response, we investigated the role of TLR agonists in restoring the innate functions of the progressors. The stimulation of PBMCs with TLR3 agonist-poly:(I:C), TLR7 agonist-GS-9620 and TLR9 agonist-ODN 2216 resulted in an increased expression of IFN-α, IFN-β and IL-6. Interestingly, the expression of IFITM3, BST-2, IFITM-3, IFI-16 was also increased upon stimulation with TLR3 and TLR7 agonists, respectively. To further understand the molecular mechanism involved, the role of miR-155 was explored. Increased miR-155 expression was noted among the progressors. MiR-155 inhibition upregulated the expression of TLR3, NF-κB, IRF-3, TNF-α and the APOBEC-3G, IFITM-3, IFI-16 and BST-2 genes in the PBMCs of the progressors. To conclude, miR-155 negatively regulates TLR-mediated cytokines as wel l as the expression of host restriction factors, which play an important role in mounting anti-HIV responses; hence, targeting miR-155 might be helpful in devising strategic approaches towards alleviating HIV disease progression.
Collapse
Affiliation(s)
- Puja Pawar
- Division of Immunology and Serology, ICMR-National AIDS Research Institute, Pune 411026, India; (P.P.); (J.G.); (S.W.); (V.G.); (A.S.)
| | - Jyotsna Gokavi
- Division of Immunology and Serology, ICMR-National AIDS Research Institute, Pune 411026, India; (P.P.); (J.G.); (S.W.); (V.G.); (A.S.)
| | - Shilpa Wakhare
- Division of Immunology and Serology, ICMR-National AIDS Research Institute, Pune 411026, India; (P.P.); (J.G.); (S.W.); (V.G.); (A.S.)
| | - Rajani Bagul
- Division of Clinical Sciences, ICMR-National AIDS Research Institute, Pune 411026, India; (R.B.); (U.G.); (A.R.)
| | - Ujjwala Ghule
- Division of Clinical Sciences, ICMR-National AIDS Research Institute, Pune 411026, India; (R.B.); (U.G.); (A.R.)
| | - Ishrat Khan
- Division of Virology, ICMR-National AIDS Research Institute, Pune 411026, India; (I.K.); (A.M.)
| | - Varada Ganu
- Division of Immunology and Serology, ICMR-National AIDS Research Institute, Pune 411026, India; (P.P.); (J.G.); (S.W.); (V.G.); (A.S.)
| | - Anupam Mukherjee
- Division of Virology, ICMR-National AIDS Research Institute, Pune 411026, India; (I.K.); (A.M.)
| | - Ashwini Shete
- Division of Immunology and Serology, ICMR-National AIDS Research Institute, Pune 411026, India; (P.P.); (J.G.); (S.W.); (V.G.); (A.S.)
| | - Amrita Rao
- Division of Clinical Sciences, ICMR-National AIDS Research Institute, Pune 411026, India; (R.B.); (U.G.); (A.R.)
| | - Vandana Saxena
- Division of Immunology and Serology, ICMR-National AIDS Research Institute, Pune 411026, India; (P.P.); (J.G.); (S.W.); (V.G.); (A.S.)
| |
Collapse
|
6
|
Shete A, Wagh V, Sawant J, Shidhaye P, Sane S, Rao A, Kulkarni S, Ghate M. Antiretroviral Treatment-Induced Galectin-9 Might Impact HIV Viremia in Addition to Contributing to Inflammaging. Int J Mol Sci 2023; 24:12273. [PMID: 37569647 PMCID: PMC10418429 DOI: 10.3390/ijms241512273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/28/2023] [Accepted: 07/06/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Galectin-9 induces HIV reactivation and also contributes to non-AIDS events through inflammaging. Hence, it is important to assess its levels in HIV-infected individuals to determine their association with HIV viremia and other comorbidities. METHODS Plasma galectin-9 levels were estimated in viremic (n = 152) and aviremic (n = 395) individuals on first-line antiretroviral therapy (ART). They were assessed for correlation with HIV-1 viral load (VL), CD4 count, and ART duration, as well as for receiver operating characteristic curve analysis. RESULT Plasma galectin-9 levels correlated positively with VL (r = 0.507, p < 0.0001) and ART duration (r = 0.308, p = 0.002) and negatively with CD4 count (r = -0.186, p < 0.0001). Area under the curve for galectin-9/CD4 count ratio for identifying viremic individuals was 0.906. Sensitivity and specificity of the ratio at a cutoff of 14.47 were 90.13% and 70.05%, respectively, for detecting viremic individuals. Further, galectin-9 levels correlated with cystatin C (r = 0.239, p = 0.0183), IL-18 (r = 0.311, p = 0.006), and systolic blood pressure (r = 0.220, p = 0.0355). Galectin-9-induced HIV reactivation was significantly lower in individuals on long-term ART than those on short-term ART. CONCLUSION The galectin-9-to-CD4 count ratio indicated the potential of galectin-9 as a cheaper monitoring tool to detect HIV viremia. Strategies for countering the effects of galectin-9 for controlling HIV viremia and non-AIDS events are urgently warranted.
Collapse
Affiliation(s)
- Ashwini Shete
- Indian Council of Medical Research, National AIDS Research Institute (ICMR-NARI), Pune 411026, India; (V.W.); (J.S.); (P.S.); (A.R.); (S.K.); (M.G.)
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Rao A, Mamulwar M, Panda S, Pachuau HZ, Vanlalvenzuali H, Lalruatsanga, Roy T, Lalnuntlangi N. Finding a way forward with the community: qualitative inquiry in the generalized HIV epidemic in Mizoram, India. Front Public Health 2023; 11:1217628. [PMID: 37554736 PMCID: PMC10405924 DOI: 10.3389/fpubh.2023.1217628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
Introduction Mizoram, the northeastern State of India bordering Myanmar, is presently witnessing a burgeoning generalized HIV epidemic along with the highest State-level HIV prevalence among female sex workers (FSWs, 24.7%) and people who inject drugs (PWID,19.8%) in the country. The present study was conducted against such background to understand the current situation of HIV prevention and care services in Mizoram, and capture community voices as well as concerns so that the way forward could be informed appropriately. Methods The study period was October through December 2020 (in the midst of COVID-restrictions) in the districts of Aizawl, Mamit, Kolasib, Lunglei, and Champhai where HIV prevalence crossed 1% among ante-natal clinic (ANC) attending women. Contrastingly, the national average HIV prevalence among ANC attendees is 0.24%, which formed the basis for selecting the aforementioned five high burden districts for this current inquiry. In-depth-interviews were conducted with community members and youth leaders, vulnerable and general population groups as well as HIV-program officials. Interviews were recorded, transcribed, translated and later coded for analysis following thematic approach. Results The emerging issues were grouped in three thematic layers; (1) HIV vulnerability, (2) challenges pertaining to prevention and care services, and (3) program elements and future roadmap. Discrimination at the community level, unfriendly behavior of some of the HIV-service staff, occasional interruption in supplies of anti-retroviral treatment and sterile syringes and needles were voiced as deterrents to accessing HIV prevention and care services by the participants. Community engagement, based on restorative approach rather than retribution and ensuring enhanced performance of the district AIDS program control units emerged as necessary programmatic elements. Conclusion This inquiry highlighted macro-social and structural forces contributing to stigma and discrimination toward people at risk of HIV. It is urgent that HIV-services are re-aligned through de-centralized district level innovations and creation of safer spaces at the physical, societal and familial level. These, even during the time of stress such as a pandemic, would help health services to remain resilient. HIV outreach, sensitization of the community leaders and health-care professionals through strategic communication and ownership of the communities in these endeavors appeared paramount.
Collapse
Affiliation(s)
- Amrita Rao
- Indian Council of Medical Research-National AIDS Research Institute (ICMR-NARI), Pune, Maharashtra, India
| | - Megha Mamulwar
- Indian Council of Medical Research-National AIDS Research Institute (ICMR-NARI), Pune, Maharashtra, India
| | - Samiran Panda
- Indian Council of Medical Research, New Delhi, India
| | | | - H. Vanlalvenzuali
- ICMR-NARI Sustained & Timely AIDS Response: A Community Engagement in Mizoram (STAR) Project, Pune, Maharashtra, India
| | - Lalruatsanga
- ICMR-NARI Sustained & Timely AIDS Response: A Community Engagement in Mizoram (STAR) Project, Pune, Maharashtra, India
| | - Tarun Roy
- ICMR-NARI Sustained & Timely AIDS Response: A Community Engagement in Mizoram (STAR) Project, Pune, Maharashtra, India
| | - Nunui Lalnuntlangi
- ICMR-NARI Sustained & Timely AIDS Response: A Community Engagement in Mizoram (STAR) Project, Pune, Maharashtra, India
| |
Collapse
|
8
|
Rao A, Lesko C, Mhlophe H, Rucinski K, Mcingana M, Pretorius A, Mcloughlin J, Baral S, Beyrer C, Hausler H, Schwartz S. Longitudinal patterns of initiation, persistence, and cycling on preexposure prophylaxis among female sex workers and adolescent girls and young women in South Africa. AIDS 2023; 37:977-986. [PMID: 36723509 PMCID: PMC10079574 DOI: 10.1097/qad.0000000000003500] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Female sex workers (FSW) and adolescent girls and young women (AGYW) face a disproportionately high risk of HIV in South Africa. Oral preexposure prophylaxis (PrEP) can avert new infections, but its effectiveness is linked to consistent use. Early discontinuation of PrEP in this population is high, but less is known about longitudinal patterns of PrEP use, including patterns of re-initiation and cycling. DESIGN Longitudinal descriptive analysis of routine program data. METHODS Between 2016 and 2021, 40 681 FSW and AGYW initiated PrEP at TB HIV Care, the largest PrEP provider to this population in South Africa and were included. Using survival analyses and group-based trajectory modeling, we described patterns of initiation, discontinuation, re-initiation, and cycling. RESULTS Total initiations increased over the life of the program for both FSW and AGYW. About 40% of FSW [0.41, 95% confidence interval (CI) [0.40-0.42]] and AGYW (0.38, 95% CI [0.37-0.38]) remained on PrEP at one month. FSW were more likely to restart PrEP, however <10% restarted PrEP within a year of initiation. Three latent trajectory groups of PrEP use were identified for FSW (low use, early cycling, and ongoing cycling) and two for AGYW (low use and ongoing cycling). Persistence was negatively associated with initiation among AGYW, but there was no clear relationship among FSW. Those initiating later in the program and older women had a reduced risk of discontinuation. CONCLUSIONS Persistence on PrEP was low, but cycling on and off PrEP was common, with early missed visits and inconsistent, but ongoing use. A push to increase PrEP initiations needs to factor in readiness and persistence support, to achieve public health impact.
