Sustaining the future of HIV counselling to reach 90-90-90 : a regional country analysis

Introduction: Counselling services are recommended by the World Health Organization and have been partially adopted by national HIV guidelines. In settings with a high HIV burden, patient education and counselling is often performed by lay workers, mainly supported with international funding. There are few examples where ministries of health have been able to absorb lay counsellors into their health systems or otherwise sustain their work. We document the role of lay cadres involved in HIV testing and counselling and adherence support and discuss approaches to sustainability. Methods: We focused on a purposive sample of eight sub-Saharan African countries where Medecins Sans Frontieres supports HIV programmes: Guinea, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe. We reviewed both published and grey literature, including national policies and donor proposals, and interviewed key informants, including relevant government staff, donors and non-governmental organizations. Results and discussion: Lay counsellors play a critical role in scaling up HIV services and addressing gaps in the HIV testing and treatment cascade by providing HIV testing and counselling and adherence support at both the facility and community levels. Countries have taken various steps in recognizing lay counsellors, including harmonizing training, job descriptions and support structures. However, formal integration of this cadre into national health systems is limited, as lay counsellors are usually not included in national strategies or budgeting. Conclusions: The current trend of reduced donor support for lay counsellors, combined with lack of national prioritization, threatens the sustainability of this cadre and thereby quality HIV service delivery

A multifaceted intervention to improve syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cluster randomised controlled trial

Background: Despite international recommendations, coverage of syphilis testing in pregnant women and treatment of those found seropositive remains limited in sub-Saharan Africa. We assessed whether combining the provision of supplies with a behavioural intervention was more effective than providing supplies only, to improve syphilis screening and treatment during antenatal care. Methods: In this 18-month, cluster randomised controlled trial, we randomly assigned (1:1) 26 urban antenatal care clinics in Kinshasa, Democratic Republic of the Congo, and Lusaka, Zambia, to receive a behavioural intervention (opinion leader selection, academic detailing visits, reminders, audits and feedback, and supportive supervision) plus supplies for syphilis testing and treatment (intervention group) or to receive supplies only (control group). The primary outcomes were proportion of pregnant women who had syphilis screening out of the total who attended the clinic; and the proportion of women who had treatment with benzathine benzylpenicillin out of those who tested positive for syphilis at their first antenatal care visit. This trial is registered at ClinicalTrials.gov, number NCT02353117. Findings: The 18-month study period was Feb 1, 2016, to July 14, 2017. 18 357 women were enrolled at the 13 intervention clinics and 17 679 women were enrolled at the 13 control clinics at their first antenatal care visit. Syphilis screening was done in a median of 99·9% (IQR 99·0–100·0) of women in the intervention clinics and 93·8% (85·0–98·9) in the control clinics (absolute difference 6·1% [95% CI 1·1–14·1]; p=0·00092). Syphilis treatment at the first visit was done in a median of 100% (IQR 99·7–100·0) of seropositive women in intervention clinics and 43·2% (2·6–83·2) of seropositive women in control clinics (absolute difference 56·8% [12·8–99·0]; p=0·0028). Interpretation: A behavioural intervention, together with the provision of supplies, can lead to more than 95% of women being screened and treated for syphilis. The sole provision of supplies is sufficient to reach such levels of screening coverage but is not sufficient to ensure high levels of treatment. Funding: Bill & Melinda Gates Foundation.Fil: Althabe, Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina. Organizacion Mundial de la Salud; ArgentinaFil: Chomba, Elwyn. University Teaching Hospital of Lusaka; ZambiaFil: Tshefu, Antoinette K. University of Kinshasa; República Democrática del CongoFil: Banda, Ernest. University Teaching Hospital of Lusaka; ZambiaFil: Belizán, María Melina Eleonora. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bergel, Eduardo. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Berrueta, Amanda Mabel. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Bertrand, Jane. University of Tulane; Estados UnidosFil: Bose, Carl. University of North Carolina; Estados UnidosFil: Cafferata, Maria Luisa. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Carlo, Waldemar A. University of Alabama at Birmingahm; Estados UnidosFil: Ciganda, Alvaro. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Donnay, France. University of Tulane; Estados UnidosFil: Garcia Elorrio, Ezequiel. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gibbons, Luz. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Klein, Karen. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Liljestrand, Jerker. Bill And Melinda Gates Foundation; Estados UnidosFil: Lusamba, Paul D. University of Kinshasa; República Democrática del CongoFil: Mavila, Arlette K. University of Kinshasa; República Democrática del CongoFil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Nkamba, Dalau M. University of Kinshasa; República Democrática del CongoFil: Mwanakalanga, Friday H. University Teaching Hospital Lusaka; ZambiaFil: Mwapule Tembo, Abigail. University Teaching Hospital Lusaka; ZambiaFil: Mwenechanya, Musaku. University Teaching Hospital Lusaka; ZambiaFil: Pyne Mercier, Lee. Bill And Melinda Gates Foundation; Estados UnidosFil: Spira, Cintia. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Wetshikoy, Jean D. University of Kinshasa; República Democrática del CongoFil: Xiong, Xu. University of Tulane; Estados UnidosFil: Buekens, Pierre. University of Tulane; Estados Unido

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Representation Dilemmas in Civil Society Organisations in Global Health Donor Resource Prioritisation Decisions: the case of PEPFAR in South Africa

