Project YES! Youth Engaging for Success: A randomized controlled trial testing a peer mentoring approach among HIV-positive adolescents and young adults in Ndola, Zambia

This research addresses the gaps in knowledge about how to best support adolescents and young adults transitioning to HIV self-management in the context of both child-focused and adult-focused HIV care settings. Johns Hopkins University, in partnership with the Arthur Davison Children’s Hospital, implemented this study through the USAID-funded Project SOAR (led by the Population Council)

Yield of facility-based targeted universal testing for tuberculosis with Xpert and mycobacterial culture in high-risk groups attending primary care facilities in South Africa

DATA SHARING : Individual participant data that underlie the results reported in this article, after de-identification, the data dictionary, study protocol, statistical analysis plan, and analytic code will be made available to investigators whose proposed use of the data has been approved by an independent review committee to achieve aims in the approved proposal. Proposals should be submitted to N. A. M. ([email protected]). To gain access, data requestors will need to sign a data access agreement.BACKGROUND : We report the yield of targeted universal tuberculosis (TB) testing of clinic attendees in high-risk groups. METHODS : Clinic attendees in primary healthcare facilities in South Africa with one of the following risk factors underwent sputum testing for TB: human immunodeficiency virus (HIV), contact with a TB patient in the past year, and having had TB in the past 2 years. A single sample was collected for Xpert-Ultra (Xpert) and culture. We report the proportion positive for Mycobacterium tuberculosis. Data were analyzed descriptively. The unadjusted clinical and demographic factors’ relative risk of TB detected by culture or Xpert were calculated and concordance between Xpert and culture is described. RESULTS : A total of 30 513 participants had a TB test result. Median age was 39 years, and 11 553 (38%) were men. The majority (n=21734, 71%) had HIV, 12 492 (41%) reported close contact with a TB patient, and 1573 (5%) reported prior TB. Overall, 8.3% were positive for M. tuberculosis by culture and/or Xpert compared with 6.0% with trace-positive results excluded. In asymptomatic participants, the yield was 6.7% and 10.1% in symptomatic participants (with trace-positives excluded). Only 10% of trace-positive results were culture-positive. We found that 55% of clinic attendees with a sputum result positive for M. tuberculosis did not have a positive TB symptom screen. CONCLUSIONS : A high proportion of clinic attendees with specific risk factors (HIV, close TB contact, history of TB) test positive for M. tuberculosis when universal testing is implemented.The Bill & Melinda Gates Foundation, the National Institutes of Health, all laboratory testing was paid for by the Government of South Africa.https://academic.oup.com/cidam2024Family MedicineSDG-03:Good heatlh and well-bein

Project YES! Youth Engaging for Success: A randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15–24 years) in Ndola, Zambia

Background: Youth-led strategies remain untested in clinic-based programs to improve viral suppression (VS) and reduce stigma among HIV-positive adolescents and young adults (AYA) in sub-Saharan Africa. In response, Project YES! placed paid HIV-positive youth peer mentors (YPM) in four HIV clinics in Ndola, Zambia including a Children’s Hospital (pediatric setting), an adult Hospital and two primary care facilities (adult settings). Methods: A randomized controlled trial was conducted from December 2017 to February 2019. Consecutively recruited 15 to 24-year-olds were randomly assigned to an intervention arm with monthly YPM one-on-one and group sessions and optional caregiver support groups, or a usual care comparison arm. Survey data and blood samples were collected at baseline and at the six-month midline. Generalized estimating equation models evaluated the effect of study arm over time on VS, antiretroviral treatment (ART) adherence gap, and internalized stigma. Results: Out of 276 randomized youth, 273 were included in the analysis (Intervention n = 137, Comparison n = 136). VS significantly improved in both arms (I:63.5% to 73.0%; C:63.7% to 71.3.0%) [OR:1.49, 95% CI:1.08, 2.07]. In a stratified analysis intervention (I:37.5% to 70.5%) versus the comparison (C:60.3% to 59.4%) participants from the pediatric clinic experienced a relative increase in the odds of VS by a factor of 4.7 [interaction term OR:4.66, 95% CI:1.84, 11.78]. There was no evidence of a study arm difference in VS among AYA in adult clinics, or in ART adherence gaps across clinics. Internalized stigma significantly reduced by a factor of 0.39 [interaction term OR:0.39, 95% CI:0.21,0.73] in the intervention (50.4% to 25.4%) relative to the comparison arm (45.2% to 39.7%). Conclusions: Project YES! engaged AYA, improving VS in the pediatric clinic and internalized stigma in the pediatric and adult clinics. Further research is needed to understand the intersection of VS and internalized stigma among AYA attending adult HIV clinics

CKD and hospitalization in the elderly: a community-based cohort study in the United Kingdom

Background: we previously have shown that chronic kidney disease (CKD) is associated with cardiovascularand all-cause mortality in community-dwelling people 75 years and older. The present study addresses thehypothesis that CKD is associated with a higher rate of hospital admission at an older age.Study Design: cohort study.Setting & Participants: 15,336 participants from 53 UK general practices underwent comprehensive healthassessment between 1994 and 1999.Predictor: data for estimated glomerular filtration rate (eGFR, derived from creatinine levels using the CKDEpidemiology Collaboration [CKD-EPI] study equation) and dipstick proteinuria were available for 12,371participants.Outcomes: hospital admissions collected from hospital discharge letters for 2 years after assessment.Measurements: Age, sex, cardiovascular risk factors, possible biochemical and health consequences ofkidney disease (hemoglobin, phosphate, and albumin levels; physical and mental health problems).Results: 2,310 (17%) participants had 1 hospital admission, and 981 (7%) had 2 or more. After adjusting forage, sex, and cardiovascular risk factors, HRs were 1.66 (95% CI, 1.21-2.27), 1.17 (95% CI, 0.95-1.43), 1.08(95% CI, 0.90-1.30), and 1.11 (95% CI, 0.91-1.35) for eGFRs ?30, 30-44, 45-59, and ?75 mL/min/1.73 m2,respectively, compared with eGFRs of 60-74 mL/min/1.73 m2 for hospitalizations during ?6 months offollow-up. HRs were weaker for follow-up of 6-18 months. Dipstick-positive proteinuria was associated with anincreased HR throughout follow-up (HR, 1.29 [95% CI, 1.11-1.49], adjusting for cardiovascular risk factors).Dipstick-positive proteinuria and eGFR ?30 mL/min/1.73 m2 were independently associated with 2 or morehospital admissions during the 2-year follow-up. Adjustment for other health factors and laboratory measurementsattenuated the effect of eGFR, but not the effect of proteinuria.Limitations: follow-up limited to 2 years, selection bias due to nonparticipation in study, missing data forpotential covariates, and single noncalibrated measurements from multiple laboratories.Conclusions: the study indicates that community-dwelling older people who have dipstick-positive proteinuriaand/or eGFR ?30 mL/min/1.73 m2 are at increased risk of hospitalization