Collapse
Affiliation(s)
- Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Catherine Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Katherine Rucinski
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
9
|
Suprabha BS, Shenoy R, Mahabala KY, Nayak AP, Rao A, D'Souza V. Early Feeding and Weaning Practices of Indian Children with Early Childhood Caries: A Qualitative Exploration. JDR Clin Trans Res 2023; 8:131-138. [PMID: 35302409 DOI: 10.1177/23800844221083645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the early feeding, weaning, and oral hygiene practices of children with early childhood caries (ECC), their parents' knowledge and attitudes regarding infant feeding, and the feeding-related challenges faced by the parents. METHODS This descriptive qualitative study involved parents of children with ECC who sought dental treatment at an academic dental college in India. Data were collected though focus groups conducted with the 27 parents of children with ECC, using a focus group discussion guide. Data were analyzed using the content analysis method. RESULTS Community norms, such as learning from the older women in the families or neighborhoods, guided the feeding method, duration of feeding, and weaning. Breastfeeding or bottle-feeding at bedtime beyond 12 mo of age and feeding sugary drinks during weaning were standard practices, despite knowing the risk for dental caries. Parents faced multiple challenges regarding weaning and were unaware of the significance of infant oral hygiene practices. CONCLUSION In children with ECC, infant feeding practices included prolonged breastfeeding or bottle-feeding beyond the required age, feeding at bedtime, and feeding sugary drinks. Although the parents knew that these feeding habits could increase the risk for caries, they lacked the self-efficacy to translate their knowledge into action during weaning. Also, they lacked awareness regarding infant oral hygiene practices. KNOWLEDGE TRANSFER STATEMENT The study provides information on the feeding habits of infants that can increase the risk for caries, the challenges faced by the parents of these children in altering these risky habits, and their lack of knowledge on infant oral hygiene practices. Policy/decision makers can advocate for pediatricians and pediatric dentists to incorporate anticipatory guidance or motivational interviewing techniques to tailor the preventive program for ECC for Indian children.
Collapse
Affiliation(s)
- B S Suprabha
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - R Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - K Y Mahabala
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A P Nayak
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A Rao
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - V D'Souza
- Department of Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
10
|
Sharma H, Suprabha BS, Shenoy R, Rao A, Kotian H. Clinical effectiveness of alkasite versus nanofilled resin composite in the restoration of occlusal carious lesions in permanent molar teeth of children: a randomized clinical trial. Eur Arch Paediatr Dent 2023:10.1007/s40368-023-00788-0. [PMID: 36947344 DOI: 10.1007/s40368-023-00788-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE To evaluate and compare the clinical effectiveness of alkasite with nanofilled resin composite restorations for occlusal caries lesions in permanent molar teeth of children, at one-year follow-up. METHODS In this randomized controlled clinical trial with parallel design, 38 children aged 7-13 years with occlusal caries lesions on 59 first permanent molars were randomly allocated into two groups, Group 1: Filtek™ Z350XT (nanocomposite) and Group 2: Cention N® (alkasite resin composite). The restorations were evaluated at one year using the United States Public Health Service (USPHS) criteria. Data were analyzed using Chi-square or Fisher's exact test. RESULTS All restorations had either Alpha or Bravo scores at one-year follow-up. In Group 1, all restorations scored Alpha, while one restoration each (3.6%) in Group 2 scored Bravo for fracture and marginal adaptation. All restorations in both groups scored Alpha for retention, secondary caries, and post-operative sensitivity. For anatomic form, all restorations in Group 1 scored Alpha, while three (10.7%) restorations in Group 2 had Bravo scores. For marginal discolouration, three restorations in both groups scored Bravo (11.5% and 10.7%, respectively). For surface roughness, one restoration (3.8%) in Group 1 and three restorations in Group 2 (10.7%) scored Bravo. The comparative results between the two groups for all the variables in the USPHS criteria were not statistically significantly different. CONCLUSIONS The performances of the nanofilled composite and alkasite were clinically acceptable and comparable. Alkasite can be an alternative material for the restoration of occlusal caries lesions in permanent molars of children. CLINICAL TRIAL REGISTRATION The clinical trial was registered at Clinical Trials Registry-India (CTRI Reg no: CTRI/2020/12/029830 Dated: 15/12/2020).
Collapse
Affiliation(s)
- H Sharma
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Light House Hill Road, Mangalore, Karnataka, 575001, India
| | - B S Suprabha
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Light House Hill Road, Mangalore, Karnataka, 575001, India.
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - R Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A Rao
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Light House Hill Road, Mangalore, Karnataka, 575001, India
| | - H Kotian
- Department of Community Medicine, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
11
|
Laga I, Niu X, Rucinski K, Baral S, Rao A, Chen D, Viswasam N, Phaswana-Mafuya NR, Diouf D, Sabin K, Zhao J, Eaton JW, Bao L. Mapping the number of female sex workers in countries across sub-Saharan Africa. Proc Natl Acad Sci U S A 2023; 120:e2200633120. [PMID: 36595685 PMCID: PMC9926247 DOI: 10.1073/pnas.2200633120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 11/16/2022] [Indexed: 01/05/2023] Open
Abstract
Female sex workers (FSW) are affected by individual, network, and structural risks, making them vulnerable to poor health and well-being. HIV prevention strategies and local community-based programs can rely on estimates of the number of FSW to plan and implement differentiated HIV prevention and treatment services. However, there are limited systematic assessments of the number of FSW in countries across sub-Saharan Africa to facilitate the identification of prevention and treatment gaps. Here we provide estimated population sizes of FSW and the corresponding uncertainties for almost all sub-national areas in sub-Saharan Africa. We first performed a literature review of FSW size estimates and then developed a Bayesian hierarchical model to synthesize these size estimates, resolving competing size estimates in the same area and producing estimates in areas without any data. We estimated that there are 2.5 million (95% uncertainty interval 1.9 to 3.1) FSW aged 15 to 49 in sub-Saharan Africa. This represents a proportion as percent of all women of childbearing age of 1.1% (95% uncertainty interval 0.8 to 1.3%). The analyses further revealed substantial differences between the proportions of FSW among adult females at the sub-national level and studied the relationship between these heterogeneities and many predictors. Ultimately, achieving the vision of no new HIV infections by 2030 necessitates dramatic improvements in our delivery of evidence-based services for sex workers across sub-Saharan Africa.
Collapse
Affiliation(s)
- Ian Laga
- Montana State University, Bozeman, MT59717
| | - Xiaoyue Niu
- Pennsylvania State University, University Park, PA16802
| | | | | | - Amrita Rao
- Johns Hopkins University, Baltimore, MD21205
| | - David Chen
- Pennsylvania State University, University Park, PA16802
| | | | - Nancy Refilwe Phaswana-Mafuya
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit and Faculty of Health Sciences, University of Johannesburg, Johannesburg2028, South Africa
| | | | - Keith Sabin
- The Joint United Nations Programme on HIV/AIDS, Geneva1211, Switzerland
| | - Jinkou Zhao
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva1218, Switzerland
| | - Jeffrey W. Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, LondonSW7 2AZ, UK
| | - Le Bao
- Pennsylvania State University, University Park, PA16802
| |
Collapse
|
12
|
Razzaq H, Rao A, Sathananthan S, Majeed A, Dworkin M. Screening tool to improve patient referral to acute surgical care from accident and emergency. Ann R Coll Surg Engl 2023; 105:14-19. [PMID: 35133208 PMCID: PMC9773239 DOI: 10.1308/rcsann.2021.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION This study aimed, first, to audit the appropriateness of surgical referrals to an acute surgical unit for urgent assessment and, second, to devise a screening tool for use in the emergency department to categorise patients into those who need an urgent surgical review and those who can be seen in an ambulatory setting within the next few days. METHODS The first phase of the study was an audit of surgical referrals between 1 and 18 February 2020 to check the appropriateness of the surgical referral. In the second phase, a tool was designed to screen patients who did not require urgent surgical review and could be seen in the ambulatory clinic. A prospective questionnaire study was conducted from 1 February to 24 March 2020 with patients who were admitted to an acute surgical ward. Based on responses to the screening tool, patients were given the outcome of whether they can be discharged and seen in an ambulatory clinic. The accuracy of the screening tool outcome was assessed and compared with actual patient discharge outcomes by the surgical team evaluating patients' electronic medical records. RESULTS In the first audit of referrals to the acute surgical ward, 206 patients were referred to the acute surgical unit and seen by the senior surgeon. Of these, 142 (68.9%) were discharged on the same day with or without follow-up in the ambulatory surgical clinic. In the prospective questionnaire phase of the study, 98 patients completed the questionnaire. The most common presentation was abdominal pain (n=60) followed by urological symptoms (n=11), symptoms of hernia complication (n=10), abscess (n=7), testicular pain (n=2) and trauma (n=2). Of the patients discharged on the same day, 50% were given ambulatory care appointments and 50% were discharged with no further follow-up. The sensitivity and specificity of the screening tool were 100% and 60.7%, respectively; the overall accuracy was 88.4%. CONCLUSION A large proportion of patients who are referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool used for acute surgical referral had reasonable sensitivity and high specificity to screen patients who can be seen in ambulatory clinics. At the same time, it identified patients who were unwell and required urgent surgical admission.
