Integrating Prevention of Mother-to-Child HIV Transmission Programs to Improve Uptake: A Systematic Review

BACKGROUND: We performed a systematic review to assess the effect of integrated perinatal prevention of mother-to-child transmission of HIV interventions compared to non- or partially integrated services on the uptake in low- and middle-income countries. METHODS: We searched for experimental, quasi-experimental and controlled observational studies in any language from 21 databases and grey literature sources. RESULTS: Out of 28 654 citations retrieved, five studies met our inclusion criteria. A cluster randomized controlled trial reported higher probability of nevirapine uptake at the labor wards implementing HIV testing and structured nevirapine adherence assessment (RRR 1.37, bootstrapped 95% CI, 1.04-1.77). A stepped wedge design study showed marked improvement in antiretroviral therapy (ART) enrolment (44.4% versus 25.3%, p<0.001) and initiation (32.9% versus 14.4%, p<0.001) in integrated care, but the median gestational age of ART initiation (27.1 versus 27.7 weeks, p = 0.4), ART duration (10.8 versus 10.0 weeks, p = 0.3) or 90 days ART retention (87.8% versus 91.3%, p = 0.3) did not differ significantly. A cohort study reported no significant difference either in the ART coverage (55% versus 48% versus 47%, p = 0.29) or eight weeks of ART duration before the delivery (50% versus 42% versus 52%; p = 0.96) between integrated, proximal and distal partially integrated care. Two before and after studies assessed the impact of integration on HIV testing uptake in antenatal care. The first study reported that significantly more women received information on PMTCT (92% versus 77%, p<0.001), were tested (76% versus 62%, p<0.001) and learned their HIV status (66% versus 55%, p<0.001) after integration. The second study also reported significant increase in HIV testing uptake after integration (98.8% versus 52.6%, p<0.001). CONCLUSION: Limited, non-generalizable evidence supports the effectiveness of integrated PMTCT programs. More research measuring coverage and other relevant outcomes is urgently needed to inform the design of services delivering PMTCT programs

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Missed opportunities: poor linkage into ongoing care for HIV-positive pregnant women in Mwanza, Tanzania.

BACKGROUND: Global coverage of prevention of mother-to-child (PMTCT) services reached 53% in 2009. However the number of pregnant women who test positive for HIV in antenatal clinics and who link into long-term HIV care is not known in many resource-poor countries. We measured the proportion of HIV-positive pregnant women in Mwanza city, Tanzania, who completed the cascade of care from antenatal HIV diagnosis to assessment and engagement in care in adult HIV clinics. METHODS: Thirty antenatal and maternity ward health workers were interviewed about PMTCT activities. Nine antenatal HIV education sessions were observed. A prospective cohort of 403 HIV-positive women was enrolled by specially-trained clinicians and nurses on admission to delivery and followed for four months post-partum. Information was collected on referral and attendance at adult HIV clinics, eligibility for highly active antiretroviral therapy (HAART) and reasons for lack of attendance. RESULTS: Overall, 70% of PMTCT health workers referred HIV-positive pregnant women to the HIV clinic for assessment and care. Antenatal HIV education sessions did not cover on-going care for HIV-infected women. Of 310 cohort participants tested in pregnancy, 51% had received an HIV clinic referral pre-delivery. Only 32% of 244 women followed to four months post-partum had attended an HIV clinic and been assessed for HAART eligibility. Non-attendance for HIV care was independently associated with fewer antenatal visits, poor PMTCT prophylaxis compliance, non-disclosure of HIV status, and non-Sukuma ethnicity. CONCLUSION: Most women identified as HIV-positive during pregnancy were not assessed for HAART eligibility during pregnancy or in the first four months post-partum. Initiating HAART at the antenatal clinic, improved counselling and linkages to care between PMTCT and adult HIV treatment services and reducing stigma surrounding disclosure of HIV results would benefit on-going care of HIV-positive pregnant women

A revision of the New Zealand Placostylus

We have analysed mitochondrial DNA and shell morphometric data from all species and subspecies of Placostylus land snails in New Zealand. These subspecies were originally described on the basis of shell morphology. The genetic data show that each of the three species P. bollonsi, P. hongii and P. ambagiosus are well differentiated and monphyletic for mitochondrial DNA, consistent with their species status. Variation among subspecies within each of the three species was minimal with sharing of haplotypes among subspecies. Morphometric analysis of shell shape characters shows large amounts of environmental plasticity. On the basis of these data we have synonymised all subspecies within each of the three Placostylus species. Consequently, the New Zealand fauna now consists of three Placostylus species, P. ambagiosus, P. hongii and P. bollonsi, and no subspecies. We recommend conservation of multiple populations within each species to ensure preservation of genetic variation

Challenges and Benefits of Standardising Early Warning Systems: A Case Study of New Zealand’s Volcanic Alert Level System

Volcano early warning systems are used globally to communicate volcano-related information to diverse stakeholders ranging from specific user groups to the general public, or both. Within the framework of a volcano early warning system, Volcano Alert Level (VAL) systems are commonly used as a simple communication tool to inform society about the status of activity at a specific volcano. Establishing a VAL system that is effective for multiple volcanoes can be challenging, given that each volcano has specific behavioural characteristics. New Zealand has a wide range of volcano types and geological settings, including rhyolitic calderas capable of very large eruptions (\u3e500 km 3 ) and frequent unrest episodes, explosive andesitic stratovolcanoes, and effusive basaltic eruptions at both caldera and volcanic field settings. There is also a range in eruption frequency, requiring the VAL system to be used for both frequently active ‘open-vent’ volcanoes, and reawakening ‘closed-vent’ volcanoes. Furthermore, New Zealand’s volcanoes are situated in a variety of risk settings ranging from the Auckland Volcanic Field, which lies beneath a city of 1.4 million people; to Mt. Ruapehu, the location of popular ski fields that are occasionally impacted by ballistics and lahars, and produces tephra that falls in distant cities. These wide-ranging characteristics and their impact on society provide opportunities to learn from New Zealand’s experience with VAL systems, and the adoption of a standardised single VAL system for all of New Zealand’s volcanoes following a review in 2014. This chapter outlines the results of qualitative research conducted in 2010–2014 with key stakeholders and scientists, including from the volcano observatory at GNS Science, to ensure that the resulting standardised VAL system is an effective communication tool. A number of difficulties were faced in revising the VAL system so that it remains effective for all of the volcanic settings that exist in New Zealand. If warning products are standardised too much, end-user decision making and action can be limited when unusual situations occur, e.g., there may be loss of specific relevance in the alert message. Specific decision-making should be based on more specific parameters than the VAL alone, however wider VAL system standardisation can increase credibility, a known requirement for effective warning, by ensuring that warning sources are clear, trusted and widely understood. With a credible source, user groups are less likely to look for alternatives or confirmation, leading to faster action. Here we consider volcanic warnings within the wider concept of end-to-end multi-hazard early warning systems including detection, evaluation, notification, decision-making and action elements (based on Carsell et al. 2004)