Association between HCV infection and diabetes type 2 in Egypt: Is it time to split up?

Purpose: There is a conflicting evidence about the association between hepatitis C virus (HCV) infection and diabetes mellitus. The objective of this study was to assess this association in Egypt, the country with the highest HCV prevalence in the world. Methods: The source of data was from the Egypt Demographic and Health Survey conducted in 2008. Using multivariable logistic regression analyses to account for known confounders, the association was investigated at two levels']: (1) HCV exposure (HCV antibody status) and diabetes mellitus and (2) diabetes mellitus and chronic HCV infection (HCV RNA status) among HCV-exposed individuals. Results: We found no evidence for an association between HCV antibody status and diabetes (adjusted odds ratio [OR] = 0.87; 95% confidence interval [CI], 0.63-1.19). However, among HCV-exposed individuals, we found an evidence for an association between diabetes and active HCV infection (adjusted OR = 2.44, 95% CI, 1.30-4.57). Conclusions: Although it does not appear that HCV exposure and diabetes are linked, there might be an association between diabetes and chronic HCV infection. The HCV-diabetes relationship may be more complex than previously anticipated. Therefore, a call for an "amicable divorce" to the HCV-diabetes relationship could be premature

Setting a baseline for global urban virome surveillance in sewage

The rapid development of megacities, and their growing connectedness across the world is becoming a distinct driver for emerging disease outbreaks. Early detection of unusual disease emergence and spread should therefore include such cities as part of risk-based surveillance. A catch-all metagenomic sequencing approach of urban sewage could potentially provide an unbiased insight into the dynamics of viral pathogens circulating in a community irrespective of access to care, a potential which already has been proven for the surveillance of poliovirus. Here, we present a detailed characterization of sewage viromes from a snapshot of 81 high density urban areas across the globe, including in-depth assessment of potential biases, as a proof of concept for catch-all viral pathogen surveillance. We show the ability to detect a wide range of viruses and geographical and seasonal differences for specific viral groups. Our findings offer a cross-sectional baseline for further research in viral surveillance from urban sewage samples and place previous studies in a global perspective

Spatial structure of depression in South Africa: A longitudinal panel survey of a nationally representative sample of households

Wider recognition of the mental health burden of disease has increased its importance as a global public health concern. However, the spatial heterogeneity of mental disorders at large geographical scales is still not well understood. Herein, we investigate the spatial distribution of incident depression in South Africa. We assess depressive symptomatology from a large longitudinal panel survey of a nationally representative sample of households, the South African National Income Dynamics Study. We identified spatial clusters of incident depression using spatial scan statistical analysis. Logistic regression was fitted to establish the relationship between clustering of depression and socio-economic, behavioral and disease risk factors, such as tuberculosis. There was substantial geographical clustering of depression in South Africa, with the excessive numbers of new cases concentrated in the eastern part of the country. These clusters overlapped with those of self-reported tuberculosis in the same region, as well as with poorer, less educated people living in traditional rural communities. Herein, we demonstrate, for the first time, spatial structuring of depression at a national scale, with clear geographical ‘hotspots’ of concentration of individuals reporting new depressive symptoms. Such geographical clustering could reflect differences in exposure to various risk factors, including socio-economic and epidemiological factors, driving or reinforcing the spatial structure of depression. Identification of the geographical location of clusters of depression should inform policy decisions

Mapping the spatial variability of HIV infection in Sub-Saharan Africa: Effective information for localized HIV prevention and control

Under the premise that in a resource-constrained environment such as Sub-Saharan Africa it is not possible to do everything, to everyone, everywhere, detailed geographical knowledge about the HIV epidemic becomes essential to tailor programmatic responses to specific local needs. However, the design and evaluation of national HIV programs often rely on aggregated national level data. Against this background, here we proposed a model to produce high-resolution maps of intranational estimates of HIV prevalence in Kenya, Malawi, Mozambique and Tanzania based on spatial variables. The HIV prevalence maps generated highlight the stark spatial disparities in the epidemic within a country, and localize areas where both the burden and drivers of the HIV epidemic are concentrated. Under an era focused on optimal allocation of evidence-based interventions for populations at greatest risk in areas of greatest HIV burden, as proposed by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR), such maps provide essential information that strategically targets geographic areas and populations where resources can achieve the greatest impact

Towards UNAIDS Fast-Track goals: Targeting priority geographic areas for HIV prevention and care in Zimbabwe

Introduction: Zimbabwe has made substantial progress towards the Joint United Nations Programme on HIV/AIDS (UNAIDS) targets of 90-90-90 by 2020, with 73% of people living with HIV diagnosed, 87% of those diagnosed on antiretroviral therapy (ART) and 86% of those on ART virally suppressed. Despite this exceptional response, more effort is needed to completely achieve the UNAIDS targets. Here, we conducted a detailed spatial analysis of the geographical structure of the HIV epidemic in Zimbabwe to include geographical prioritization as a key component of their overall HIV intervention strategy. Methods: Data were obtained from Zimbabwe Demographic and Health Survey (ZDHS) conducted in 2015 as well as estimations from the Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2016 report, and other published literature. Data were used to produce high-resolution maps of HIV prevalence. Using these maps combined with the population density maps, we mapped the HIV-infected population lacking ART coverage and viral suppression. Results: HIV maps for both sexes illustrated similar geographical variation of HIV prevalence within the country. HIV-infected populations lacking ART coverage and viral suppression were concentrated in the main cities and urban settlements such as Bulawayo, Harare, Ruwa and Chitungwiza. Conclusion: Our study showed extensive local variation in HIV disease burden across Zimbabwe for both women and men. The high-resolution maps generated here identified areas wherein high density of HIV-infected individuals are lacking ART coverage and viral suppression. These results suggest that there is need to tailor HIV programmes to address specific local needs to efficiently achieve epidemic control in Zimbabwe

Setting a baseline for global urban virome surveillance in sewage

The rapid development of megacities, and their growing connectedness across the world is becoming a distinct driver for emerging disease outbreaks. Early detection of unusual disease emergence and spread should therefore include such cities as part of risk-based surveillance. A catch-all metagenomic sequencing approach of urban sewage could potentially provide an unbiased insight into the dynamics of viral pathogens circulating in a community irrespective of access to care, a potential which already has been proven for the surveillance of poliovirus. Here, we present a detailed characterization of sewage viromes from a snapshot of 81 high density urban areas across the globe, including in-depth assessment of potential biases, as a proof of concept for catch-all viral pathogen surveillance. We show the ability to detect a wide range of viruses and geographical and seasonal differences for specific viral groups. Our findings offer a cross-sectional baseline for further research in viral surveillance from urban sewage samples and place previous studies in a global perspective