Collapse
Affiliation(s)
- H Razzaq
- Mid and South Essex NHS Foundation Trust, UK
| | - A Rao
- Mid and South Essex NHS Foundation Trust, UK
| | | | | | - M Dworkin
- Mid and South Essex NHS Foundation Trust, UK
| |
Collapse
|
13
|
Bishayi D, Srinivasan A, Mahabala KY, Natarajan S, Rao A, Nayak AP. A novel application of a bioactive material as a pit and fissure sealant: in vitro pilot study evaluating the sealing ability and penetration. Eur Arch Paediatr Dent 2022; 24:195-201. [PMID: 36575275 DOI: 10.1007/s40368-022-00773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/11/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare the sealing ability and penetration of a bioactive material used as pit and fissure sealant to those of glass ionomer sealant. METHODS This was an in vitro experimental study conducted on 20 permanent teeth. For Group I of ten teeth, ACTIVA BioACTIVE-Base/Liner was applied as a sealant on pits and fissures, and the remaining ten teeth of Group II were sealed using glass ionomer cement. After thermocycling, the apex of the teeth was sealed using composite resin and they were immersed in 1% methylene blue solution, buffered at pH 7 for 24 h. Longitudinal sections were obtained from each tooth for evaluating the sealing ability and penetration, using a binocular light microscope at 4 × magnification. The obtained data were subjected to analysis using the Chi-square test and independent t test. RESULTS The comparison of the sealing ability and sealant penetration, between the two groups, showed statistically no significant difference (p = 0.104 and p = 1.0, respectively). CONCLUSION Bioactive material as a pit and fissure sealant, performed on par with glass ionomer sealant in terms of tested properties like sealing ability and penetration.
Collapse
Affiliation(s)
- D Bishayi
- Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A Srinivasan
- Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - K Y Mahabala
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - S Natarajan
- Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A Rao
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - A P Nayak
- Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
14
|
Grosso A, Berg L, Rucinski K, Rao A, Djaló MA, Diouf D, Baral S. Sexual and Reproductive Health Service Needs Associated with Underage Initiation of Selling Sex among Adult Female Sex Workers in Guinea-Bissau. Int J Environ Res Public Health 2022; 19:12715. [PMID: 36232014 PMCID: PMC9566000 DOI: 10.3390/ijerph191912715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To assess the prevalence and predictors of underage initiation of selling sex among female sex workers (FSW) in Guinea-Bissau. METHODS 505 adult FSW recruited using respondent-driven sampling were surveyed in 2017. Multivariable logistic regression was used to identify demographic, behavioral, and psychosocial characteristics associated with initiation of selling sex while underage (<18 years). RESULTS A total of 26.3% (133/505) of FSW started selling sex before age 18. Underage initiation of selling sex was associated with experiencing forced sex before age 18 (adjusted odds ratio (aOR): 6.74; 95% confidence interval (CI): 2.05-22.13), and never being tested for HIV (aOR: 0.43; 95% CI: 0.20-0.91). Despite having lower odds of wanting to have children or more children (aOR: 0.31; 95% CI: 0.17-0.56), FSW who started selling sex while underage had lower odds of using highly effective contraception such as implants (aOR: 0.43; 95% CI: 0.24-0.77). Among those who were ever pregnant, a lower percentage of FSW who started selling sex while underage accessed antenatal care (56.6% vs. 74.7%, p = 0.008). CONCLUSIONS These data suggest that early initiation of selling sex among adult FSW in Guinea-Bissau is common. Social services for youth and integrated HIV and reproductive health services are critical to address the persisting sexual and reproductive health needs of FSW who started selling sex while underage.
Collapse
Affiliation(s)
- Ashley Grosso
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ 07102, USA
- Center for Population Behavioral Health, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ 08901, USA
| | - Lindsay Berg
- Center for Population Behavioral Health, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ 08901, USA
| | - Katherine Rucinski
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| |
Collapse
|
15
|
Talish M, Fukushima L, Wang J, Lee C, Rao A. 228 Hold the mayo on the elexacaftor/tezacaftor/ivacaftor special! A single-center experience. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
16
|
Haddad V, Hohos N, Stueve M, Timm A, Rao A, Slocum H, Lee J. 21P Analytical performance of FusionPlex Dx. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
17
|
Aggarwal R, Heller G, Hillman D, Xiao H, Picus J, Wang J, Taplin M, Dorff T, Appleman L, Weckstein D, Patnaik A, Bryce A, Shevrin D, Mohler J, Anderson D, Rao A, Tagawa S, Tan A, Eggener S, Morris M. LBA63 PRESTO: A phase III, open-label study of androgen annihilation in patients (pts) with high-risk biochemically relapsed prostate cancer (AFT-19). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
18
|
Baral S, Rao A, Rwema JOT, Lyons C, Cevik M, Kågesten AE, Diouf D, Sohn AH, Phaswana-Mafuya RN, Kamarulzaman A, Millett G, Marcus JL, Mishra S. Competing health risks associated with the COVID-19 pandemic and early response: A scoping review. PLoS One 2022; 17:e0273389. [PMID: 36037216 PMCID: PMC9423636 DOI: 10.1371/journal.pone.0273389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats. OBJECTIVES We conducted a scoping review to characterize the early impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. METHODS A scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from November 1st, 2019 to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection or mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English. RESULTS A total of 1604 published papers and 205 preprints were retrieved in the search. Overall, 8.0% (129/1604) of published studies and 10.2% (21/205) of preprints met the inclusion criteria and were included in this review: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (19/183) on sexual and reproductive health, and 9.8% (13/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. DISCUSSION COVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. The data reviewed here suggest that effective strengthening of health systems should include investment and planning focused on ensuring the continuity of care for both rapidly emergent and existing public health threats.
Collapse
Affiliation(s)
- Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St. Andrews, St. Andrews, Scotland
| | - Anna E. Kågesten
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | | | - Annette H. Sohn
- TREAT Asia, amfAR, The Foundation for AIDS Research, Bangkok, Thailand
| | - Refilwe Nancy Phaswana-Mafuya
- South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, Johannesburg, South Africa
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Adeeba Kamarulzaman
- Department of Medicine and Infectious Diseases, University of Malaya, Kuala Lumpur, Malaysia
| | - Gregorio Millett
- Public Policy Office, amfAR, Washington, District of Columbia, United States of America
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States of America
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
19
|
Llewellyn J, Garner D, Rao A. Complications in Device Therapy: Spectrum, Prevalence, and Management. Curr Heart Fail Rep 2022; 19:316-324. [PMID: 35932445 DOI: 10.1007/s11897-022-00563-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE OF REVIEW Cardiac implantable electronic device implant numbers are continually increasing due to the expanding indications and ageing population. This review explores the complications associated with device therapy and discusses ways to minimise and manage such complications. RECENT FINDINGS Complications related to device therapy contribute to mortality and morbidity. Recent publications have detailed clear guidelines for appropriate cardiac device selection, as well as consensus documents discussing care quality and optimal implantation techniques. There have also been advances in device technologies that may offer alternative options to patients at high risk of/or already having encountered a complication. Adherence to guidelines, appropriate training, and selection of device, in addition to good surgical technique are key in reducing the burden of complications and improving acceptability of device therapy.
Collapse
Affiliation(s)
- J Llewellyn
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK.
| | - D Garner
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK
- Wirral University Teaching Hospital NHS Foundation Trust, Arrowe Park Road, Upton, Wirral, CH49 5PE, UK
| | - A Rao
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK
| |
Collapse
|
20
|
Li X, Zhang A, Al-Zaidy R, Rao A, Baral S, Bao L, Giles CL. Automating document classification with distant supervision to increase the efficiency of systematic reviews: A case study on identifying studies with HIV impacts on female sex workers. PLoS One 2022; 17:e0270034. [PMID: 35771807 PMCID: PMC9246134 DOI: 10.1371/journal.pone.0270034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 06/02/2022] [Indexed: 12/03/2022] Open
Abstract
There remains a limited understanding of the HIV prevention and treatment needs among female sex workers in many parts of the world. Systematic reviews of existing literature can help fill this gap; however, well-done systematic reviews are time-demanding and labor-intensive. Here, we propose an automatic document classification approach to a systematic review to significantly reduce the effort in reviewing documents and optimizing empiric decision making. We first describe a manual document classification procedure that is used to curate a pertinent training dataset and then propose three classifiers: a keyword-guided method, a cluster analysis-based method, and a random forest approach that utilizes a large set of feature tokens. This approach is used to identify documents studying female sex workers that contain content relevant to either HIV or experienced violence. We compare the performance of the three classifiers by cross-validation in terms of area under the curve of the receiver operating characteristic and precision and recall plot, and found random forest approach reduces the amount of manual reading for our example by 80%; in sensitivity analysis, we found that even trained with only 10% of data, the classifier can still avoid reading 75% of future documents (68% of total) while retaining 80% of relevant documents. In sum, the automated procedure of document classification presented here could improve both the precision and efficiency of systematic reviews and facilitate live reviews, where reviews are updated regularly. We expect to obtain a reasonable classifier by taking 20% of retrieved documents as training samples. The proposed classifier could also be used for more meaningfully assembling literature in other research areas and for rapid documents screening with a tight schedule, such as COVID-related work during the crisis.
