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Gare J, Toto B, Pokeya P, Le LV, Dala N, Lote N, John B, Yamba A, Soli K, DeVos J, Paulin H, Wagar N, Zheng DP, Nishijima T, Boas P, Kelly-Hanku A, Gurung A. High prevalence of pre-treatment HIV drug resistance in Papua New Guinea: findings from the first nationally representative pre-treatment HIV drug resistance study. BMC Infect Dis 2022; 22:266. [PMID: 35305571 PMCID: PMC8934451 DOI: 10.1186/s12879-022-07264-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 03/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background Determining the prevalence of pre-treatment HIV drug resistance (PDR) is important to assess the effectiveness of first-line therapies. To determine PDR prevalence in Papua New Guinea (PNG), we conducted a nationally representative survey. Methods We used a two-stage cluster sampling method to recruit HIV treatment initiators with and without prior exposure to antiretroviral therapies (ART) in selected clinics. Dried blood spots were collected and tested for PDR. Results A total of 315 sequences were available for analysis. The overall PDR prevalence rate was 18.4% (95% CI 13.8–24.3%). The prevalence of PDR to non-nucleoside analog reverse-transcriptase inhibitors (NNRTIs) was 17.8% (95% CI 13.6–23.0%) and of PDR to nucleoside reverse transcriptase inhibitors (NRTIs) was 6.3% (95% CI 1.6–17.1%). The PDR prevalence rate among people reinitiating ART was 42.4% (95% CI 29.1–56.4%). Conclusions PNG has a high PDR prevalence rate, especially to NNRTI-based first-line therapies. Our findings suggest that removing NNRTIs as part of first-line treatment is warranted and will lead to improving viral suppression rates in PNG.
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Machekera S, Boas P, Temu P, Mosende Z, Lote N, Kelly-Hanku A, Mahiane SG, Glaubius R, Rowley J, Gurung A, Korenromp E. Strategic options for syphilis control in Papua New Guinea- impact and cost-effectiveness projections using the syphilis interventions towards elimination (SITE) model. Infect Dis Model 2021; 6:584-597. [PMID: 33869906 PMCID: PMC8039768 DOI: 10.1016/j.idm.2021.03.004] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives Papua New Guinea (PNG) has among the highest rates of sexually transmitted infections (STIs) globally and is committed to reducing their incidence. The Syphilis Interventions Towards Elimination (SITE) model was used to explore the expected impact and cost of alternative syphilis intervention scale-up scenarios. Methods SITE is a dynamical model of syphilis transmission among adults 15-49 years. Individuals are divided into nine groups based on sexual behaviour and into six stages of infection. The model was calibrated to PNG using data from routine surveillance, bio-behavioural surveys, research studies and program records. Inputs included syphilis prevalence, risk behaviours, intervention coverage and service delivery unit costs. Scenarios compared different interventions (clinical treatment, contact tracing, syphilis screening, and condom promotion) for incidence and cost per infection averted over 2021-2030. Results Increasing treatment coverage of symptomatic primary/secondary-stage syphilis cases from 25-35% in 2020 to 60% from 2023 onwards reduced estimated incidence over 2021-2030 by 55%, compared to a scenario assuming constant coverage at 2019-2020 levels. The introduction of contact tracing in 2020, assuming 0.4 contacts per symptomatic person treated, reduced incidence over 2021-2030 by 10%. Increasing screening coverage by 20-30 percentage points from the 2019-2020 level reduced incidence over 2021-2030 by 3-16% depending on the target population. Scaling-up clinical, symptom-driven treatment and contact tracing had the lowest cost per infection averted, followed by condom promotion and periodic screening of female sex workers and men who have sex with men. Conclusions PNG could considerably reduce its syphilis burden by scaling-up clinical treatment and contact tracing alongside targeted behavioural risk reduction interventions. SITE is a useful tool countries can apply to inform national STI programming and resource allocation.
