Innovative strategies for the elimination of viral hepatitis at a national level: a country case series

Viral hepatitis is a leading cause of morbidity and mortality worldwide, but has long been neglected by national and international policymakers. Recent modelling studies suggest that investing in the global elimination of viral hepatitis is feasible and cost-effective. In 2016, all 194 member states of the World Health Organization endorsed the goal to eliminate viral hepatitis as a public health threat by 2030, but complex systemic and social realities hamper implementation efforts. This paper presents eight case studies from a diverse range of countries that have invested in responses to viral hepatitis and adopted innovative approaches to tackle their respective epidemics. Based on an investment framework developed to build a global investment case for the elimination of viral hepatitis by 2030, national activities and key enablers are highlighted that showcase the feasibility and impact of concerted hepatitis responses across a range of settings, with different levels of available resources and infrastructural development. These case studies demonstrate the utility of taking a multipronged, public health approach to: (a) evidence-gathering and planning; (b) implementation; and (c) integration of viral hepatitis services into the Agenda for Sustainable Development. They provide models for planning, investment and implementation strategies for other countries facing similar challenges and resource constraints

Couple-oriented prenatal HIV counseling for HIV primary prevention: an acceptability study

<p>Abstract</p> <p>Background</p> <p>A large proportion of the 2.5 million new adult HIV infections that occurred worldwide in 2007 were in stable couples. Feasible and acceptable strategies to improve HIV prevention in a conjugal context are scarce. In the preparatory phase of the ANRS 12127 Prenahtest multi-site HIV prevention trial, we assessed the acceptability of couple-oriented post-test HIV counseling (COC) and men's involvement within prenatal care services, among pregnant women, male partners and health care workers in Cameroon, Dominican Republic, Georgia and India.</p> <p>Methods</p> <p>Quantitative and qualitative research methods were used: direct observations of health services; in-depth interviews with women, men and health care workers; monitoring of the COC intervention and exit interviews with COC participants.</p> <p>Results</p> <p>In-depth interviews conducted with 92 key informants across the four sites indicated that men rarely participated in antenatal care (ANC) services, mainly because these are traditionally and programmatically a woman's domain. However men's involvement was reported to be acceptable and needed in order to improve ANC and HIV prevention services. COC was considered by the respondents to be a feasible and acceptable strategy to actively encourage men to participate in prenatal HIV counseling and testing and overall in reproductive health services.</p> <p>Conclusions</p> <p>One of the keys to men's involvement within prenatal HIV counseling and testing is the better understanding of couple relationships, attitudes and communication patterns between men and women, in terms of HIV and sexual and reproductive health; this conjugal context should be taken into account in the provision of quality prenatal HIV counseling, which aims at integrated PMTCT and primary prevention of HIV.</p

Knowledge and anticipated behavior of health care workers in response to an outbreak of pandemic influenza in Georgia

Background: Avian influenza has been documented in over 331 humans since 2003 with 203 associated deaths. Health Care Workers (HCWs) have been shown to be at personal risk during other highly virulent outbreaks with a high attack rate. This study aimed to determine the magnitude and factors associated with absenteeism of hospital based health care workers (HCWs) in Georgia associated with a potential highly virulent influenza pandemic.Methodology: This was a cross-sectional study of how HCWs responded to a potentially highly virulent influenza pandemic in two urban hospitals in Georgia. Hospital based physicians and nurses were studied. Data was collected utilizing a survey instrument. The survey was either self-administered or interviewer administered based upon the preference of the respondent.Results: There were 288 HCWs surveyed. The study suggested a 23% rate of worker absenteeism, predominately among women and nurses. The majority of the respondents (58.1%), mostly HCWs less than age 35, were opposed to forced isolation or quarantine of staff during a highly virulent influenza pandemic. Seventy-six percent of respondents correctly reported that the strain of virus that was responsible for the outbreaks in the neighboring countries was H5N1. Only 15.5% of respondents, however, correctly identified influenza as the culprit virus.Conclusions: The rate of work absenteeism suggested by this study represents a significant workforce reduction. There are specific groups who would choose not to attend work in the face of a flu pandemic. This information may allow planners to target these specific groups for education and social support services to encourage greater inclination to attend to clinical duties

Factors affecting development of Clostridium difficile infection in hospitalized pediatric patients in the country Georgia

Abstract Objective Main aims of our study were to investigate occurrence of Clostridium difficile among hospitalized pediatric patients in Georgia and examine risk factors for the development of C. difficile infection. During our study we tested and piloted the real-time PCR diagnostic systems for rapid and simultaneous identification of C. difficile and number of other pathogens in our facility settings. A cross-sectional study has been performed in children less than 18 years of age in two pediatric hospitals in Georgia, between May 2016 and December 2017. Stool specimens negative by the conventional bacteriology analysis were analyzed for the presence of C. difficile and several viral and protozoa pathogens using enzyme immune assay and polymerase chain reaction. In total samples from 220 hospitalized children with gastroenteritis symptoms were analyzed in this study. Results The average age of the study participants was 4.7 years. Overall 23 children were identified positive for C. difficile (10.5%). Antibiotic exposure within 2 months preceding the onset of diarrhea was associated with an increased risk of C. difficile infections. The risk was greatest with cephalosporins, followed by penicillins, carbapenems and macrolides. Clostridium difficile is an important cause of healthcare-associated diarrhea in pediatric population of Georgia

Hepatitis C core antigen test as an alternative for diagnosing HCV infection: mathematical model and cost-effectiveness analysis

Background: The cost and complexity of the polymerase chain reaction (PCR) test are barriers to diagnosis and treatment of hepatitis C virus (HCV) infection. We investigated the cost-effectiveness of testing strategies using antigen instead of PCR testing. Methods: We developed a mathematical model for HCV to estimate the number of diagnoses and cases of liver disease. We compared the following testing strategies: antibody test followed by PCR in case of positive antibody (baseline strategy); antibody test followed by HCV-antigen test (antibody-antigen); antigen test alone; PCR test alone. We conducted cost-effectiveness analyses considering either the costs of HCV testing of infected and uninfected individuals alone (A1), HCV testing and liver-related complications (A2), or all costs including HCV treatment (A3). The model was parameterized for the country of Georgia. We conducted several sensitivity analyses. Results: The baseline scenario could detect 89% of infected individuals. Antibody-antigen detected 86% and antigen alone 88% of infected individuals. PCR testing alone detected 91% of the infected individuals: the remaining 9% either died or spontaneously recovered before testing. In analysis A1, the baseline strategy was not essentially more expensive than antibody-antigen. In analysis A2, strategies using PCR became cheaper than antigen-based strategies. In analysis A3, antibody-antigen was again the cheapest strategy, followed by the baseline strategy, and PCR testing alone. Conclusions: Antigen testing, either following a positive antibody test or alone, performed almost as well as the current practice of HCV testing. The cost-effectiveness of these strategies depends on the inclusion of treatment costs.</p