Evaluation of the training program to train HIV treatment center staff in Pakistan

Introduction In Pakistan, HIV training programs, especially for health professionals working in HIV treatment centers, are limited. Consequently, there is little data about HIV awareness among physicians and allied health workers and how it may affect their care for people living with HIV (PLWH). Recently, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) grant Principal Recipient UNDP engaged an NGO experienced in HIV/AIDS training, on a competitive basis, to develop a training manual and conduct training of all categories of HIV treatment centers staff. The goal of this study was to assess the training program\u27s influence on trainees\u27 (both physicians and allied health staff) knowledge and abilities and describe its major lessons. Methodology This was a one-group pre-post test study, carried out between January 17 and February 22, 2023. The study was carried out in three phases. In the first phase, a team of experts developed an antiretroviral treatment (ART) training manual. In the second phase, 9- and three-day training workshops were conducted in six different cities of Pakistan, which were attended by physicians and allied health staff working in different HIV treatment centers across Pakistan. The workshops had plenary lectures, discussions, role plays, video cases, and case studies. In the third phase, a quiz, comprising multiple/best choice questions (MCQs/BCQs) and true and false questions, was administered before (pre) and after the workshop (post) to assess the impact of these training sessions in enhancing the level of HIV knowledge, especially related to ART. The workshop was attended by a total of 256 health workers from different cities in Pakistan. The participants had backgrounds in medical science, psychology, laboratory science, nursing, and computer science. Pre-and post-test responses were statistically analyzed to determine the impact of the training program on participant\u27s knowledge. For this, the Shapiro-Wilk test was applied to test data normality, followed by the application of paired t-test or Wilcoxon Signed Rank Test for normally and non-normally distributed data, respectively. Finally, a chi-square test was applied to examine the significant (p\u3c0.05) association between training workshops and improvement in the participant\u27s level of understanding of HIV. In all statistical tests, p\u3c0.05 was considered significant. Results The results from our study showed that before the training session, both physicians and allied staff possessed limited knowledge about HIV-related domains. After the workshops, participants from all cities demonstrated a uniform enhancement of knowledge related to different HIV-related domains, evident from the improvement in post-test scores compared to pre-test scores (p\u3c0.0001). The chi-square test showed a significant association between training workshops and improvement in the participant\u27s level of understanding about HIV (p-values for BCQ, MCQ, and true and false: 0.001, 0.0047, and 0.0024, respectively). Conclusions Pre- and post-test evaluation provides an objective, data-driven method for measuring the impact of educational interventions in improving healthcare workers\u27 awareness about HIV. The results emphasize the role of continuous workshops and training programs in enhancing the knowledge and understanding of healthcare and allied health workers regarding HIV

A Novel Appraisal Protocol for Spatiotemporal Patterns of Rainfall by Reconnaissance the Precipitation Concentration Index (PCI) with Global Warming Context

In global warming contexts, continuous increment in temperature triggers several environmental, economic, and ecological challenges. Its impacts have severe effects on energy, agriculture, and socioeconomic structure. Moreover, the strong correlation between temperature and dynamic changing of rainfall patterns greatly influences the natural cycles of water resources. Therefore, it is necessary to examine the spatiotemporal variation of precipitation to improve precipitation monitoring systems. Thereby, it helps to make future planning for flood control and water resource management. Considering the importance of the spatiotemporal assessment of precipitation, the current study provides a new method: regional contextual precipitation concentration index (RCPCI) to analyze spatial-temporal patterns of annual rainfall intensities by reconnaissance the precipitation concentration index (PCI) in the global warming context. The current study modifies the existing version of PCI by propagating the role of temperature as auxiliary information. Further, based on spatial and nonspatial correlation analysis, the current study compares the performance of RCPCI and PCI for 45 meteorological stations of Pakistan. Tjøstheim’s coefficient and the modified t-test are used for testing and estimating the spatial correlation between both indices. In addition, the Poisson log-normal spatial model is used to assess the spatial distribution of each rainfall pattern. Outcomes associated with the current analysis show that the proposed method is a good and efficient substitute for PCI in the global warming scenario in the presence of temperature data. Therefore, to make accurate and precise climate and precipitation mitigation policies, the proposed method may incorporate uncovering the yearly pattern of rainfall.Validerad;2022;Nivå 2;2022-08-05 (hanlid);Part of special issue: Multivariate and Big Data Modeling and Related Issues</p

Genomic Insights into and In Vitro Evaluation of Antimicrobial Combination Therapies for Carbapenem-Resistant <i>Acinetobacter baumannii</i>

Background and Objectives: Acinetobacter baumannii (A. baumannii), particularly carbapenem-resistant A. baumannii (CRAB), represents a grave concern in healthcare settings and is associated with high mortality. This study aimed to conduct molecular, mutational, and phylogenetic analyses of specific genes in CRAB and evaluate the synergistic effects of selected antimicrobial combinations. Materials and Methods: Phenotypic characterization was performed on six CRAB strains by using the Modified Hodge Test (MHT) and IMP-EDTA Double-Disc Synergy Test (IMP-EDTA DDST). Carbapenemase- and metallo-beta-lactamase-encoding genes were amplified by using Polymerase Chain Reaction. Phylogenetic analysis using the MEGA 11 tool was used to determine the evolutionary relatedness of these genes. Mutational analysis was performed by using I-Mutant, MUPro, and PHD-SNP bioinformatics tools to predict mutations in the carbapenemase-encoding genes. Microdilution checkerboard titration assessed the synergistic effects of antimicrobial combinations (azithromycin–meropenem, rifampicin–meropenem, meropenem–colistin, and azithromycin–colistin) on these CRAB isolates. Results: The phenotypic characterization of six CRAB isolates revealed positive results for MHT and IMP-EDTA DDST. The molecular characterization revealed that carbapenemase- and MBL-encoding genes were present in all isolates with varying frequencies, including blaOXA-51 (100%) and blaIMP (0%). The sequence analysis revealed high evolutionary relatedness to sequences in the NCBI database. The mutational analysis identified 16 mutations, of which 1 mutation (P116L) in the blaOXA-58 gene predicted a change in the protein product, potentially contributing to carbapenem resistance. The checkerboard titration method did not reveal any synergism among the tested antimicrobial combinations against CRAB. Conclusion: This study’s findings underscore the significant challenges posed by CRAB isolates harboring multiple resistant genes in treatment. This highlights the urgent need for novel antimicrobial agents, a crucial step towards reducing mortality rates not only in Pakistan but also globally