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Key Words
- (I)BBS, (Integrated) Bio-Behavioural Survey
- ANC, antenatal care
- Cost-effectiveness
- DHS, Demographic and Health Survey
- FSW, Female Sex Worker
- GUD, Genital Ulcer Disease
- MSM, Men who have sex with men
- National program strategy
- PNG, Papua New Guinea
- PoM, Port Moresby
- Prevention
- RPR, Rapid Plasma Reagin test
- Resource allocation
- STI, sexually transmitted infection
- Syphilis
- TPHA, Treponema pallidum hemagglutination assay
- TPPA, Treponema pallidum particle agglutination assay
- Treatment
- VDRL, Venereal Disease Research Laboratory
- WHO, World Health Organization
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Affiliation(s)
- Shepherd Machekera
- Government of Papua New Guinea, National Department of Health, AOPI Center, Waigani Drive, PO Box, 5896, Port Moresby, Papua New Guinea
- World Vision International, Ruta Place, Morata St, Gordons. P.O Box 4254, Boroko, National Capital District, Port Moresby, Papua New Guinea
| | - Peniel Boas
- Government of Papua New Guinea, National Department of Health, AOPI Center, Waigani Drive, PO Box, 5896, Port Moresby, Papua New Guinea
| | - Poruan Temu
- Government of Papua New Guinea, National Department of Health, AOPI Center, Waigani Drive, PO Box, 5896, Port Moresby, Papua New Guinea
| | | | - Namarola Lote
- Government of Papua New Guinea, National Department of Health, AOPI Center, Waigani Drive, PO Box, 5896, Port Moresby, Papua New Guinea
- WHO Papua New Guinea Country Office, Communicable Disease & Health Emergency Dept., AOPI Centre, Waigani Drive, Port Moresby, Papua New Guinea
| | - Angela Kelly-Hanku
- Papua New Guinea Institute of Medical Research, 441 Homate Street, PO Box 60, Goroka, Eastern Highland Province, Papua New Guinea
- Kirby Institute, UNSW Sydney, Wallace Wurth Building, High Street, UNSW Australia Kensington, NSW 2052, Sydney, Australia
| | - S. Guy Mahiane
- Avenir Health, Modelling, Planning and Policy Analysis Dept., 655 Winding Brook Drive, Glastonbury, CT, 06033, USA
| | - Robert Glaubius
- Avenir Health, Modelling, Planning and Policy Analysis Dept., 655 Winding Brook Drive, Glastonbury, CT, 06033, USA
| | - Jane Rowley
- Independent Consultant, 135 Gloucester Terrace, W2 6DX, London, UK
| | - Anup Gurung
- WHO Papua New Guinea Country Office, Communicable Disease & Health Emergency Dept., AOPI Centre, Waigani Drive, Port Moresby, Papua New Guinea
| | - Eline Korenromp
- Avenir Health, Modelling, Planning and Policy Analysis Dept., 150 Route de Ferney, PO box 2100, CH-1211 Geneva 2, Switzerland
- Corresponding author.
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Fujita M, Poudel KC, Green K, Wi T, Abeyewickreme I, Ghidinelli M, Kato M, Vun MC, Sopheap S, San KO, Bollen P, Rai KK, Dahal A, Bhandari D, Boas P, Yaipupu J, Sirinirund P, Saonuam P, Duong BD, Nhan DT, Thu NTM, Jimba M. HIV service delivery models towards 'Zero AIDS-related Deaths': a collaborative case study of 6 Asia and Pacific countries. BMC Health Serv Res 2015; 15:176. [PMID: 25902708 PMCID: PMC4421992 DOI: 10.1186/s12913-015-0804-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/19/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In the Asia-Pacific region, limited systematic assessment has been conducted on HIV service delivery models. Applying an analytical framework of the continuum of prevention and care, this study aimed to assess HIV service deliveries in six Asia and Pacific countries from the perspective of service availability, linking approaches and performance monitoring for maximizing HIV case detection and retention. METHODS Each country formed a review team that provided published and unpublished information from the national HIV program. Four types of continuum were examined: (i) service linkages between key population outreach and HIV diagnosis (vertical-community continuum); (ii) chronic care provision across HIV diagnosis and treatment (chronological continuum); (iii) linkages between HIV and other health services (horizontal continuum); and (iv) comprehensive care sites coordinating care provision (hub and heart of continuum). RESULTS Regarding the vertical-community continuum, all districts had voluntary counselling and testing (VCT) in all countries except for Myanmar and Vietnam. In these two countries, limited VCT availability was a constraint for referring key populations reached. All countries monitored HIV testing coverage among key populations. Concerning the chronological continuum, the proportion of districts/townships having antiretroviral treatment (ART) was less than 70% except in Thailand, posing a barrier for accessing pre-ART/ART care. Mechanisms for providing chronic care and monitoring retention were less developed for VCT/pre-ART process compared to ART process in all countries. On the horizontal continuum, the availability of HIV testing for tuberculosis patients and pregnant women was limited and there were sub-optimal linkages between tuberculosis, antenatal care and HIV services except for Cambodia and Thailand. These two countries indicated higher HIV testing coverage than other countries. Regarding hub and heart of continuum, all countries had comprehensive care sites with different degrees of community involvement. CONCLUSIONS The analytical framework was useful to identify similarities and considerable variations in service availability and linking approaches across the countries. The study findings would help each country critically adapt and adopt global recommendations on HIV service decentralization, linkages and integration. Especially, the findings would inform cross-fertilization among the countries and national HIV program reviews to determine county-specific measures for maximizing HIV case detection and retention.
