Integrating tuberculosis and HIV services in low- and middle-income countries: a systematic review.

OBJECTIVES: Given the imperative to scale up integrated tuberculosis (TB) and HIV services in settings where both are of major public health importance, we aimed to synthesise knowledge concerning implementation of TB/HIV service integration. METHODS: Systematic review of studies describing a strategy to facilitate TB and HIV service integration, searching 15 bibliographic databases including Medline, Embase and the Cochrane library; and relevant conference abstracts. RESULTS: Sixty-three of 1936 peer-reviewed articles and 70 of 170 abstracts met our inclusion criteria. We identified five models: entry via TB service, with referral for HIV testing and care; entry via TB service, on-site HIV testing, and referral for HIV care; entry via HIV service with referral for TB screening and treatment; entry via HIV service, on-site TB screening, and referral for TB diagnosis and treatment; and TB and HIV services provided at a single facility. Referral-based models are most easily implemented, but referral failure is a key risk. Closer integration requires more staff training and additional infrastructure (e.g. private space for HIV counselling; integrated records). Infection control is a major concern. More integrated models hold potential efficiencies from both provider and user perspective. Most papers report 'outcomes' (e.g. proportion of TB patients tested for HIV); few report downstream 'impacts' such as outcomes of TB treatment or antiretroviral therapy. Very few studies address the perspectives of service users or staff, or costs or cost-effectiveness. CONCLUSIONS: While scaling up integrated services, robust comparisons of the impacts of different models are needed using standardised outcome measures

Social learning, selection, and HIV infection: Evidence from Malawi

"This paper examines social learning regarding HIV infection, using HIV test results and sibling death data from Malawi. In the analysis, we compare hypotheses on social learning, selection. and common factors. Empirical results show that young women are less likely to be HIV-infected if they observed prime-age deaths among their siblings, whereas HIV infection is found to be positively related to prime-age sibling deaths among older women. This supports the social-learning hypothesis. Notably, schooling reinforces the social-learning effect of sibling deaths on HIV infection in women regardless of age. The above findings are robust to age (cohort) effects and unobserved location factors." from authors' abstractSocial learning, HIV infection, AIDS (Disease) Africa, Sub-Saharan, siblings,

Children’s school participation and HIV/AIDS in rural Malawi:

Studies of the relationship between HIV/AIDS and children’s educational attainment largely focus on the direct impacts of parental illness and death, overlooking the potential indirect impact that parental knowledge and perceptions of their HIV status may have on children’s school enrollment. Drawing on both quantitative and qualitative evidence from Malawi, this paper finds that women’s real and perceived anticipation of future health shocks has a positive impact on their children’s educational attainment. Interventions that target health uncertainty, such as HIV testing programs, may make a significant contribution to maintaining children’s educational attainment in communities affected by HIV/AIDS.Africa, AIDS/HIV, education, health uncertainty, HIV testing, orphans, risk perception

The Impact of HIV on Children´s Welfare

Children living in HIV/AIDS affected households bear the heaviest burden of the epidemic. Besides direct vertical transmission, HIV/ AIDS potentially worsens the children’s welfare indirectly through its socio-economic impact. This paper uses household survey data including information about individual HIV infection status to analyze the direct and indirect effects of HIV-infected household members on child mortality, undernutrition and educational attainment for Burkina Faso, Cameroon, Ghana and Kenya. The results indicate that the main channel through which HIV effects the child mortality risk is mother to child transmission. Whereas no effect of HIV is found on child mortality and undernutrition, a negative effect for school enrollment is found for Burkina Faso and Cameroon.Child Mortality, HIV/AIDS, Undernutrition, Education, Sub-Saharan Africa

Bridging user and provider perspectives: Family planning access and utilization in rural Mozambique

Objectives: To examine how the contraceptive behavior of women in rural southern Mozambique is shaped by their individual and household characteristics; community characteristics; access to family planning services; and characteristics of health facilities.<p></p> Methods: Quantitative and qualitative data were collected mostly between January 20 and December 15, 2011, in rural areas of four districts in Gaza Province, Mozambique. The data included: a retrospective household-based survey of women of reproductive age (the analytical sample consisted of 1554 non-pregnant women in marital union); qualitative interviews with a subsample of surveyed women; a survey of communities where the women resided (n = 56); and a survey of all health facilities in the study area (n = 56). Binomial and multinomial logistic models were fitted to predict current use of modern contraceptive methods. Statistical analyses were complemented by insights from qualitative data.<p></p> Results: Positive associations were detected between contraceptive use and education, household wealth, and perceived HIV infection status. Distance to the clinic was negatively associated with contraceptive use. These effects were additive, with some varying by type of contraceptive method. Examination of qualitative data highlighted frequent cognitive dissonance between service providers and users.<p></p> Conclusion: A simultaneous consideration of user-level and provider-level perspectives on contraceptive use improves our understanding of contraceptive dynamics and can usefully inform policy

