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Pharmacokinetics of efavirenz in patients on antituberculosis treatment in high HIV and tuberculosis burden countries: a systematic review

Title: Pharmacokinetics of efavirenz in patients on antituberculosis treatment in high HIV and tuberculosis burden countries: a systematic review Authors: Atwine, D; Bonnet, M; Taburet, AM Abstract: Efavirenz (EFV) and Rifampicin-Isoniazid (RH) are cornerstone drugs in HIV-tuberculosis (TB) co-infection treatment but with complex drug interactions, efficacy and safety challenges. We reviewed recent data on EFV and RH interaction in TB/HIV high-burden countries.

Breast tuberculosis in men: A systematic review

Title: Breast tuberculosis in men: A systematic review Authors: Quaglio, G; Pizzol, D; Bortolani, A; Manenti, F; Isaakidis, P; Putoto, G; Olliaro, PL Abstract: Breast tuberculosis in male is a rarely reported and poorly described condition.

Global programmatic use of bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis

Title: Global programmatic use of bedaquiline and delamanid for the treatment of multidrug-resistant tuberculosis Authors: Cox, V; Brigden, G; Crespo, RH; Lessem, E; Lynch, S; Rich, ML; Waning, B; Furin, J Abstract: The World Health Organization recommended two new drugs, bedaquiline (BDQ) and delamanid (DLM), for the treatment of multidrug-resistant tuberculosis (MDR-TB) in 2013 and 2014, respectively. An estimated one third of patients with MDR-TB would benefit from the inclusion of these drugs in their treatment regimens.

Anthropology in public health emergencies:what is anthropology good for?

Title: Anthropology in public health emergencies:what is anthropology good for? Authors: Stellmach, D; Beshar, I; Bedford, J; du Cros, P; Stringer, B Abstract: Recent outbreaks of Ebola virus disease (2013-2016) and Zika virus (2015-2016) bring renewed recognition of the need to understand social pathways of disease transmission and barriers to care. Social scientists, anthropologists in particular, have been recognised as important players in disease outbreak response because of their ability to assess social, economic and political factors in local contexts. However, in emergency public health response, as with any interdisciplinary setting, different professions may disagree over methods, ethics and the nature of evidence itself. A disease outbreak is no place to begin to negotiate disciplinary differences. Given increasing demand for anthropologists to work alongside epidemiologists, clinicians and public health professionals in health crises, this paper gives a basic introduction to anthropological methods and seeks to bridge the gap in disciplinary expectations within emergencies. It asks: 'What can anthropologists do in a public health crisis and how do they do it?' It argues for an interdisciplinary conception of emergency and the recognition that social, psychological and institutional factors influence all aspects of care.

IPT during HIV treatment in Myanmar: high rates of coverage, completion and drug adherence

Title: IPT during HIV treatment in Myanmar: high rates of coverage, completion and drug adherence Authors: Ousley, J; Soe, KP; Kyaw, NTT; Anicete, R; Mon, PE; Lwin, H; Win, T; Cristofani, S; Telnov, A; Fernandez, M; Ciglenecki, I Abstract: Setting: A southern Myanmar district providing isoniazid preventive therapy (IPT) in one of the last countries to formally recommend it as part of human immunodeficiency virus (HIV) care.Objective:To assess coverage and adherence and the feasibility of IPT scale-up in a routine care setting in Myanmar.Design:A retrospective analysis of people living with HIV (PLHIV) screened for tuberculosis (TB) and enrolled in IPT over a 3-year period (July 2011-June 2014) using clinical databases.Results:Among 3377 patients under HIV care and screened for TB, 2740 (81.1%) initiated IPT, with 2651 (96.8%) completing a 6- or 9-month course of IPT; 83 (3.1%) interrupted treatment for different reasons, including loss to follow-up (n= 41), side effects (n= 15) or drug adherence issues (n= 9); 6 (0.2%) died. Among the IPT patients, 33 (1.2%) were diagnosed with TB, including 9 (0.3%) while on IPT and 24 (0.9%) within 1 year of completion of therapy. Among the PLHIV who completed IPT, one case of isoniazid resistance was detected.Conclusion:Scaling up IPT in Myanmar HIV settings is feasible with high rates of drug adherence and completion, and a low rate of discontinuation due to side effects. IPT scale-up should be prioritised in HIV clinical settings in Myanmar.

Early safety and efficacy of the combination of bedaquiline and delamanid for the treatment of patients with drug-resistant tuberculosis in Armenia, India, and South Africa: a retrospective cohort study

Title: Early safety and efficacy of the combination of bedaquiline and delamanid for the treatment of patients with drug-resistant tuberculosis in Armenia, India, and South Africa: a retrospective cohort study Authors: Ferlazzo, G; Mohr, E; Laxmeshwar, C; Hewison, C; Hughes, J; Jonckheere, S; Khachatryan, N; De Avezedo, V; Egazaryan, L; Shroufi, A; Kalon, S; Cox, H; Furin, J; Isaakidis, P Abstract: Bedaquiline and delamanid have been approved for treatment of multidrug-resistant (MDR) tuberculosis in the past 5 years. Because of theoretical safety concerns, patients have been unable to access the two drugs in combination. Médecins Sans Frontières has supported the use of combination bedaquiline and delamanid for people with few treatment options since 2016. We describe early safety and efficacy of regimens containing the bedaquiline and delamanid combination in patients with drug-resistant tuberculosis in Yerevan, Armenia; Mumbai, India; and Khayelitsha, South Africa.