Collapse
Affiliation(s)
- Xiaoxiao Li
- Department of Statistics, Pennsylvania State University, University Park, PA, United States of America
| | - Amy Zhang
- Department of Statistics, Pennsylvania State University, University Park, PA, United States of America
| | - Rabah Al-Zaidy
- Information and Computer Science Department, King Fahad University of Petroleum and Minerals, Dhahran, Saudi Arabia
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States of America
| | - Le Bao
- Department of Statistics, Pennsylvania State University, University Park, PA, United States of America
| | - C. Lee Giles
- College of Information Sciences and Technology, Pennsylvania State University, University Park, PA, United States of America
| |
Collapse
|
21
|
Munoz N, Pavuluri S, Dupuis C, Williams M, Dixon K, McWatters A, Zhang J, Rao A, Duda D, Kaseb A, Sheth R. Abstract No. 331 ▪ FEATURED ABSTRACT Immune modulation by molecularly targeted photothermal ablation in a mouse model of advanced hepatocellular carcinoma and cirrhosis. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
22
|
Patil A, Patil S, Rao A, Gadhe S, Kurle S, Panda S. Exploring the Evolutionary History and Phylodynamics of Human Immunodeficiency Virus Type 1 Outbreak From Unnao, India Using Phylogenetic Approach. Front Microbiol 2022; 13:848250. [PMID: 35663884 PMCID: PMC9158528 DOI: 10.3389/fmicb.2022.848250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Certain rural and semiurban settings in the Unnao district, Uttar Pradesh, India observed an unprecedented increase in the detection of HIV cases during July 2017. Subsequent investigations through health camps and a follow-up case-control study attributed the outbreak to the unsafe injection exposures during treatment. In this study, we have undertaken a secondary analysis to understand the phylogenetic aspects of the outbreak-associated HIV-1 sequences along with the origin and phylodynamics of these sequences. The initial phylogenetic analysis indicated separate monophyletic grouping and there was no mixing of outbreak-associated sequences with sequences from other parts of India. Transmission network analysis using distance-based and non-distance-based methods revealed the existence of transmission clusters within the monophyletic Unnao clade. The median time to the most recent common ancestor (tMRCA) for sequences from Unnao using the pol gene region was observed to be 2011.87 [95% highest posterior density (HPD): 2010.09–2013.53], while the estimates using envelope (env) gene region sequences traced the tMRCA to 2010.33 (95% HPD: 2007.76–2012.99). Phylodynamics estimates demonstrated that the pace of this local epidemic has slowed down in recent times before the time of sampling, but was certainly on an upward track since its inception till 2014.
Collapse
Affiliation(s)
- Ajit Patil
- HIV Drug Resistance Laboratory, Indian Council of Medical Research (ICMR)-National AIDS Research Institute, Pune, India
| | - Sandip Patil
- Division of Clinical Sciences, Indian Council of Medical Research (ICMR)-National AIDS Research Institute, Pune, India
| | - Amrita Rao
- Division of Clinical Sciences, Indian Council of Medical Research (ICMR)-National AIDS Research Institute, Pune, India
| | - Sharda Gadhe
- HIV Drug Resistance Laboratory, Indian Council of Medical Research (ICMR)-National AIDS Research Institute, Pune, India
| | - Swarali Kurle
- HIV Drug Resistance Laboratory, Indian Council of Medical Research (ICMR)-National AIDS Research Institute, Pune, India
- *Correspondence: Swarali Kurle
| | - Samiran Panda
- Indian Council of Medical Research Headquarter, New Delhi, India
- Samiran Panda ;
| |
Collapse
|
23
|
Mane A, Kasibhatla SM, Vidhate P, Saxena V, Patil S, Rao A, Nirmalkar A, Kulkarni-Kale U, Panda S. Phylogenetic Analysis of Spread of Hepatitis C Virus Identified during HIV Outbreak Investigation, Unnao, India. Emerg Infect Dis 2022; 28:725-733. [PMID: 35318918 PMCID: PMC8962895 DOI: 10.3201/eid2804.211845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
An HIV outbreak investigation during 2017–2018 in Unnao District, Uttar Pradesh, India, unearthed high prevalence of hepatitis C virus (HCV) antibodies among the study participants. We investigated these HCV infections by analyzing NS5B and core regions. We observed no correlation between HIV–HCV viral loads and clustering of HCV sequences, regardless of HIV serostatus. All HCV isolates belonged to genotype 3a. Monophyletic clustering of isolates in NS5B phylogeny indicates emergence of the outbreak from a single isolate or its closely related descendants. The nucleotide substitution rate for NS5B was 6 × 10−3 and for core was 2 × 10−3 substitutions/site/year. Estimated time to most recent common ancestor of these isolates was 2012, aligning with the timeline of this outbreak, which might be attributable to unsafe injection practices while seeking healthcare. HIV–HCV co-infection underlines the need for integrated testing, surveillance, strengthening of healthcare systems, community empowerment, and molecular analyses as pragmatic public health tools.
Collapse
|
24
|
Patel P, Nallandhighal S, Scoville D, Tran L, Cotta B, Udager A, Rao A, Palapattu G, Dadhania V, Pitchiaya S, Salami S. Spatial transcriptomic profiling of prostate cancer reveals zone specific androgen receptor signaling and immune infiltration. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
25
|
Mohammed S, Ravikumar V, Warner E, Patel S, Bakas S, Rao A, Jain R. Quantifying T2-FLAIR Mismatch Using Geographically Weighted Regression and Predicting Molecular Status in Lower-Grade Gliomas. AJNR Am J Neuroradiol 2022; 43:33-39. [PMID: 34764084 PMCID: PMC8757555 DOI: 10.3174/ajnr.a7341] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/03/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The T2-FLAIR mismatch sign is a validated imaging sign of isocitrate dehydrogenase-mutant 1p/19q noncodeleted gliomas. It is identified by radiologists through visual inspection of preoperative MR imaging scans and has been shown to identify isocitrate dehydrogenase-mutant 1p/19q noncodeleted gliomas with a high positive predictive value. We have developed an approach to quantify the T2-FLAIR mismatch signature and use it to predict the molecular status of lower-grade gliomas. MATERIALS AND METHODS We used multiparametric MR imaging scans and segmentation labels of 108 preoperative lower-grade glioma tumors from The Cancer Imaging Archive. Clinical information and T2-FLAIR mismatch sign labels were obtained from supplementary material of relevant publications. We adopted an objective analytic approach to estimate this sign through a geographically weighted regression and used the residuals for each case to construct a probability density function (serving as a residual signature). These functions were then analyzed using an appropriate statistical framework. RESULTS We observed statistically significant (P value = .05) differences between the averages of residual signatures for an isocitrate dehydrogenase-mutant 1p/19q noncodeleted class of tumors versus other categories. Our classifier predicts these cases with area under the curve of 0.98 and high specificity and sensitivity. It also predicts the T2-FLAIR mismatch sign within these cases with an under the curve of 0.93. CONCLUSIONS On the basis of this retrospective study, we show that geographically weighted regression-based residual signatures are highly informative of the T2-FLAIR mismatch sign and can identify isocitrate dehydrogenase-mutation and 1p/19q codeletion status with high predictive power. The utility of the proposed quantification of the T2-FLAIR mismatch sign can be potentially validated through a prospective multi-institutional study.
Collapse
Affiliation(s)
- S. Mohammed
- From the Departments of Biostatistics (S.M., A.R.),Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.)
| | - V. Ravikumar
- Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.)
| | - E. Warner
- Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.)
| | - S.H. Patel
- Department of Radiology & Medical Imaging (S.H.P.), University of Virginia School of Medicine, Charlottesville, Virginia
| | - S. Bakas
- Departments of Radiology (S.B.),Pathology & Laboratory Medicine (S.B.), University of Pennsylvania, Philadelphia, Pennsylvania
| | - A. Rao
- From the Departments of Biostatistics (S.M., A.R.),Computational Medicine & Bioinformatics (S.M., V.R., E.W., A.R.),Radiation Oncology (A.R.),Michigan Institute for Data Sciences (A.R.),Department of Biomedical Engineering (A.R.), University of Michigan, Ann Arbor, Michigan
| | - R. Jain
- Departments of Radiology (R.J.),Neurosurgery (R.J.), New York University Grossman School of Medicine, New York, New York
| |
Collapse
|
26
|
Panda S, Rao A, Patil S, Nirmalkar A, Bagul R, Ghule U, Panchal N. HIV oral self-screening test among HIV/STD/TB clinic attendees: A mixed-method pilot investigation examining merit for larger evaluation. Indian J Med Res 2022; 155:403-412. [DOI: 10.4103/ijmr.ijmr_3131_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
27
|
Rao A, Ng A, Sy R, Chia K, Hansen P, Chiha J, Kilian J, Kanagaratnam L. Interaction of Age, Sex, Body Mass Index and QRS Duration on Prevalence of Atrial Fibrillation in a Large Australian Cohort Study. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
28
|
Gan G, Bhat A, Rao A, Gu K, Thangarajah M, Kean A, Michail D, Tanous D, Thomas L. Prevalence and Impact of Comorbid Atrial Fibrillation in Patients With Pulmonary Hypertension. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
29
|
Rao A, Mamulwar M, Shahabuddin S, Roy T, Lalnuntlangi N, Panda S. HIV epidemic in Mizoram, India: A rapid review to inform future responses. Indian J Med Res 2022; 156:203-217. [PMID: 37006035 PMCID: PMC10057371 DOI: 10.4103/ijmr.ijmr_1453_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background & objectives Mizoram, a northeastern State of India bordering Myanmar, is home to several tribal clans under the ethnic group Mizo: Renthelei, Ralte, Paite, Lai, Hmar, Lusei, Mara, Thado and Kuki. Mizos also reside in the neighbouring northeastern States of Tripura, Assam, Manipur and Nagaland. The majority of Mizo people outside India live across the border in the neighbouring Chin State and Sagaing Region of Myanmar. Over the last decade, Mizoram witnessed a concerning level of rise in HIV prevalence among the general population. The present rapid review was conducted to identify various interventions that could help curb this rising trend. Methods An electronic search strategy with broad domains of 'HIV/AIDS', 'key population', 'community engagement' and 'interventions in Mizoram' using PubMed, Embase and Cochrane was adopted; grey literature were also accessed. Evidence, thus gleaned, were synthesized. Results Twenty eight resource materials comprising articles, reports and dissertations contributed to the current review. Changing tribal social support structure, early initiation of drugs, sexual debut at an early age and drug-sex interface were identified as factors associated with the progression of HIV epidemic in the State. Issues pertaining to the migration of people across the borders and easy access to drugs continue to be of concern. Churches and youth leaders have a strong influence on the society, at times even constraining access of key population groups to HIV prevention and care services. Tackling stigma and discrimination, ensuring uninterrupted HIV services and creation of an enabling environment in this context seems urgently needed. Incarcerated people in the State have been found with a high level of HIV infection and their linkages with prevention and care services need strengthening. Interpretation & conclusions This review underscores the importance of drawing upon successful intervention examples from the past such as 'Friends on Friday' and Red Ribbon Clubs. Active engagement of community-based organizations in programme planning, implementation and monitoring is essential. Establishment of harm reduction interventions for general and key populations paired with strategic communication appear to be the need of the hour.