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Affiliation(s)
- Masami Fujita
- World Health Organization Cambodia, P.O. Box 1217, , No. 177-179 Pasteur (St.51), Sangkat Chak Tomouk, Phnom Penh, Cambodia.
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, USA.
| | | | - Teodora Wi
- World Health Organization, Geneva, Switzerland.
| | - Iyanthi Abeyewickreme
- Formerly World Health Organization Regional Office for South-East Asia, New Delhi, India.
| | - Massimo Ghidinelli
- Pan American Health Organization, World Health Organization Regional Office for the Americas, Washington, DC, USA.
| | | | - Mean Chhi Vun
- National Center for HIV/AIDS, Dermatology and STD, Ministry of Health, Phnom Penh, Cambodia.
| | - Seng Sopheap
- National Center for HIV/AIDS, Dermatology and STD, Ministry of Health, Phnom Penh, Cambodia.
| | - Khin Ohnmar San
- Formerly National AIDS Program, Ministry of Health, Nay Pyi Taw, Myanmar.
| | | | - Krishna Kumar Rai
- National Center for AIDS and STD Control, Ministry of Health, Kathmandu, Nepal.
| | - Atul Dahal
- World Health Organization, Kathmandu, Nepal.
| | | | - Peniel Boas
- STI, HIV and AIDS Surveillance Unit, Ministry of Health, Port Moresby, Papua New Guinea.
| | | | - Petchsri Sirinirund
- National AIDS Management Center, Ministry of Public Health, Bangkok, Thailand.
| | - Pairoj Saonuam
- National AIDS Management Center, Ministry of Public Health, Bangkok, Thailand.
| | - Bui Duc Duong
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
| | - Do Thi Nhan
- Vietnam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
| | | | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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Friesen H, Vince J, Boas P, Danaya R, Mokela D, Ogle G, Asuo P, Kemiki A, Lagani W, Rongap T, Varughese M, Saweri W. Infant feeding practices in Papua New Guinea. Ann Trop Paediatr 1998; 18:209-15. [PMID: 9924558 DOI: 10.1080/02724936.1998.11747949] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Concern about a possibly increasing prevalence of bottle-feeding led in 1995 to an Infant Feeding Survey of 1822 mothers attending urban health facilities. Infant feeding practices including feeding of colostrum, exclusive breastfeeding, weaning practices and bottle-feeding were assessed. This revealed that 28.8% of mothers had not given colostrum to their babies, that 43.5% of 3-month-old babies were exclusively breastfed, and that solids were introduced before 4 months of age in over half of the study population. Bottle-feeding was used by 20% of the study population. Feeding practices differed in women of Highlands and of Coastal origin. The findings emphasize the need to strengthen health education programmes which take into account the mothers' different cultural backgrounds. The issue of breast-feeding by mothers in paid employment needs to be addressed.
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Affiliation(s)
- H Friesen
- Division of Paediatrics, University of Papua New Guinea
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Boas P. Neuro linguistic programming--an aid to management. AUST HEALTH REV 1983; 6:38-40. [PMID: 10263094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
This is an article that asks two questions. Do you presently, get what you want with the people who work for you and with you? Are you able to easily understand what they are asking or telling you and do you easily find ways to communicate your intentions and requirements to them? If you answered no to any of the three parts of these two questions then this article will have information of interest to you. Neuro Linguistic Programming or NLP as it is usually referred to is without doubt the most powerful communication model, to have emerged for use in management, during the last decade. It takes the elements of everyday behaviour patterns and makes them available to any serious student.
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