The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone

Title: The factors affecting household transmission dynamics and community compliance with Ebola control measures: a mixed-methods study in a rural village in Sierra Leone Authors: Caleo, G; Duncombe, J; Jephcott, F; Lokuge, K; Mills, C; Looijen, E; Theoharaki, F; Kremer, R; Kleijer, K; Squire, J; Lamin, M; Stringer, B; Weiss, HA; Culli, D; Di Tanna, GL; Greig, J Abstract: Little is understood of Ebola virus disease (EVD) transmission dynamics and community compliance with control measures over time. Understanding these interactions is essential if interventions are to be effective in future outbreaks. We conducted a mixed-methods study to explore these factors in a rural village that experienced sustained EVD transmission in Kailahun District, Sierra Leone.

Single-Dose Cholera Vaccine in Response to an Outbreak in Zambia

Title: Single-Dose Cholera Vaccine in Response to an Outbreak in Zambia Authors: Ferreras, E; Chizema-Kawesha, E; Blake, A; Chewe, O; Mwaba, J; Zulu, G; Poncin, M; Rakesh, A; Page, AL; Stoitsova, S; Voute, C; Uzzeni, F; Robert, H; Serafini, M; Matapo, B; Eiros, JM; Quilici, ML; Pezzoli, L; Azman, AS; Cohuet, S; Ciglenecki, I; Malama, K; Luquero, FJ

Long-term clinical, immunological and virological outcomes of patients on antiretroviral therapy in southern Myanmar

Title: Long-term clinical, immunological and virological outcomes of patients on antiretroviral therapy in southern Myanmar Authors: Bermúdez-Aza, EH; Shetty, S; Ousley, J; Kyaw, NTT; Soe, TT; Soe, K; Mon, PE; Tun, KT; Ciglenecki, I; Cristofani, S; Fernandez, M Abstract: To study the long-term clinical, immunological and virological outcomes among people living with HIV on antiretroviral therapy (ART) in Myanmar.

Efficacy of artesunate-amodiaquine, dihydroartemisinin-piperaquine and artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Maradi, Niger

Title: Efficacy of artesunate-amodiaquine, dihydroartemisinin-piperaquine and artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Maradi, Niger Authors: Grandesso, Francesco; Guindo, Ousmane; Woi Messe, Lynda; Makarimi, Rockyath; Traore, Aliou; Dama, Souleymane; Laminou, Ibrahim Maman; Rigal, Jean; de Smet, Martin; Ouwe Missi Oukem-Boyer, Odile; Doumbo, Ogobara K; Djimdé, Abdoulaye; Etard, Jean-François Abstract: Malaria endemic countries need to assess efficacy of anti-malarial treatments on a regular basis. Moreover, resistance to artemisinin that is established across mainland South-East Asia represents today a major threat to global health. Monitoring the efficacy of artemisinin-based combination therapies is of paramount importance to detect as early as possible the emergence of resistance in African countries that toll the highest burden of malaria morbidity and mortality.

Navigating the risks of prevention of mother to child transmission (PMTCT) of HIV services in Kibera, Kenya: Barriers to engaging and remaining in care

Title: Navigating the risks of prevention of mother to child transmission (PMTCT) of HIV services in Kibera, Kenya: Barriers to engaging and remaining in care Authors: Thomson, Kerry A; Telfer, Barbara; Opondo Awiti, Patricia; Munge, Jane; Ngunga, Mathew; Reid, Anthony Abstract: Within the first year of implementation, 43% of women who tested HIV positive at their first antenatal care visit were no longer retained and being followed in the free prevention of mother to child transmission (PMTCT) of HIV program offered by the Kenyan Ministry of Health and Médecins Sans Frontières in the informal settlement of Kibera, Nairobi. This study aimed to explore barriers to enrolling and remaining engaged in PMTCT services throughout the pregnancy and postpartum periods. Qualitative data from 31 focus group discussions and 35 in-depth interviews across six stakeholder groups that included women, men, and PMTCT service providers were analyzed. Using an inductive exploratory approach, four researchers coded the data and identified key themes. Five themes emerged from the data that may influence attrition from PMTCT service in this setting: 1) HIV in the context of Kibera, 2) knowledge of HIV status, 3) knowledge of PMTCT, 4) disclosure of HIV status, and 5) male partner support for PMTCT services. A new HIV diagnosis during pregnancy immediately triggered an ongoing risk assessment of perceived hazards in the home, community, and clinic environments that could occur as a result of female participation in PMTCT services. Male partners were a major influence in this risk assessment, but were generally unaware of PMTCT services. To preserve relationships with male partners, meet community expectations of womanhood, and maintain confidentiality while following recommendations of healthcare providers, women had to continuously weigh the risks and benefits of PMTCT services and interventions. Community-based HIV testing and PMTCT education, male involvement in antenatal care, and counseling customized to assist each woman in her own unique risk assessment, may improve uptake of and retention in care and optimize the HIV prevention benefit of PMTCT interventions.