Collapse
|
30
|
Redd AD, Peetluk LS, Jarrett BA, Hanrahan C, Schwartz S, Rao A, Jaffe AE, Peer AD, Jones CB, Lutz CS, McKee CD, Patel EU, Rosen JG, Garrison Desany H, McKay HS, Muschelli J, Andersen KM, Link MA, Wada N, Baral P, Young R, Boon D, Grabowski MK, Gurley ES. Curating the Evidence About COVID-19 for Frontline Public Health and Clinical Care: The Novel Coronavirus Research Compendium. Public Health Rep 2021; 137:197-202. [PMID: 34969294 DOI: 10.1177/00333549211058732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The public health crisis created by the COVID-19 pandemic has spurred a deluge of scientific research aimed at informing the public health and medical response to the pandemic. However, early in the pandemic, those working in frontline public health and clinical care had insufficient time to parse the rapidly evolving evidence and use it for decision-making. Academics in public health and medicine were well-placed to translate the evidence for use by frontline clinicians and public health practitioners. The Novel Coronavirus Research Compendium (NCRC), a group of >60 faculty and trainees across the United States, formed in March 2020 with the goal to quickly triage and review the large volume of preprints and peer-reviewed publications on SARS-CoV-2 and COVID-19 and summarize the most important, novel evidence to inform pandemic response. From April 6 through December 31, 2020, NCRC teams screened 54 192 peer-reviewed articles and preprints, of which 527 were selected for review and uploaded to the NCRC website for public consumption. Most articles were peer-reviewed publications (n = 395, 75.0%), published in 102 journals; 25.1% (n = 132) of articles reviewed were preprints. The NCRC is a successful model of how academics translate scientific knowledge for practitioners and help build capacity for this work among students. This approach could be used for health problems beyond COVID-19, but the effort is resource intensive and may not be sustainable in the long term.
Collapse
Affiliation(s)
- Andrew D Redd
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lauren S Peetluk
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brooke A Jarrett
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Colleen Hanrahan
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sheree Schwartz
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Amrita Rao
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew E Jaffe
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Lieber Institute for Brain Development, Baltimore, MD, USA
| | - Austin D Peer
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carli B Jones
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Chelsea S Lutz
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Clifton D McKee
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Eshan U Patel
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Joseph G Rosen
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Henri Garrison Desany
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Heather S McKay
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - John Muschelli
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kathleen M Andersen
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Nikolas Wada
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Prativa Baral
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ruth Young
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Denali Boon
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Corteva Inc, Indianapolis, IN, USA
| | - M Kate Grabowski
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Emily S Gurley
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | |
Collapse
|
31
|
Baral S, Rao A, Twahirwa Rwema JO, Lyons C, Cevik M, Kågesten AE, Diouf D, Sohn AH, Phaswana-Mafuya N, Kamarulzaman A, Millett G, Marcus JL, Mishra S. Competing Health Risks Associated with the COVID-19 Pandemic and Early Response: A Scoping Review. medRxiv 2021:2021.01.07.21249419. [PMID: 33442703 PMCID: PMC7805463 DOI: 10.1101/2021.01.07.21249419] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats. OBJECTIVES We conducted a scoping review to characterize the early impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. METHODS A scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from January 1st to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection or mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English. RESULTS A total of 1604 published papers and 205 preprints met inclusion criteria, including 8.2% (132/1604) of published studies and 10.2% (21/205) of preprints: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (13/166) on sexual and reproductive health, and 9.8% (13/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. DISCUSSION COVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. The data reviewed here suggest that effective strengthening of health systems should include investment and planning focused on ensuring the continuity of care for both rapidly emergent and existing public health threats.
Collapse
Affiliation(s)
- Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | | | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St. Andrews, Scotland
| | - Anna E Kågesten
- Department of Global Public Health, Karolinska Institutet, Sweden
| | | | - Annette H Sohn
- TREAT Asia, amfAR, the Foundation for AIDS Research, Bangkok, Thailand
| | - Nancy Phaswana-Mafuya
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg
| | | | | | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
32
|
Hong E, Rao A, Beringer P. 242: Evaluation of the drug-drug interaction potential of clofazimineivacaftor using a physiologically based pharmacokinetic simulation approach. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Mayo C, Mierzwa M, Medlin R, Casper K, Rao A, Worden F, Evans J. Anticipating Poor Outcomes: A Prognostic Machine Learning Model of Unplanned Visits to the Emergency Department for Patients Undergoing Treatment for Head and Neck Cancer Using Comprehensive Multi-Factor Electronic Health Records. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
34
|
Malik P, Antonini L, Mannam P, Aboobacker FN, Merve A, Gilmour K, Rao K, Kumar S, Mani SE, Eleftheriou D, Rao A, Hemingway C, Sudhakar SV, Bartram J, Mankad K. MRI Patterns in Pediatric CNS Hemophagocytic Lymphohistiocytosis. AJNR Am J Neuroradiol 2021; 42:2077-2085. [PMID: 34620587 DOI: 10.3174/ajnr.a7292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/19/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Neuroimaging has an important role in detecting CNS involvement in children with systemic or CNS isolated hemophagocytic lymphohistiocytosis. We characterized a cohort of pediatric patients with CNS hemophagocytic lymphohistiocytosis focusing on neuroradiologic features and assessed whether distinct MR imaging patterns and genotype correlations can be recognized. MATERIALS AND METHODS We retrospectively enrolled consecutive pediatric patients diagnosed with hemophagocytic lymphohistiocytosis with CNS involvement treated at 2 pediatric neurology centers between 2010 and 2018. Clinical and MR imaging data were analyzed. RESULTS Fifty-seven children (40 primary, 70%) with a median age of 36 months (interquartile range, 5.5-80.8 months) were included. One hundred twenty-three MR imaging studies were assessed, and 2 broad imaging patterns were identified. Pattern 1 (significant parenchymal disease, 32/57, 56%) was seen in older children (P = .004) with worse clinical profiles. It had 3 onset subpatterns: multifocal white matter lesions (21/32, 66%), brainstem predominant disease (5, 15%), and cerebellitis (6, 19%). All patients with the brainstem pattern failed to meet the radiologic criteria for chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. An attenuated imaging phenotype (pattern 2) was seen in 25 patients (44%, 30 studies) and was associated with younger age. CONCLUSIONS Distinct MR imaging patterns correlating with clinical phenotypes and possible genetic underpinnings were recognized in this cohort of pediatric CNS hemophagocytic lymphohistiocytosis. Disruptive mutations and missense mutations with absent protein expression correlate with a younger onset age. Children with brainstem and cerebellitis patterns and a negative etiologic work-up require directed assessment for CNS hemophagocytic lymphohistiocytosis.
Collapse
Affiliation(s)
- P Malik
- From the Departments of Diagnostic Imaging (P. Malik, P. Mannam, S.E.M.)
| | - L Antonini
- Department of Paediatric Hemato-Oncology (L.A.), G. Salesi Hospital, Ancona, Italy
| | - P Mannam
- From the Departments of Diagnostic Imaging (P. Malik, P. Mannam, S.E.M.)
| | | | - A Merve
- Department of Histopathology (A.M.)
| | | | - K Rao
- Bone Marrow Transplant Unit (K.R.)
| | - S Kumar
- Child Heath (S.K.), Christian Medical College, Vellore, India
| | - S E Mani
- From the Departments of Diagnostic Imaging (P. Malik, P. Mannam, S.E.M.)
| | - D Eleftheriou
- Paediatric Rheumatology (D.E.), Great Ormond Street Hospital for Children and University College, London, UK
| | - A Rao
- Department of Pediatric Hematology (A.R., J.B.)
| | | | | | - J Bartram
- Department of Pediatric Hematology (A.R., J.B.)
| | - K Mankad
- Pediatric Neuroradiology Unit (S.V.S., K.M.)
| |
Collapse
|
35
|
Craver K, Beringer P, Lester M, Rao A. 182: Treatment of airway hyperreactivity in patients with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
36
|
Ruge M, Gill A, Gomez JMD, Du Fay De Lavallaz J, Simmons JA, Williams KA, Volgman AS, Marinescu K, Rao A, Suboc T. In-hospital predictors of 60-day readmission in COVID-19 patients. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Preventing hospital readmissions can improve a patient's quality of life and decrease healthcare costs. While prior work has focused on pre-existing comorbidities to predict COVID-19 readmissions, the prognostic role of in-hospital data and complications has been less studied.