A research report submitted in partial fulfilment of the requirements for the degree of Masters in Political StudiesJuxtaposing citizen and civil society representation in a democracy, some scholars assert that civil society organisations assume representation in their public interest advocacy work on behalf of marginalized populations. They argue that civil society organisations lack formal members or constituents to authorise and hold them accountable as representatives. I conducted a study to understand the representation dilemmas in civil society organisations in global health donor resources prioritisation decisions looking at the case of United States President’s Emergency Plan for AIDS Relief (PEPFAR) in South Africa between 2016 and 2018. Specifically, I assessed, what and who gives civil society authority to speak on the citizens’ behalf, how they are held accountable by the people they represent and how internally democratic civil society organisations are. A mixed method of questionnaire and in-depth interviews was used. In some cases, I observed some meetings and engagement processes between PEPFAR and civil society organisations. Using a purposive sampling method, a total of ten participants were interviewed. One was working for PEPFAR and nine participants were staff who ‘represent’ people living with HIV in their participation in the PEPFAR’s resource prioritisation processes. Thematic content analysis was used to analyse and interpret the interviews. Democratic theory, particularly examining the concept of representation, was the theoretical framework used to guide the discourse and interpretation of the research study. The study suggests that there was both authorised, delegated as well as assumed representation in the PEPFAR resource prioritisation. There is either formal independent electoral systems in place to elect and appoint representatives or membership based structures. The study found deep polarisation of civil society organisations. On one camp is a group with formal electoral systems group engaging in an ‘invited’ space through the SANAC Civil Society Forum. On the other is a camp with membership based structures participating in an ‘invented’ space. I argue while there are deep internal democratic flaws and gaps, there was no evidence of the impact of this polarisation on the legitimacy of the representation work done by both camps. In both camps, accountability and responsiveness mechanisms exist but are very weak. The study found participation remains very elite with those in Director role engaging with PEPFAR every week. Two out of the eight representatives were in contact at least once every two to three months, another two were in contact once every six months with the remaining four in contact once every twelve months only for the consultation processes. I argue that representatives’ participation in the process is only for compliance of the requirements of the process. There was no little evidence of issues raised by the representatives translate into changes to the initial proposed prioritisation of resources, design of programmes, and monitoring of implementation.NG (2020

The therapy dog as a nursing mesure for anxiety : a literature review

Bakgrund   Psykisk ohälsa kan drabba alla människor i alla åldrar, varaktigheten och svårighetsgraden är varierande för varje enskild individ. År 2020 uppgav 41 procent av befolkningen i Sverige att de någon gång upplevt känslan av oro, ångest eller ängslan. Ångest är ett av de vanligaste tillstånden inom psykisk ohälsa, behandling av ångest sker vanligtvis med hjälp av olika medicinska behandlingar alternativt med omvårdnadsåtgärder i form av samtalsterapi eller kognitiv beteendeterapi. Terapihunden är ytterligare en omvårdnadsåtgärd för personer som lever med ångest. Syfte Syftet var att beskriva personers erfarenheter av mötet med terapihund vid ångest. Metod En icke-systematisk litteraturöversikt är den valda metoden för denna litteraturöversikt, 16 vetenskapliga artiklar av både kvalitativ samt kvantitativ design inkluderades. Sökningen av de inkluderade artiklarna utfördes i databaserna PsycINFO samt CINAHL med relevanta sökord kopplade till studiens syfte. Resultat Litteraturöversiktens resultat lyfter fram personers erfarenheter av mötet med terapihund vid ångest. Följande huvudkategorier framkom vid sammanställningen av resultatet: Upplevelsen av psykiskt mående efter mötet med terapihunden, Upplevelsen av fysiskt mående efter mötet med terapihunden och Upplevelsen av interventionen som helhet. Slutsats Terapihundar bidrar i stor utsträckning till en positiv erfarenhet bland personer som upplever ångest i olika kontexter. Att använda sig av terapihund som omvårdnadsåtgärd minskar bland annat känslor av ångest, depression och smärta. Terapihunden bidrar även till en minskad känsla av ensamhet och därmed en ökad känsla av sammanhang. En ökad användning av terapihunden som omvårdnadsåtgärd för personer som lever med ångest kan bidra till en förbättrad samt mer personcentrerad vård.  Background Mental illness can affect all people of all ages, the duration and severity vary for each individual. In 2020, 41 percent of the population in Sweden stated that they at some point in life had experienced the feeling of worry, anxiety or unease. Anxiety is one of the most common conditions in mental illness, anxiety treatment is usually done with the help of various medical treatments or with nursing measures in the form of talk therapy or cognitive behavioral therapy. The therapy dog ​​is another nursing measure for people living with anxiety. Aim The purpose was to describe people's experiences of meeting a therapy dog ​​when experiencing feelings of anxiety. Method A non-systematic literature review is the chosen method for this study, 16 scientific articles of both qualitative and quantitative design were included. The search for the included articles was performed in the databases PsycINFO and CINAHL with relevant keywords linked to the purpose of the study.  Results The results of the literature review highlight the experience of the therapy dog ​​as a nursing measure for people with anxiety. The following main categories emerged in compiling the results: The experience of mental state after the meeting with the therapy dog, The experience of physical state after the meeting with the therapy dog ​​and The experience of the intervention as a whole. Conclusions Therapy dogs contribute greatly to a positive experience among people who have emotions of anxiety in different contexts. Using a therapy dog ​​as a nursing measure reduces feelings of anxiety, depression and pain, among other things. The therapy dog ​​also contributes to a reduced feeling of loneliness and thus an increased sense of context. An increased use of the therapy dog ​​as a nursing measure for people living with anxiety can contribute to improved and more person-centered care