Unreported cases in the 2014-2016 Ebola epidemic: Spatiotemporal variation, and implications for estimating transmission

Title: Unreported cases in the 2014-2016 Ebola epidemic: Spatiotemporal variation, and implications for estimating transmission Authors: Dalziel, Benjamin D; Lau, Max S Y; Tiffany, Amanda; McClelland, Amanda; Zelner, Jon; Bliss, Jessica R; Grenfell, Bryan T Abstract: In the recent 2014-2016 Ebola epidemic in West Africa, non-hospitalized cases were an important component of the chain of transmission. However, non-hospitalized cases are at increased risk of going unreported because of barriers to access to healthcare. Furthermore, underreporting rates may fluctuate over space and time, biasing estimates of disease transmission rates, which are important for understanding spread and planning control measures. We performed a retrospective analysis on community deaths during the recent Ebola epidemic in Sierra Leone to estimate the number of unreported non-hospitalized cases, and to quantify how Ebola reporting rates varied across locations and over time. We then tested if variation in reporting rates affected the estimates of disease transmission rates that were used in surveillance and response. We found significant variation in reporting rates among districts, and district-specific rates of increases in reporting over time. Correcting time series of numbers of cases for variable reporting rates led, in some instances, to different estimates of the time-varying reproduction number of the epidemic, particularly outside the capital. Future analyses that compare Ebola transmission rates over time and across locations may be improved by considering the impacts of differential reporting rates.

Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV

Title: Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV Authors: Gils, T; Bossard, C; Verdonck, K; Owiti, P; Casteels, I; Mashako, M; Van Cutsem, G; Ellman, T Abstract: Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29-90) and 44 days (interquartile range 24-90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction of new ART regimens needs additional planning.

Single low-dose primaquine for blocking transmission of Plasmodium falciparum malaria - a proposed model-derived age-based regimen for sub-Saharan Africa

Title: Single low-dose primaquine for blocking transmission of Plasmodium falciparum malaria - a proposed model-derived age-based regimen for sub-Saharan Africa Authors: Taylor, WR; Naw, HK; Maitland, K; Williams, TN; Kapulu, M; D'Alessandro, U; Berkley, JA; Bejon, P; Okebe, J; Achan, J; Amambua, AN; Affara, M; Nwakanma, D; van Geertruyden, JP; Mavoko, M; Lutumba, P; Matangila, J; Brasseur, P; Piola, P; Randremanana, R; Lasry, E; Fanello, C; Onyamboko, M; Schramm, B; Yah, Z; Jones, J; Fairhurst, RM; Diakite, M; Malenga, G; Molyneux, M; Rwagacondo, C; Obonyo, C; Gadisa, E; Aseffa, A; Loolpapit, M; Henry, MC; Dorsey, G; John, C; Sirima, SB; Barnes, KI; Kremsner, P; Day, NP; White, NJ; Mukaka, M Abstract: In 2012, the World Health Organization recommended blocking the transmission of Plasmodium falciparum with single low-dose primaquine (SLDPQ, target dose 0.25 mg base/kg body weight), without testing for glucose-6-phosphate dehydrogenase deficiency (G6PDd), when treating patients with uncomplicated falciparum malaria. We sought to develop an age-based SLDPQ regimen that would be suitable for sub-Saharan Africa.

Higher Art Adherence is Associated with Lower Systemic Inflammation in Treatment-Naïve Ugandans Who Achieve Virologic Suppression

Title: Higher Art Adherence is Associated with Lower Systemic Inflammation in Treatment-Naïve Ugandans Who Achieve Virologic Suppression Authors: Castillo-Mancilla, JR; Morrow, M; Boum, Y; Byakwaga, H; Haberer, JE; Martin, JN; Bangsberg, D; Mawhinney, S; Musinguzi, N; Huang, Y; Tracy, RP; Burdo, TH; Williams, K; Muzoora, C; Hunt, PW; Siedner, MJ Abstract: Residual systemic inflammation persists despite suppressive antiretroviral therapy (ART) and is associated with non-AIDS clinical outcomes. We aimed to evaluate the association between ART adherence and inflammation in Ugandans living with HIV who were predominantly receiving nevirapine-based ART with a thymidine analog backbone and were virologically suppressed by conventional assays. Description: We regret that this article is behind a paywall.

Seasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa: analysis of cohort studies at antiretroviral treatment programmes

Title: Seasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa: analysis of cohort studies at antiretroviral treatment programmes Authors: Ballif, M; Zürcher, K; Reid, SE; Boulle, A; Fox, MP; Prozesky, HW; Chimbetete, C; Zwahlen, M; Egger, M; Fenner, L Abstract: Seasonal variations in tuberculosis diagnoses have been attributed to seasonal climatic changes and indoor crowding during colder winter months. We investigated trends in pulmonary tuberculosis (PTB) diagnosis at antiretroviral therapy (ART) programmes in Southern Africa.

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