Principles of condom provision programs in prisons from the standpoint of European prison health experts: a qualitative study

Background Condom provision is one of the most effective harm reduction interventions to control sexually transmitted infections (STIs) including HIV/AIDS and viral hepatitis in prisons. Yet, very few countries around the world provide prisoners with condoms. The present study aimed to elucidate principles of effective prison-based condom programs from the perspective of European public health and prison health experts. Methods As a part of the “Joint Action on HIV and Co-infection Prevention and Harm Reduction (HA-REACT)” twenty-one experts from the field of prison health from eight European countries were invited to discuss the principles of condom provision programs in prisons within two focus groups. The audio records were transcribed verbatim, coded, categorized, and analyzed using thematic analysis method. Results Six components emerged from the analysis as essential for successful condom programs in prisons: (1) highlighting the necessity of condom provision in prisons, (2) engagement of internal and external beneficiaries in all stages of designing and implementing the program, (3) conducting a pilot phase, (4) condom program in a comprehensive package of harm reduction interventions, (5) vending machine as the best method of condom distribution in prisons and (6) assuring the sustainability and quality of the intervention. Conclusion Results of the present study can help prison health policy makers to design and conduct acceptable, accessible and high-quality prison-based condom provision programs, and consequently to mitigate the burden of STIs in prisons. Having access to high-quality healthcare services including condom provision programs is not only the right of prisoners to health, but also is a move towards achieving the sustainable development goal 3 of “leaving no one behind.”Open Access funding enabled and organized by Projekt DEAL

Influence of 'Trichobilharzia regenti' (Digenea: Schistosomatidae) on the defence activity of 'Radix lagotis' (Lymnaeidae) haemocytes

Radix lagotis is an intermediate snail host of the nasal bird schistosome Trichobilharzia regenti. Changes in defence responses in infected snails that might be related to host-parasite compatibility are not known. This study therefore aimed to characterize R. lagotis haemocyte defence mechanisms and determine the extent to which they are modulated by T. regenti. Histological observations of R. lagotis infected with T. regenti revealed that early phases of infection were accompanied by haemocyte accumulation around the developing larvae 2–36 h post exposure (p.e.) to the parasite. At later time points, 44–92 h p.e., no haemocytes were observed around T. regenti. Additionally, microtubular aggregates likely corresponding to phagocytosed ciliary plates of T. regenti miracidia were observed within haemocytes by use of transmission electron microscopy. When the infection was in the patent phase, haemocyte phagocytic activity and hydrogen peroxide production were significantly reduced in infected R. lagotis when compared to uninfected counterparts, whereas haemocyte abundance increased in infected snails. At a molecular level, protein kinase C (PKC) and extracellular-signal regulated kinase (ERK) were found to play an important role in regulating these defence reactions in R. lagotis. Moreover, haemocytes from snails with patent infection displayed lower PKC and ERK activity in cell adhesion assays when compared to those from uninfected snails, which may therefore be related to the reduced defence activities of these cells. These data provide the first integrated insight into the immunobiology of R. lagotis and demonstrate modulation of haemocyte-mediated responses in patent T. regenti infected snails. Given that immunomodulation occurs during patency, interference of snail-host defence by T. regenti might be important for the sustained production and/or release of infective cercariae

Effect of PKC (GF109203X) and MEK (U0126) inhibitors on phagocytosis by haemocytes from uninfected <i>Radix lagotis</i>.

<p>Haemocyte monolayers were pre-incubated with (A) GF109203X, (B) U0126, or vehicle (DMSO; shown as controls) prior to challenge with <i>E. coli</i> bioparticles. The intracellular fluorescence resulting from phagocytosis was measured using a microplate reader and mean (± SEM; n = 7) levels of phagocytosis expressed in relation to control (100%) values. **p<0.01, ***p<0.001, when compared to control values; paired t-test.</p

The effect of MEK inhibition on PMA-stimulated H₂O₂ production in haemocytes from uninfected <i>Radix lagotis</i>.

<p>H₂O₂ output by haemocyte monolayers in SSS+ alone, U0126 (5 µM) and PMA, or DMSO (vehicle) and PMA was detected by Amplex red and the intensity of fluorescence was measured by microplate reader over 60 min. The mean (± SEM; n = 3 for SSS+ otherwise n = 7) relative fluorescence values shown represent the increase in H₂O₂ production over time in the various treatments. *p<0.05, **p<0.01 and ***p<0.001 for U0126+PMA compared to DMSO+PMA; paired t-test or paired-samples Wilcoxon test combined with Fishers's combination test.</p

Phagocytosis of <i>E. coli</i> bioparticles by haemocytes from uninfected and <i>Trichobilharzia regenti</i> infected <i>Radix lagotis</i>.

<p>Phagocytic activities were assessed by incubating <i>E. coli</i> bioparticles with haemocyte monolayers and assessing the relative fluorescence of internalised particles after 2 h using a microplate reader. (A) The combined (phase-contrast and fluorescence) image of <i>E. coli</i> bioparticles (a) within a haemocyte (b); scale bar = 10 µm. (B) Data were evaluated per volume of haemolymph (200 µl) and per number of haemocytes (50,000) (shown as mean values ± SEM; n = 7) with uninfected snails considered as having 100% activity. *p<0.05 when compared to uninfected snails (50,000 haemocytes); Wilcoxon test.</p

<i>Trichobilharzia regenti</i> larvae within the tissue of <i>Radix lagotis</i> revealed by light microscopy between 1–92 h p.e.; Wright-Giemsa stained sections.

<p>(A) Miracidium of <i>T. regenti</i> (a) containing germ cells (b) occurs within the snail tissue without haemocyte infiltration 1 h p.e. (B) and (C) Haemocytes (c) are present in the vicinity of developing <i>T. regenti</i> mother sporocyst (a) 2 and 16 h p.e., respectively; germ cells (b) and gland structure (d) of the parasite are visible. (D) The area around <i>T. regenti</i> mother sporocyst (a) contains no haemocytes 92 h p.e. Gland structure (d) is located in the body of the parasite. Scale bar = 20 µm. The images shown are representative of the situation seen in all sections observed during these experiments.</p

PKC and ERK phosphorylation and total ERK levels in haemocytes from uninfected and <i>Trichobilharzia regenti</i> infected <i>Radix lagotis</i>.

<p>Representative blots showing (A) PKC and (B) ERK phosphorylation in adherent haemocytes from uninfected and infected snails. (C) Levels of total ERK in uninfected and infected snails. Band intensities were measured and the mean (± SEM) haemocyte PKC and ERK phosphorylation (n = 10) and total ERK levels (n = 5) calculated (shown in the graphs) with uninfected values considered as 100%. **p<0.01 when compared to haemocyte PKC and ERK phosphorylation levels in uninfected snails; two-sample t-test.</p

PMA-stimulated H₂O₂ production in haemocytes from uninfected and <i>Trichobilharzia regenti</i> infected <i>Radix lagotis</i>.

<p>H₂O₂ output by haemocyte monolayers treated with 5 µM PMA was detected by Amplex red and the intensity of fluorescence was measured by microplate reader over 60 min. The mean relative fluorescence values are shown (± SEM; n = 7) and represent the increase in H₂O₂ production over time. Data were evaluated per volume of haemolymph (50 µl) and per number of haemocytes (50,000). **p<0.01, ***p<0.001, when compared to infected snails (50,000 haemocytes); two-sample t-test or Wilcoxon test combined with Fishers's combination test.</p