Methods
Data was collected on adult patients diagnosed with COVID-19 and admitted to a multicenter hospital system in Illinois between March and November 2020. Our cohort consisted of COVID-19 hospitalization survivors excluding those discharged to hospice care. Major adverse events (MAEs) were defined as venous thromboembolism (VTE), myocardial injury (troponin greater than upper limit of normal), stroke, new requirement for renal replacement therapy (RRT), life-threatening arrhythmia, or acute heart failure exacerbation. The primary outcome was readmission within 60 days of initial hospitalization.
Results
From the 1406 survivors of the index hospitalization, 223 (15.9%) patients were readmitted within 60 days. Those readmitted were older and more likely to have underlying comorbidities including atrial fibrillation, coronary artery disease, and hypertension (Table 1). Length of stay between the readmission and non-readmission groups was trending towards statistical significance (10.52 days vs 8.95 days, p=0.053).
Those with one or more MAE during their index hospitalization, when adjusted for age and body mass index, were at an increased risk of readmission (adjusted odds ratio [aOR] 1.90, p<0.01). Readmitted patients were more likely to have VTE during their index hospitalization than those not readmitted (7.2% vs 3.7%, p<0.05). The incidence of new RRT (4.9% vs 2.5%, p=0.083) and myocardial injury (3.6% vs 1.5%, p=0.067) between the groups was also trending towards statistical significance (Table 1). No statistical difference was present between the other individual MAEs; however, this is limited by small sample sizes of certain MAEs. Of the 322 patients with echocardiography during the index admission, 82 (25.5%) were readmitted. In this cohort, left ventricular ejection fraction (LVEF) that was reduced (LVEF <50%) or hyperdynamic (LVEF >65%) was not a statistically significant predictor of readmission (Figure 1).
Lastly, discharge disposition was predictive of readmission as those being sent to acute rehab (OR 2.04, p<0.01), long-term acute care (OR 2.58, p<0.01), or skilled nursing facility (OR 2.67, p<0.001) were at higher risk compared to those who were discharged to home (Figure 1).
Conclusion
In this cohort, the occurrence of any MAE during index COVID-19 hospitalization, particularly VTE, RRT, and myocardial injury, can be used to predict 60-day readmission. Furthermore, discharge disposition, but not LVEF, demonstrated prognostic value in our cohort. Identifying high risk patients prior to discharge helps health care providers focus resources on patients most likely to be readmitted.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- M Ruge
- Thomas Jefferson University Hospital, Philadelphia, United States of America
| | - A Gill
- Rush University Medical Center, Chicago, United States of America
| | - J M D Gomez
- Rush University Medical Center, Chicago, United States of America
| | | | - J A Simmons
- Rush University Medical Center, Chicago, United States of America
| | - K A Williams
- Rush University Medical Center, Chicago, United States of America
| | - A S Volgman
- Rush University Medical Center, Chicago, United States of America
| | - K Marinescu
- Rush University Medical Center, Chicago, United States of America
| | - A Rao
- Rush University Medical Center, Chicago, United States of America
| | - T Suboc
- Rush University Medical Center, Chicago, United States of America
| |
Collapse
|
37
|
Essa H, Oguguo E, Douglas H, Foster A, Walker L, Hadcroft J, Bellieu J, Kahn M, Rao A, Cuthbertson D, Akpan A, Wong C, Sankaranarayanan R. One year outcomes of heart failure multispecialty multidisciplinary team virtual meetings. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Heart Failure is frequently associated with several comorbidities such as ischaemic heard disease, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease and frailty. This level of complexity is best dealt with by a multispecialty multidisciplinary team (MDT) model.
This was a single centre observational study (January 2020-December 2020) that was undertaken in a British university hospital looking at effect of HF multispecialty virtual MDT meetings on HF outcomes. Patients acted as their own controls outcomes compared for equal period pre versus post MDT meeting. The multi-specialty meeting was conducted once monthly via video-conferencing. It consisted of heart failure cardiologists (from primary secondary and tertiary care), heart failure specialist nurses (hospital and community), nephrologist, endocrinologist, palliative care specialists, chest physician, pharmacist, pharmacologist and geriatrician. Recommendations were made as consensus from the multispecialty meeting. The main outcome measures were 1) number of hospitalisations and 2) outpatient clinic attendances 3) cost savings.
A total of 189 patients were discussed from January-December 2020. This was uninterrupted during the COVID-19 pandemic. The mean age was 70.3±18.1 years and median follow-up 6 months (range 1–13 months). The mean Charlson Co-morbidity score was 5.3±1.2 and Rockwood Frailty Score was 4.9±1. The mean number of outpatient clinic attendances avoided was 1.7±0.4. This reduced inconvenience to patients, saved patients money (transport and parking costs) and led to carbon footprint reduction. The MDT meeting total costs were £15,400 and the 31 clinic appointments they generated cost an estimated £3720. However, the MDT meetings prevented 277 clinic appointments (cost saving £33,352). Finally, the mean number of hospitalisations pre-MDT was 0.7 Vs 0.2 post MDT (p<0.01) with a saving of around 730 bed days (estimated cost-saving £260,000).
The HF multispecialty virtual MDT approach provides seamless integration of primary care community services with secondary and tertiary care. Consensus decision from MDT meetings provides holistic approach for HF patients with comorbidities and frailty, and reduces inconvenience to patients by preventing the need to attend multiple specialty clinics. This approach can also lead to significant cost-savings to the healthcare system.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- H Essa
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - E Oguguo
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - H Douglas
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - A Foster
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - L Walker
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - J Hadcroft
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - J Bellieu
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - M Kahn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - A Rao
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - D Cuthbertson
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - A Akpan
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | - C Wong
- Liverpool University Hospitals NHS Trust, Liverpool, United Kingdom
| | | |
Collapse
|
38
|
Qin A, Lima F, Bell S, Kalemkerian G, Schneider B, Ramnath N, Lew M, Rao A, Frankel T. P57.03 Cellular Engagement and Interaction in the Tumor Microenvironment (TME) Predicts Response to ICI in Metastatic NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
39
|
Rossouw J, Schwartz S, Rao A, Mcingana M, Young K, Hausler H, Baral S. Exploring the Association Between Depression and Social and Biobehavioral HIV Risk Factors Among Female Sex Workers in Nelson Mandela Bay Municipality, South Africa. AIDS Res Hum Retroviruses 2021; 37:666-675. [PMID: 33472528 DOI: 10.1089/aid.2020.0233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to estimate the prevalence of depression among female sex workers (FSW) in an urban coastal city in South Africa, and to explore the relationship between depression and HIV-related social and biobehavioral determinants. A cross-sectional respondent-driven sampling study was conducted with FSW (n = 410), including a sociobehavioral questionnaire, PHQ-9 (Patient Health Questionnaire-9) based assessment of depression, and biological testing for HIV and syphilis. The prevalence of HIV in the sample was 64.1%. The estimated prevalence of depression was 28.8%. Depression was associated with social vulnerability such as living alone [adjusted prevalence ratio 1.82, 95% confidence interval (CI) 1.15-2.90] and food insecurity (aPR 2.19, 95% CI 1.42-3.38). A positive syphilis test result (aPR 1.46, 95% CI 1.02-2.09) and self-reported sexually transmitted disease symptoms (aPR 1.78, 95% CI 1.29-2.46) was associated with depression, but self-reported condom use and HIV status was not. FSW were also less likely to disclose their occupational status to health care providers (aPR 0.61, 95% CI 0.42-0.89) or undergo sexually transmitted infection screening in the last 12 months if they are depressed (aPR 0.64, 95% CI 0.43-0.95). The results demonstrate that the prevalence of depression is high among FSW and that depressive symptoms are associated with social covariates and biobehavioral HIV risk factors.
Collapse
Affiliation(s)
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | | | | | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
40
|
Rao A, Ma H, Moloney G, Kwong JC, Jüni P, Sander B, Kustra R, Baral SD, Mishra S. A disproportionate epidemic: COVID-19 cases and deaths among essential workers in Toronto, Canada. Ann Epidemiol 2021; 63:63-67. [PMID: 34314847 PMCID: PMC8435380 DOI: 10.1016/j.annepidem.2021.07.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/09/2021] [Accepted: 07/18/2021] [Indexed: 11/28/2022]
Abstract
Shelter-in-place mandates and closure of nonessential businesses have been central to COVID19 response strategies including in Toronto, Canada. Approximately half of the working population in Canada are employed in occupations that do not allow for remote work suggesting potentially limited impact of some of the strategies proposed to mitigate COVID-19 acquisition and onward transmission risks and associated morbidity and mortality. We compared per-capita rates of COVID-19 cases and deaths from January 23, 2020 to January 24, 2021, across neighborhoods in Toronto by proportion of the population working in essential services. We used person-level data on laboratory-confirmed COVID-19 community cases and deaths, and census data for neighborhood-level attributes. Cumulative per-capita rates of COVID-19 cases and deaths were 3.3-fold and 2.5-fold higher, respectively, in neighborhoods with the highest versus lowest concentration of essential workers. Findings suggest that the population who continued to serve the essential needs of society throughout COVID-19 shouldered a disproportionate burden of transmission and deaths. Taken together, results signal the need for active intervention strategies to complement restrictive measures to optimize both the equity and effectiveness of COVID-19 responses.
