HIV Prevention, Care, and Treatment in Two Prisons in Thailand

The authors discuss the challenges of providing HIV treatment to a marginalized population: prisoners in Thailand

An inventory of supranational antimicrobial resistance surveillance networks involving low- and middle-income countries since 2000.

Low- and middle-income countries (LMICs) shoulder the bulk of the global burden of infectious diseases and drug resistance. We searched for supranational networks performing antimicrobial resistance (AMR) surveillance in LMICs and assessed their organization, methodology, impacts and challenges. Since 2000, 72 supranational networks for AMR surveillance in bacteria, fungi, HIV, TB and malaria have been created that have involved LMICs, of which 34 are ongoing. The median (range) duration of the networks was 6 years (1-70) and the number of LMICs included was 8 (1-67). Networks were categorized as WHO/governmental (n = 26), academic (n = 24) or pharma initiated (n = 22). Funding sources varied, with 30 networks receiving public or WHO funding, 25 corporate, 13 trust or foundation, and 4 funded from more than one source. The leading global programmes for drug resistance surveillance in TB, malaria and HIV gather data in LMICs through periodic active surveillance efforts or combined active and passive approaches. The biggest challenges faced by these networks has been achieving high coverage across LMICs and complying with the recommended frequency of reporting. Obtaining high quality, representative surveillance data in LMICs is challenging. Antibiotic resistance surveillance requires a level of laboratory infrastructure and training that is not widely available in LMICs. The nascent Global Antimicrobial Resistance Surveillance System (GLASS) aims to build up passive surveillance in all member states. Past experience suggests complementary active approaches may be needed in many LMICs if representative, clinically relevant, meaningful data are to be obtained. Maintaining an up-to-date registry of networks would promote a more coordinated approach to surveillance

Accuracy and User-Acceptability of HIV Self-Testing Using an Oral Fluid-Based HIV Rapid Test

10.1371/journal.pone.0045168PLoS ONE79

Opt-out of Voluntary HIV Testing: A Singapore Hospital's Experience

INTRODUCTION: Since 2008, the Singapore Ministry of Health (MOH) has expanded HIV testing by increasing anonymous HIV test sites, as well as issuing a directive to hospitals to offer routine voluntary opt out inpatient HIV testing. We reviewed this program implemented at the end of 2008 at Tan Tock Seng Hospital (TTSH), the second largest acute care general hospital in Singapore. METHODS AND FINDINGS: From January 2009 to December 2010, all inpatients aged greater or equal than 21 years were screened for HIV unless they declined or were not eligible for screening. We reviewed the implementation of the Opt Out testing policy. There were a total of 93,211 admissions; 41,543 patients were included based on HIV screening program eligibility criteria. Among those included, 79% (n = 32,675) opted out of HIV screening. The overall acceptance rate was 21%. Majority of eligible patients who were tested (63%) were men. The mean age of tested patients was 52 years. The opt out rate was significantly higher among females (OR: 1.5, 95%CI: 1.4-1.6), aged >60 years (OR: 2.3, 95%CI: 2.2-2.4) and Chinese ethnicity (OR: 1.7, 95%CI:1.6-1.8). The false positive rate of the HIV screening test is 0.56%. The proportion of patients with HIV infection among those who underwent HIV screening is 0.18%. All 16 confirmed HIV patients were linked to care. CONCLUSION: The default opt-in rate of inpatient HIV testing was low at Tan Tock Seng Hospital, Singapore. Efforts to address individual HIV risk perception and campaigns against HIV stigma are needed to encourage more individuals to be tested for HIV

Development of a target product profile for a point-of-care cardiometabolic device