HIV/AIDS in Rural Northeast Thailand: Narratives of the impacts of HIV/AIDS on individuals and households

HIV/AIDS is one of the greatest public health and development challenges currently faced by the global community. Amongst reported statistics, such as the estimated 39.5 million people infected with HIV at the end of 2006, the human face of HIV/AIDS is often lost. This paper presents several narratives of the impacts of HIV/AIDS on individuals and households, drawn from a 2003 survey of 71 HIV/AIDS patients in Khon Kaen Province, Northeast Thailand. These narratives illustrate the broad range of impacts of HIV/AIDS, as well as the diverse coping strategies that are employed to deal with those impacts. The narratives also demonstrate how the HIV/AIDS epidemic impacts not just those who are HIV-infected and other members of their household, but also the wider community

Sociodemographic and clinical characteristics of persons who experienced spontaneous hepatitis C viral clearance.

BackgroundIn the United States Hepatitis C virus (HCV) viral clearance is estimated to range between 20 and 30%. The objective of this study was to estimate the frequency of HCV clearance and identify correlates of viral clearance among patients newly identified as HCV antibody positive in a large urban health system in Los Angeles, California.MethodsWe identified patients between November 2015 and September 2017 as part of a newly implemented HCV screening and linkage-to-care program at University of California Los Angeles (UCLA) Health System. All patients were eligible for screening, though there were additional efforts to screen patients born between 1945 and 1965. We reviewed Medical records to categorize anti-HCV antibody positive patients as having spontaneously cleared HCV infection (HCV RNA not detected) or not (HCV RNA detected). We excluded those with a prior history of anti-HCV positivity or history of HCV treatment. We compared differences between those with and without detectable HCV RNA using chi-square test, Fisher's exact test, and t-test as appropriate. We assessed factors associated with HCV clearance using logistic regression analysis.ResultsAmong the 320 patients included in this study, 56% were male. Baby boomers (52-72 years of age) comprised the single largest age group (62%). We found spontaneous HCV clearance in 58% (n = 185). HCV viral clearance was slightly higher among women as compared to men (63% vs. 53%; p value = 0.07) and varied by race/ethnicity: clearance among Blacks/African Americans was 37% vs. 58% among whites (p value = 0.02). After adjusting for age, race/ethnicity, and sex we found that those diagnosed with chronic kidney disease had a tendency of decreased HCV viral clearance (adjusted OR = 0.34; 95% CI 0.14-1.03).ConclusionOf those patients newly identified as anti-HCV positive, 58% had cleared HCV virus, while the rest showed evidence of active infection. In addition, we found that clearance varied by race/ethnicity and clinical characteristics

Predictors and Consequences of Anaemia Among Antiretroviral-Naïve HIV-Infected and HIV-Uninfected Children in Tanzania.

Predictors and consequences of childhood anaemia in settings with high HIV prevalence are not well known. The aims of the present study were to identify maternal and child predictors of anaemia among children born to HIV-infected women and to study the association between childhood anaemia and mortality. Prospective cohort study. Maternal characteristics during pregnancy and Hb measurements at 3-month intervals from birth were available for children. Information was also collected on malaria and HIV infection in the children, who were followed up for survival status until 24 months after birth. Dar es Salaam, Tanzania. The study sample consisted of 829 children born to HIV-positive women. Advanced maternal clinical HIV disease (relative risk (RR) for stage > or =2 v. stage 1: 1.31, 95 % CI 1.14, 1.51) and low CD4 cell counts during pregnancy (RR for <350 cells/mm3 v. > or =350 cells/mm3: 1.58, 95 % CI 1.05, 2.37) were associated with increased risk of anaemia among children. Birth weight <2500 g, preterm birth (<34 weeks), malaria parasitaemia and HIV infection in the children also increased the risk of anaemia. Fe-deficiency anaemia in children was an independent predictor of mortality in the first two years of life (hazard ratio 1.99, 95 % CI 1.06, 3.72). Comprehensive care including highly active antiretroviral therapy to eligible HIV-infected women during pregnancy could reduce the burden of anaemia in children. Programmes for the prevention of mother-to-child transmission of HIV and antimalarial treatment to children could improve child survival in settings with high HIV prevalence

Enhanced Meningococcal Disease Surveillance report, 2017 : confirmed and probable cases reported to the National Notifiable Diseases Surveillance System, 2017

As part of Enhanced Meningococcal Disease Surveillance (EMDS)**, additional data and isolates were collected from 45 state and 3 large jurisdiction health departments. In 2017, the population under surveillance was 319,469,805 or 98 % of the U.S. population. EMDS focuses on: (1) collecting isolates from all cases; (2) collecting complete case information, with an emphasis on college attendance for cases 15\u201324 years; history of sex with men for male cases 6516 years; and HIV infection status for all cases.CS283195Publication date from document properties.NCIRD-EMS-Report-2017.pdf201