Collapse
Affiliation(s)
- Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Huiting Ma
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Gary Moloney
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Jeffrey C Kwong
- ICES, Toronto, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada; Public Health Ontario, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; University Health Network, Toronto, ON
| | - Peter Jüni
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Beate Sander
- ICES, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Public Health Ontario, Toronto, Canada
| | - Rafal Kustra
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, United States of America
| | - Sharmistha Mishra
- St. Michael's Hospital, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.
| |
Collapse
|
41
|
Llewellyn J, Meda G, Wright DJ, Rao A. Submuscular reburial as an alternative to lead extraction in high risk patients. Europace 2021. [DOI: 10.1093/europace/euab116.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The Heart Rhythm Society (HRS) and European Heart Rhythm Association (EHRA) consensus states complete extraction is recommended for all patients with definite cardiac implantable electronic device (CIED) infection. Although complete removal of hardware is the best way to manage infections, lead extraction is a complex procedure with significant risk. As age and complexity of patients increase so too does extraction risk. In very high risk cases conservative management is cited, though little is known on outcomes.
Purpose
We are a high volume tertiary centre which serves a population of 2 million. 2 experienced operators perform 65 extraction procedures per year for the past 10 years. We report our experience of device reburial as initial management of CIED pre-erosion and erosion in cases deemed too high risk for extraction.
Method
We retrospectively reviewed all reburial procedures undertaken over 9 years. Patient and lead factors influencing decisions were assessed. Information on number of leads, dwell time, prior procedure, infective status and comorbidity was collated. The outcomes included morbidity, defined by repeat procedure (revision and/or extraction) and mortality.
Results
86 patients underwent 96 procedures from March 2013 until August 2020. All patients undergoing device reburial were included. 55.8% of patients were male, mean age was 73. 21 patients died, 7 of these deaths occurred within 12 months of the index reburial procedure. The mean follow up period was 39 months (range 5–90). 65.1% of patients had a procedure (de novo implant, upgrade or replacement) within 12 months prior to revision.
We reviewed patients in 2 subgroups based on revision indication – erosion and pre-erosion. Erosion was defined as externalised lead/device. Pre-erosion was defined as superficial device with skin tethering but no exposure. The former is a definite indication for lead extraction, the latter a relative indication. All in the pre-erosion group were systemically well with no infection evident. One patient with erosion had a positive blood culture.
The mean age in the erosion group was 85 years with a Clinical Frailty Score (CFS) 4.98 and lead dwell time 17.87 years compared to age 68 years, CFS 3.98 and dwell time 8.14 years in the pre-erosion group. Patients in this cohort with an eroded device were deemed too high risk to undergo transvenous lead extraction.
A higher proportion of patients presenting with erosion died within 12 months of the index reburial procedure (16.67% vs 4.84%). 21% with an eroded device and 11% with a pre-eroding device undergoing reburial as first line management required future extraction.
Conclusion
Our 9 year data suggests less invasive intervention is a valid option in high risk groups such as older age, frailty, long lead dwell time, with an acceptable incidence of reintervention and/or extraction. This data can help guide informed consent in the future.
Collapse
Affiliation(s)
- J Llewellyn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - G Meda
- University of Liverpool, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - DJ Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - A Rao
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
42
|
Garner D, Leung WY, Llewellyn J, Goode R, Lunt L, Hughes S, Kahn M, Wright DJ, Rao A. CIED guided HF management : a prospective cohort study. Europace 2021. [DOI: 10.1093/europace/euab116.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Liverpool Clinical Commissioning Group
Background
Heart failure (HF) is associated with significant morbidity and mortality. (1) Cardiac Implantable Electronic Devices (CIED) generated Heart Failure Risk Score (HFRS) alerts may guide management in this complex cohort and help direct resources to appropriate patients. (2)
Aim
To develop and evaluate an integrated, multidisciplinary approach to HF management for patients with CIED by sharing HFRS alerts directly with the HF teams.
Methods
We undertook a prospective, single centre cohort study of patients who generated high risk HFRS alerts. These alerts were shared with community HF teams responsible for routine care of patient, prompting patient contact and appropriate intervention by the team. Impact of the pathway was evaluated by review of outcomes including hospitalisation and clinical intervention within 4- 6 weeks of the alert and mortality during the follow up period. Ongoing education was provided to help teams deal with alerts. A validated user questionnaire was completed by the stake holders to obtain user feedback.
Results
365 "High risk" alerts were noted in 188 patients in a 2 year period (November 2018 - November 2020). The mean number of alerts per patients was 1.9 and 44 (23%) of patients had >3 "high risk" alerts in the follow up period. Having three or more alerts significantly increased the risk of hospitalisation for heart failure (HR 2.5, CI 1.1–5.6 p = 0.03) but not mortality (HR 2.1 CI 0.6-7.2 p = 0.23). Overall 75 (39%) of patients were hospitalised in the 4-6 week period of the alert – 53 (28%) of these were unplanned of which 24(13%) were for decompensated HF. A further 24(13%) had planned admissions for care to improve therapy (AV node ablation, device and lead replacement) and reduce morbidity (LA appendage occlude, IV Iron therapy). 33(18%) of patients died in the follow up period. 15(8%) received therapy from the device. 18(10%) of patient underwent deactivation of ICD therapy.
Contact was established in 176 (94%) of patients, and alerts actioned appropriately. 55 patients reported being asymptomatic, and in 45 the trends were improving so no further clinical action was taken. 76 patients had an onward referral made for further management including; 32 to a Cardiologist, 20 to primary care, 13 referrals to community HF teams and 11 referrals to palliative care. 23 patients had medications changes instituted. The feedback on the pathway was positive.
Conclusions
An integrated approach to HF for patients with CIEDs in situ can facilitate timely risk stratification and intervention in this cohort of patients and potentially reduce unplanned health care utilisation. Intervention in these patients is not limited to HF alone and provides the opportunity for holistic management of this complex cohort Abstract Figure.
Collapse
Affiliation(s)
- D Garner
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - WY Leung
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Llewellyn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - R Goode
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - L Lunt
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - S Hughes
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Kahn
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - DJ Wright
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - A Rao
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
43
|
Hansoti B, Hahn E, Rao A, Harris J, Jenson A, Markadakis N, Moonat S, Osula V, Pousson A. Calibrating a chief complaint list for low resource settings: a methodologic case study. Int J Emerg Med 2021; 14:32. [PMID: 34011284 PMCID: PMC8132346 DOI: 10.1186/s12245-021-00347-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The chief or presenting complaint is the reason for seeking health care, often in the patient's own words. In limited resource settings, a diagnosis-based approach to quantifying burden of disease is not possible, partly due to limited availability of an established lexicon or coding system. Our group worked with colleagues from the African Federation of Emergency Medicine building on the existing literature to create a pilot symptom list representing an attempt to standardize undifferentiated chief complaints in emergency and acute care settings. An ideal list for any setting is one that strikes a balance between ease of use and length, while covering the vast majority of diseases with enough detail to permit epidemiologic surveillance and make informed decisions about resource needs. METHODS This study was incorporated as a part of a larger prospective observational study on human immunodeficiency virus testing in Emergency Departments in South Africa. The pilot symptom list was used for chief complaint coding in three Emergency Departments. Data was collected on 3357 patients using paper case report forms. Chief complaint terms were reviewed by two study team members to determine the frequency of concordance between the coded chief complaint term and the selected symptom(s) from the pilot symptom list. RESULTS Overall, 3537 patients' chief complaints were reviewed, of which 640 were identified as 'potential mismatches.' When considering the 191 confirmed mismatches (29.8%), the Delphi process identified 6 (3.1%) false mismatches and 185 (96.9%) true mismatches. Significant chief-complaint clustering was identified with 9 sets of complaints frequently selected together for the same patient. "Pain" was used 2076 times for 58.7% of all patients. A combination of user feedback and expert-panel modified Delphi analysis of mismatched complaints and clustered complaints resulted in several substantial changes to the pilot symptom list. CONCLUSIONS This study presented a systematic methodology for calibrating a chief complaint list for the local context. Our revised list removed/reworded symptoms that frequently clustered together or were misinterpreted by health professionals. Recommendations for additions, modifications, and/or deletions from the pilot chief complaint list we believe will improve the functionality of the list in low resource environments.
Collapse
Affiliation(s)
- B Hansoti
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - E Hahn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Harris
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Jenson
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - N Markadakis
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - S Moonat
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - V Osula
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - A Pousson
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
44
|
Sheu T, Park S, Rao A, Gans D, King R, Whitehead T, Swischuk J. Abstract No. 577 Basket thrombectomy using distal protection wires for arterial thromboembolism: a case series. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
45
|
Rao A, Rucinski K, Jarrett BA, Ackerman B, Wallach S, Marcus J, Adamson T, Garner A, Santos GM, Beyrer C, Howell S, Baral S. Perceived Interruptions to HIV Prevention and Treatment Services Associated With COVID-19 for Gay, Bisexual, and Other Men Who Have Sex With Men in 20 Countries. J Acquir Immune Defic Syndr 2021; 87:644-651. [PMID: 33443963 PMCID: PMC8276834 DOI: 10.1097/qai.0000000000002620] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The coronavirus pandemic has necessitated a range of population-based measures to stem the spread of infection. These measures may be associated with disruptions to other health services including for gay, bisexual, and other men who have sex with men (MSM) at risk for or living with HIV. Here, we assess the relationship between stringency of COVID-19 control measures and interruptions to HIV prevention and treatment services for MSM. SETTING Data for this study were collected between April 16, 2020, and May 24, 2020, as part of a COVID-19 Disparities Survey implemented by the gay social networking app, Hornet. Pandemic control measures were quantified using the Oxford Government Response Tracker Stringency Index: each country received a score (0-100) based on the number and strictness of 9 indicators related to restrictions, closures, and travel bans. METHODS We used a multilevel mixed-effects generalized linear model with Poisson distribution to assess the association between stringency of pandemic control measures and access to HIV services. RESULTS A total of 10,654 MSM across 20 countries were included. Thirty-eight percent (3992/10,396) reported perceived interruptions to in-person testing, 55% (5178/9335) interruptions to HIV self-testing, 56% (5171/9173) interruptions to pre-exposure prophylaxis, and 10% (990/9542) interruptions to condom access. For every 10-point increase in stringency, there was a 3% reduction in the prevalence of perceived access to in-person testing (aPR: 0·97, 95% CI: [0·96 to 0·98]), a 6% reduction in access to self-testing (aPR: 0·94, 95% CI: [0·93 to 0·95]), and a 5% reduction in access to pre-exposure prophylaxis (aPR: 0·95, 95% CI: [0·95 to 0·97]). Among those living with HIV, 20% (218/1105) were unable to access their provider; 65% (820/1254) reported being unable to refill their treatment prescription remotely. CONCLUSIONS More stringent responses were associated with decreased perceived access to services. These results support the need for increasing emphasis on innovative strategies in HIV-related diagnostic, prevention, and treatment services to minimize service interruptions during this and potential future waves of COVID-19 for gay men and other MSM at risk for HIV acquisition and transmission.