INTRODUCTION: Multi-parameter diagnostic devices can simplify cardiometabolic disease diagnosis. However, existing devices may not be suitable for use in low-resource settings, where the burden of non-communicable diseases is high. Here we describe the development of a target product profile (TPP) for a point-of-care multi-parameter device for detection of biomarkers for cardiovascular disease and metabolic disorders, including diabetes, in primary care settings in low- and middle-income countries (LMICs). METHODS: A draft TPP developed by an expert group was reviewed through an online survey and semi-structured expert interviews to identify device characteristics requiring refinement. The draft TPP included 41 characteristics with minimal and optimal requirements; characteristics with an agreement level for either requirement of ≤ 85% in either the survey or among interviewees were further discussed by the expert group and amended as appropriate. RESULTS: Twenty people responded to the online survey and 18 experts participated in the interviews. Twenty-two characteristics had an agreement level of ≤ 85% in either the online survey or interviews. The final TPP defines the device as intended to be used for basic diagnosis and management of cardiometabolic disorders (lipids, glucose, HbA1c, and creatinine) as minimal requirement, and offering an expanded test menu for wider cardiometabolic disease management as optimal requirement. To be suitable, the device should be intended for level 1 healthcare settings or lower, used by minimally trained healthcare workers and allow testing using self-contained cartridges or strips without the need for additional reagents. Throughput should be one sample at a time in a single or multi-analyte cartridge, or optimally enable testing of several samples and analytes in parallel with random access. CONCLUSION: This TPP will inform developers of cardiometabolic multi-parameter devices for LMIC settings, and will support decision makers in the evaluation of existing and future devices

Innovative and New Approaches to Laboratory Diagnosis of Zika and Dengue: A Meeting Report.

Epidemics of dengue, Zika, and other arboviral diseases are increasing in frequency and severity. Current efforts to rapidly identify and manage these epidemics are limited by the short diagnostic window in acute infection, the extensive serologic cross-reactivity among flaviviruses, and the lack of point-of-care diagnostic tools to detect these viral species in primary care settings. The Partnership for Dengue Control organized a workshop to review the current landscape of Flavivirus diagnostic tools, identified current gaps, and developed strategies to accelerate the adoption of promising novel technologies into national programs. The rate-limiting step to bringing new diagnostic tools to the market is access to reference materials and well-characterized clinical samples to facilitate performance evaluation. We suggest the creation of an international laboratory-response consortium for flaviviruses with a decentralized biobank of well-characterized samples to facilitate assay validation. Access to proficiency panels are needed to ensure quality control, in additional to in-country capacity building

Ano ba talaga? ang paggamit ng di-tuwirang pagtanggi bilang pagpapahalaga sa pakikipagkapwa

Ang pag-aaral na ito na ginawa sa Barangay Sipac-Alamacen ng Navotas, ay naglalayon na pag-aaralan ang iba\u27t-ibang salitang ginagamit sa di-tuwirang pagtanggi. Bukod dito, inalam din sa pag-aaral na ito kung kailan, bakit at kanino ginagamit ang di-tuwirang pagtanggi. Inalam din ang mga pakiramdam ng mga gumagamit at ginagamitan ng di-tuwirang pagtanggi. Layunin din sa pag-aaral na ito na alamin ang mga naiisip ng mga taong ginagamitan ng di-tuwirang pagtanggi. Sinuri ang kamalayan ng taong gumamit at ginamitan ng di-tuwirang pagtanggi. Inalam din kung sino sa bawat baryabol na edad, kasarian at hanapbuhay ang gumagamit ng ganitong uri ng pagtanggi. Sinuri rin sa pag-aaral na ito ang kahalagahan ng pakikipagkapwa at ang ugnayan nito sa pakikiramdam at pagtanggi ng di-tuwiran.Ang pag-aaral ay binuo ng tatlong daan siyamnapu\u27t dalawang (392) katao na inayos ayon sa edad, kasarian at hanapbuhay. Gumamit ng descriptive research design ang pag-aaral na ito ay interbyu at sarbey naman ang ginamit na paraan ng pag-ipon ng datos. Gumamit ng content analysis at pagbilang kadalasan ang pag-aaral na ito sa pagsusuri ng datos.Nalaman mula sa pag-aaral na ang di-tuwirang pagtanggi ay ginagamit dahil sa pagkasensitibo ng mga Pilipino sa kanilang kapwa kapag sila\u27y gumamit at ginamitan ng di-tuwirang pagtanggi tulad ng naiintindihan ang kapwa at palagay ang loob. Anupa\u27t lahat ay patungo sa pakikipagkapwa. sa tuwing sila ay gagamit ng ganitong uri ng pagtanggi, pinakikiramdaman muna nila ang kanilang kapwa. Sa pamamagitan ng paggamit ng di-tuwirang pagtanggi, ang mga Pilipino ay nakikipagkapwa-tao