Using Risk-Tracing Snowball Approach to Increase HIV Case Detection Among High-Risk Populations in Cambodia: An Intervention Study

Background: Early HIV diagnosis and initiation onto antiretroviral therapy may prevent ongoing spread of HIV. Risk Tracing Snowball Approach (RTSA) has been shown to be effective in detecting new HIV cases in other settings. The main objective of this study is to evaluate the effectiveness of RTSA in increasing the rate of newly identified HIV cases among high-risk populations. Our second objective was to evaluate the effectiveness of RTSA, as compared to the walk-in group, in increasing the number of HIV tests and early case detection. Methods: This study was conducted from April 1 to September 30, 2016 at two NGO clinics in Phnom Penh, Cambodia. Respondent driven sampling method was adapted to develop RTSA to reach high-risk populations, including key populations and the general population who have social connections with key populations. Bivariate and multivariate logistic regression analyses were conducted. Results: During the implementation period, 721 clients walked in for HIV testing (walk-in group), and all were invited to be seeds. Of the invited clients, 36.6% agreed to serve as seeds. Throughout the implementation, 6195 coupons were distributed to seeds or recruiters, and resulted in 1572 clients visiting the two clinics with coupons (RTSA group), for a coupon return rate of 25.3%. The rate of newly identified HIV cases among the RTSA group was significantly lower compared to that in walk-in group. However, the highest number of newly identified HIV cases was found during the implementation period, compared to both pre- and post-implementation period. Although statistically not significant, the mean CD4 count of newly identified HIV cases detected through RTSA was almost 200 cells/mm3 higher than that in the walk-in group. Conclusions: Although the rate of newly identified HIV cases among the RTSA group was lower than that in the walk-in group, the inclusion of RTSA in addition to the traditional walk-in method boosted new HIV case detection in the two participating clinics. A higher mean CD4 count for the RTSA group may reveal that RTSA may be able to detect HIV cases earlier than the traditional walk-in approach. Further research is needed to understand whether RTSA is a cost-effective intervention to prevent ongoing spread of the HIV among high-risk populations in Cambodia

Using risk-tracing snowball approach to increase HIV case detection among high-risk populations in Cambodia: an intervention study

10.1186/s12879-017-2790-1BMC INFECTIOUS DISEASES17

Cost-Effectiveness Analysis of a Regional Program for Identifying and Treating Children with Correctable Refractive Error in Indonesia

Indonesia is a rapidly growing county with over 262 million inhabitants, but among highly populated countries it has one of the lowest concentrations of eye care providers. This study evaluated the cost-effectiveness of a program implemented in South Sulawesi, Indonesia that trained school teachers to conduct vision screenings, organized in-school evaluations by opticians, and provided free eyeglasses to school children with refractive error (RE). Schoolteachers across 6 districts in South Sulawesi were trained to screen children with possible RE for subsequent evaluation by opticians. All costs associated with designing and implementing the program (administration, training personnel, labor, service delivery, etc.) were assessed. Expenditures and outcomes data were utilized to calculate the cost per disability-adjusted-life-year (DALY) averted using both 2010 and 2016 Global Burden of Disease (GBD) weights. 521 teachers screened 41,212 students across 172 schools in South Sulawesi. 4,506 (10.9%) students failed screening, 2,652 were seen by optometrists, and 2,038 received glasses. The total program cost was US$97,380, with glasses (39.6$2.57, $31.33, and$41.40, respectively; costs were $2.04,$59.80, and $73.22 when district services were instead provided centrally. The estimated cost per DALY averted was US$89.04 based on GBD 2010 weights. Treating children with correctable RE in limited resource settings can be done cost-effectively through a school-based model.</p

HIV prevalence and factors associated with HIV infection among transgender women in Cambodia:results from a national Integrated Biological and Behavioral Survey

Objective To examine factors associated with HIV infection among transgender women in Cambodia. Design Cross-sectional study. Settings HIV high-burden sites including the capital city and 12 provinces. Participants This study included 1375 sexually active transgender women with a mean age of 25.9 years (SD 7.1), recruited by using respondent-driven sampling for structured questionnaire interviews and rapid finger-prick HIV testing. Primary outcome measure HIV infection detected by using Determine antibody test. Results HIV prevalence among this population was 5.9%. After adjustment for other covariates, participants living in urban areas were twice as likely to be HIV infected as those living in rural areas. Participants with primary education were 1.7 times as likely to be infected compared with those with high school education. HIV infection increased with age; compared with those aged 18–24 years, the odds of being HIV infected were twice as high among transgender women aged 25–34 years and 2.8 times higher among those aged ≥35 years. Self-injection of gender affirming hormones was associated with a fourfold increase in the odds of HIV infection. A history of genital sores over the previous 12 months increased the odds of HIV infection by threefold. Transgender women with stronger feminine identity, dressing as a woman all the time, were twice as likely to be HIV infected compared with those who did not dress as a woman all the time. Having never used online services developed for transgender women in the past six months was also associated with higher odds of being HIV infected. Conclusions Transgender women in Cambodia are at high risk of HIV. To achieve the goal of eliminating HIV in Cambodia, effective combination prevention strategies addressing the above risk factors among transgender women should be strengthened

HIV prevalence and factors associated with HIV infection among transgender women in Cambodia: results from a national Integrated Biological and Behavioral Survey

10.1136/bmjopen-2016-015390BMJ OPEN7

The social gene.

Skew selection is a multiple-selection model (not to be confused with a multi-level selection model) that explains the inherent duality of social behavior from an individualistic, self-preservation point of view. The dual behaviors of social beings are ‘greed\u27 and ‘sharing\u27. Greed produces resource stockpiles. Stockpiles buffer an individual from famine. Sharing aggregates individuals into groups. Groups buffer an individual from predation through safety-in-numbers. In this paper, skew selection is applied to genes as a potential solution for two genomic puzzles: (1) junk DNA; and (2) the C-value enigma. Junk DNA refers to the large number of non-coding DNA sequences within a genome. Skew selection hypothesizes that, when genes are exposed to agents of predation such as point mutations, viral infections or chromosomal crossovers, genes that share resources with a large number of junk DNA sequences will survive longer than genes that do not share. The C-value enigma refers to the lack of relationship between genomic size and animal complexity. Skew selection hypothesizes that genomic size and animal complexity evolve independently of each other. Genomic size (i.e., junk DNA) shields genes from agents of mutation, viruses or chromosomal crossovers. Animal complexity (i.e., gene diversity) buffers genes from resource scarcity by allowing organisms to exploit diverse resources. In conclusion, by viewing gene survival through the lens of skew selection, molecular biologists gain insight into the evolution of genomic size and animal complexity as independent survival strategies of self-interested genes facing multiple agents of selection