Collapse
Affiliation(s)
| | | | | | - Benjamin Ackerman
- Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Julia Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
- Fenway Institute, Boston, MA
| | | | | | - Glenn-Milo Santos
- Community Health Systems Department, University of California San Francisco, San Francisco, CA; and
- Center of Public Health Research, San Francisco Department of Public Health, San Francisco, CA
| | | | | | | |
Collapse
|
46
|
Rao A, Rucinski K, Jarrett BA, Ackerman B, Wallach S, Marcus J, Adamson T, Garner A, Santos GM, Beyrer C, Howell S, Baral S. Perceived Interruptions to HIV Prevention and Treatment Services Associated With COVID-19 for Gay, Bisexual, and Other Men Who Have Sex With Men in 20 Countries. J Acquir Immune Defic Syndr 2021. [DOI: http://doi.org.10.1097/qai.0000000000002620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
47
|
Rao A, Rucinski K, Jarrett BA, Ackerman B, Wallach S, Marcus J, Adamson T, Garner A, Santos GM, Beyrer C, Howell S, Baral S. Perceived Interruptions to HIV Prevention and Treatment Services Associated With COVID-19 for Gay, Bisexual, and Other Men Who Have Sex With Men in 20 Countries. J Acquir Immune Defic Syndr 2021. [DOI: http:/doi.org.10.1097/qai.0000000000002620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
|
48
|
Redd AD, Peetluk L, Jarrett B, Hanrahan C, Schwartz S, Rao A, Jaffe A, Jones C, Lutz C, McKee C, Patel E, Rosen G, Desany HG, McKay H, Muschelli J, Andersen K, Link MA, Wada N, Baral P, Young R, Boon D, Grabowski MK, Gurley ES. Curating and translating the evidence about SARS-CoV-2 and COVID-19 for frontline public health and clinical care: The Novel Coronavirus Research Compendium (NCRC). medRxiv 2021. [PMID: 33948611 PMCID: PMC8095230 DOI: 10.1101/2021.04.26.21255437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The public health crisis created by the SARS-CoV-2 pandemic has spurred a deluge of scientific research aimed at informing public health and medical response to the COVID-19 pandemic. However, those working in frontline public health and clinical care had insufficient time to parse the rapidly evolving evidence and use it for decision making. Academics in public health and medicine were well-placed to translate the evidence for use by frontline clinicians and public health practitioners. The Novel Coronavirus Research Compendium (NCRC), a group of >50 faculty and trainees, began in March 2020 with the goal to quickly triage and review the large volume of preprints and peer-reviewed publications on SARS-CoV-2 and COVID-19, and to summarize the most important, novel evidence to inform pandemic response. From April 6, 2020 through January 1, 2021, 54,192 papers and preprints were screened by NCRC teams and 527 were selected for review and uploaded to the NCRC website for public consumption. The majority of papers reviewed were peer-reviewed publications (n=395, 75%), published in 102 journals; 25% (n=132) of papers reviewed were of preprints. The NCRC is a successful model of how academics can support practitioners by translating scientific knowledge into action and help to build capacity among students for this work. This approach could be used for health problems beyond COVID-19, but the effort is resource intensive and may not be sustainable over the long term.
Collapse
|
49
|
Silhol R, Baral S, Bowring AL, Mukandavire C, Njindam IM, Rao A, Schwartz S, Tamoufe U, Billong SC, Njoya O, Zoung-Kanyi Bissek AC, Calleja JMG, Vickerman P, Mishra S, Boily MC. Quantifying the Evolving Contribution of HIV Interventions and Key Populations to the HIV Epidemic in Yaoundé, Cameroon. J Acquir Immune Defic Syndr 2021; 86:396-405. [PMID: 33234807 DOI: 10.1097/qai.0000000000002580] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Key populations (KP) including men who have sex with men (MSM), female sex workers (FSW), and their clients are disproportionately affected by HIV in Sub-Saharan Africa. We estimated the evolving impact of past interventions and contribution of unmet HIV prevention/treatment needs of key populations and lower-risk groups to HIV transmission. SETTING Yaoundé, Cameroon. METHODS We parametrized and fitted a deterministic HIV transmission model to Yaoundé-specific demographic, behavioral, HIV, and intervention coverage data in a Bayesian framework. We estimated the fraction of incident HIV infections averted by condoms and antiretroviral therapy (ART) and the fraction of all infections over 10-year periods directly and indirectly attributable to sex within and between each risk group. RESULTS Condom use and ART together may have averted 43% (95% uncertainty interval: 31-54) of incident infections over 1980-2018 and 72% (66-79) over 2009-2018. Most onward transmissions over 2009-2018 stemmed from sex between lower-risk individuals [47% (32-61)], clients [37% (23-51)], and MSM [35% (20-54)] with all their partners. The contribution of commercial sex decreased from 25% (8-49) over 1989-1998 to 8% (3-22) over 2009-2018, due to higher intervention coverage among FSW. CONCLUSION Condom use and recent ART scale-up mitigated the HIV epidemic in Yaoundé and changed the contribution of different partnerships to onward transmission over time. Findings highlight the importance of prioritizing HIV prevention and treatment for MSM and clients of FSW whose unmet needs now contribute most to onward transmission, while maintaining services that successfully reduced transmissions in the context of commercial sex.
Collapse
Affiliation(s)
- Romain Silhol
- Department of Infectious Disease Epidemiology, Imperial College London, HPTN Modelling Centre, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Anna L Bowring
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Burnet Institute, Melbourne, Australia
| | - Christinah Mukandavire
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Iliassou M Njindam
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Amrita Rao
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Sheree Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Ubald Tamoufe
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
- Metabiota, Yaoundé, Cameroon
| | - Serge C Billong
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- National AIDS Control Committee (NACC/CNLS), Yaoundé, Cameroon
| | - Oudou Njoya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Anne-Cecile Zoung-Kanyi Bissek
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
- Division of Operations Research, Ministry of Health, Yaoundé, Cameroon
| | | | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sharmistha Mishra
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Canada; and
- Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, Canada
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, HPTN Modelling Centre, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
50
|
Baral SD, Rucinski KB, Twahirwa Rwema JO, Rao A, Prata Menezes N, Diouf D, Kamarulzaman A, Phaswana-Mafuya N, Mishra S. The Relationship Between the Global Burden of Influenza From 2017 to 2019 and COVID-19: Descriptive Epidemiological Assessment. JMIR Public Health Surveill 2021; 7:e24696. [PMID: 33522974 PMCID: PMC7927952 DOI: 10.2196/24696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND SARS-CoV-2 and influenza are lipid-enveloped viruses with differential morbidity and mortality but shared modes of transmission. OBJECTIVE With a descriptive epidemiological framing, we assessed whether recent historical patterns of regional influenza burden are reflected in the observed heterogeneity in COVID-19 cases across regions of the world. METHODS Weekly surveillance data reported by the World Health Organization from January 2017 to December 2019 for influenza and from January 1, 2020 through October 31, 2020, for COVID-19 were used to assess seasonal and temporal trends for influenza and COVID-19 cases across the seven World Bank regions. RESULTS In regions with more pronounced influenza seasonality, COVID-19 epidemics have largely followed trends similar to those seen for influenza from 2017 to 2019. COVID-19 epidemics in countries across Europe, Central Asia, and North America have been marked by a first peak during the spring, followed by significant reductions in COVID-19 cases in the summer months and a second wave in the fall. In Latin America and the Caribbean, COVID-19 epidemics in several countries peaked in the summer, corresponding to months with the highest influenza activity in the region. Countries from regions with less pronounced influenza activity, including South Asia and sub-Saharan Africa, showed more heterogeneity in COVID-19 epidemics seen to date. However, similarities in COVID-19 and influenza trends were evident within select countries irrespective of region. CONCLUSIONS Ecological consistency in COVID-19 trends seen to date with influenza trends suggests the potential for shared individual, structural, and environmental determinants of transmission. Using a descriptive epidemiological framework to assess shared regional trends for rapidly emerging respiratory pathogens with better studied respiratory infections may provide further insights into the differential impacts of nonpharmacologic interventions and intersections with environmental conditions. Ultimately, forecasting trends and informing interventions for novel respiratory pathogens like COVID-19 should leverage epidemiologic patterns in the relative burden of past respiratory pathogens as prior information.
Collapse
Affiliation(s)
- Stefan David Baral
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Katherine Blair Rucinski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Jean Olivier Twahirwa Rwema
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Amrita Rao
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Neia Prata Menezes
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Nancy Phaswana-Mafuya
- Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Sharmistha Mishra
- Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| |
Collapse
|