Phase 1 Anglo-French report on the IMPRESS Health 2 (Interreg IVA Channel Programme) project 4282: understanding factors behind the late testing and diagnosis of HIV

This report outlines the combined Anglo-French findings and analysis of data from the phase 1 (research) phase of the Interreg IVA Channel Programme funded IMPRESS Health 2 project examining factors behind the late testing and diagnosis of HIV in Kent, Medway, and Picardy (France)

Understanding factors behind the late testing and diagnosis of HIV: Findings from phase 1 of the IMPRESS Health 2 (Interreg IVA Channel Programme) Project

Over 100,000 have HIV in the UK. However, while effective treatment exists, there is neither a cure nor a preventive vaccine, so 500+ people die from AIDS every year with many others dying undiagnosed. Health policy focuses on prevention and support, but it is necessary to increase the number of early diagnoses and reduce the rate of spread (Public Health England, 2014). Approximately 25% of HIV positive individuals do not know their status however, and almost half of all UK diagnoses occur late. It is vital therefore, to understand and address barriers to early testing and diagnoses to address this trend. Clinical data for 240 patients diagnosed with HIV in 3 trusts in Kent and Medway over 5 years were analysed in relation to clinical, social, demographic and psychosexual factors likely to affect knowledge of HIV and their decision to seek a test. Fifty-three semi-structured interviews were also conducted with patients and healthcare professionals to elicit experienced and perceptions about barriers to testing and ways to increase uptake. Patients were aged 19-81 (mean 40 years) and 67.5% were men. Women were more likely to be diagnosed late however (67.9% versus 56.8%), and late diagnosis was higher than the national average for both sexes (60.4%) with the highest rates in Medway (66.1%) and Maidstone and Tunbridge Wells (64.6%). Patients diagnosed late were 4 years older than those diagnosed early, and late diagnosis was higher in ethnic minority groups (70.2%) compared to white British (53.0%). Those born outside the UK were also generally diagnosed later (69.8%). The most frequent categories affected were heterosexuals (56.2%), men who have sex with men (36.6%) and intravenous drug users (2.0%). Patients diagnosed during an acute hospital admission were far more likely to be diagnosed late (89.1%) compared to other settings (49.6% - 57.1%). Qualitative data suggested that outmoded notions of HIV as a ‘gay’ disease still prevailed and heterosexuals did not generally consider themselves to be at risk. Healthcare professionals sometimes failed to acknowledge risks in ‘non-traditional’ groups and often overlooked HIV as a likely cause of symptoms until they were seriously unwell. Clearer public health messages should be targeted at the general population and there is a need to better educate healthcare professionals, especially GPs about the clinical indicators of HIV which also needs to be de-stigmatised

Rodents as natural hosts of zoonotic Schistosoma species and hybrids: an epidemiological and evolutionary perspective from West Africa

The complex multi-host disease dynamics of schistosomiasis and Schistosoma spp., including the emergence of zoonotic parasite hybrids, remain largely unexplored in West Africa. We elucidated the role of wild small mammals as reservoir for zoonotic Schistosoma species and hybrids in endemic areas of Senegal. We identified Schistosoma mansoni, Schistosoma bovis, and a Schistosoma haematobium/S. bovis hybrid, with local prevalence in wild rodents ranging from 1.9% to 28.6%. Our findings indicate that rodents may be an important local reservoir for zoonotic schistosomiasis in endemic areas of West Africa, amplifying transmission to humans and acting as natural definitive hosts of schistosome hybrids

Plagiorchis sp. in small mammals of Senegal and the potential emergence of a zoonotic trematodiasis

Trematodes of the genus Plagiorchis have a wide geographical distribution and can exploit a variety of hosts. The occurrence and zoonotic potential of Plagiorchis spp. have been characterised across several countries in Asia; in contrast, information on Plagiorchis parasites in Africa remains anecdotal. We isolated a previously undescribed Plagiorchis species from the biliary tract and small intestine of 201 out of 427 small mammals collected in the region of Lake Guiers, Senegal, with local prevalence ranging from 38.6% to 77.0%. Conversely, Plagiorchis isolates were not observed in the 244 small mammals sampled in and around the town of Richard Toll, Senegal. Molecular phylogenetics of the internal transcribed spacer region, nuclear ribosomal DNA, and of the cytochrome c oxidase subunit 1 gene, mitochondrial DNA, supported the monophyly and multi-host spectrum of this newly discovered West African Plagiorchis species. Sequencing of individual cercariae shed by Radix natalensis (Gastropoda: Lymnaeidae) suggested that these freshwater snails may act as suitable first intermediate hosts. Phylogenetic analysis yielded a highly resolved topology indicating two different clades, one composed by Plagiorchis spp. infecting rodents, insectivores, and birds, while the other included parasites of bats. Our findings showed the low host specificity and high prevalence of the isolated Plagiorchis sp. in the Lake Guiers region, with Hubert's multimammate mice (Mastomys huberti) appearing to play a primary role in the epidemiology of this parasite. The results raise concern about the zoonotic potential of Plagiorchis sp. in local communities of the Lake Guiers region, and highlight food-borne trematodiases and their link to land-use change as a neglected public health issue in regions of West Africa

Mini-FLOTAC as an alternative, non-invasive diagnostic tool for Schistosoma mansoni and other trematode infections in wildlife reservoirs

Schistosomiasis and food-borne trematodiases are not only of major public health concern, but can also have profound implications for livestock production and wildlife conservation. The zoonotic, multi-host nature of many digenean trematodes is a significant challenge for disease control programmes in endemic areas. However, our understanding of the epidemiological role that animal reservoirs, particularly wild hosts, may play in the transmission of zoonotic trematodiases suffers a dearth of information, with few, if any, standardised, reliable diagnostic tests available. We combined qualitative and quantitative data derived from post-mortem examinations, coprological analyses using the Mini-FLOTAC technique, and molecular tools to assess parasite community composition and the validity of non-invasive methods to detect trematode infections in 89 wild Hubert’s multimammate mice (Mastomys huberti) from northern Senegal

Chorioamnionitis: Case definition & guidelines for data collection, analysis, and presentation of immunization safety data

Chorioamnionitis is a term encompassing a broad spectrum of disease during pregnancy that is characterized by inflammation and/or infection of intrauterine structures such as the placenta, the chorion and amnion. The clinical presentation of chorioamnionitis can vary based on clinical, microbiologic, and histologic factors which interact and overlap to varying degrees

Improving mechanical and thermal properties of graphite–aluminium composite using Si, SiC and eggshell particles

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