Soil-transmitted helminths: A critical review of the impact of co-infections and implications for control and elimination

Researchers have raised the possibility that soil-transmitted helminth (STH) infections might modify the host's immune response against other systemic infections. STH infections can alter the immune response towards type 2 immunity that could then affect the likelihood and severity of other illnesses. However, the importance of co-infections is not completely understood, and the impact and direction of their effects vary considerably by infection. This review synthesizes evidence regarding the relevance of STH co-infections, the potential mechanisms that explain their effects, and how they might affect control and elimination efforts. According to the literature reviewed, there are both positive and negative effects associated with STH infections on other diseases such as malaria, human immunodeficiency virus (HIV), tuberculosis, gestational anemia, pediatric anemia, neglected tropical diseases (NTDs) like lymphatic filariasis, onchocerciasis, schistosomiasis, and trachoma, as well as Coronavirus Disease 2019 (COVID-19) and human papillomavirus (HPV). Studies typically describe how STHs can affect the immune system and promote increased susceptibility, survival, and persistence of the infection in the host by causing a TH2-dominated immune response. The co-infection of STH with other diseases has important implications for the development of treatment and control strategies. Eliminating parasites from a human host can be more challenging because the TH2-dominated immune response induced by STH infection can suppress the TH1 immune response required to control other infections, resulting in an increased pathogen load and more severe disease. Preventive chemotherapy and treatment are currently the most common approaches used for the control of STH infections, but these approaches alone may not be adequate to achieve elimination goals. Based on the conclusions drawn from this review, integrated approaches that combine drug administration with water, sanitation and hygiene (WASH) interventions, hygiene education, community engagement, and vaccines are most likely to succeed in interrupting the transmission of STH co-infections. Gaining a better understanding of the behavior and relevance of STH co-infections in the context of elimination efforts is an important intermediate step toward reducing the associated burden of disease

LIGHT-FIBER SCINTILLATION DETECTOR

FIELD: physics.SUBSTANCE: detector has block for registering x-ray and nuclear emissions in form of filaments assembly and photo-detector, in optical contact with each other. Filaments, included in registering block, are scintillation fiber crystals Bi4Ge3O12 (BGO) of same length with diameter from 0,05 mm and greater. If x-ray or nuclear emission gets onto end portion of registering block filaments, on the latter visual picture of particles tracks or space distribution of emission is displayed with resolution, appropriate for diameter of used filaments. This image is transferred along BGO filaments to photo-detector, where actual registering of visual picture takes place.EFFECT: higher efficiency, higher thermal stability.1 dwg.Использование: для визуализации траектории и пространственного распределения высокоэнергетических частиц, и может быть использован для фундаментальных исследований и экспериментов в области физики высоких энергий на высокоэнергетических ускорительных установках, в дозиметрической практике в системах радиационного мониторинга, особо в интроскопах медицинского назначения (томография, рентгенография, сцинтиграфия), а также в рентгеновских системах неразрушающего радиационного контроля изделий автомобилестроения, кораблестроения, самолетостроения и ответственных элементов атомной и космической техники. Технический результат изобретения: повышение эффективности регистрации рентгеновского гамма- и других видов ядерного излучения, а также повышение термической устойчивости. Сущность: детектор содержит блок регистрации рентгеновского и ядерных излучений в виде сборки волокон и фотоприемное устройство, находящиеся в оптическом контакте друг с другом. Волокна, входящие в блок регистрации, представляют собой сцинтилляционные волоконные кристаллы Bi4Ge3О12 (BGO) одинаковой длины с диаметром от 0,05 мм и более. При попадании рентгеновского или ядерного излучения на торцевую часть волокон блока регистрации на последних формируется визуальная картина треков частиц или пространственного распределения излучения с разрешением, соответствующим диаметру используемых волокон. Это изображение передается по волокнам BGO в фотоприемное устройство, где и осуществляется регистрация визуальной картины. 1 ил

Shifting from traditional infrastructure planning to a collaborative approach: lessons from the Freetown sanitation master plan

Planning frameworks, usually in the form of master plans, provide the direction for investment priorities necessary to achieve development objectives in many sub-Saharan African countries. Traditionally, master plans were developed using engineering methodologies with little stakeholder participation. There is little understanding of how master plans for sanitation infrastructure and services can be collaboratively designed. Through the application of a case study from Freetown, Sierra Leone, the paper proposes a framework for shifting infrastructure planning from conventional models to participatory, evidence-based methods. Findings highlight that the commitment of government and funding institutions created a sense of urgency and importance around sanitation issues and unlocked opportunities for increased financing and a better enabling policy and regulatory environment. Active engagement of the community and evidence-based decision-making ensured that the master plan aligned with the specific needs, preferences, and aspirations of all stakeholders. It was however challenging to use the principles of citywide inclusive sanitation (CWIS) for participatory planning because the implementing agencies and stakeholders lacked adequate capacity to do so. These findings hold significant implications for decision-makers, sanitation planners, and municipal authorities engaged in the development of sanitation master plans. HIGHLIGHTS It is rare for sanitation master plans to be participatory and to involve a diverse range of stakeholders.; By using inclusive sanitation principles and a participatory framework, we developed a new city sanitation master plan for Freetown.; Stakeholders’ needs, preferences, and aspirations were reflected in the master plan through peer-to-peer learning and consensus-building activities.

Sexual partnership concurrency and age disparities associated with sexually transmitted infection and risk behavior in rural communities in Kenya and Uganda.

ObjectivesWe examined sex-specific associations of partner age disparity and relationship concurrency with Neisseria gonorrhoeae and/or Chlamydia trachomatis (NG/CT) infection, higher-risk relationships, and condom use as proxies for HIV risk.MethodsData were collected in 2016 from 2179 adults in 12 communities in Uganda and Kenya. Logistic regression models examined associations of age disparity and relationship concurrency with NG/CT infection, condom use, and higher-risk (commercial sex and other higher-risk) relationships in the past 6 months, controlling for covariates.ResultsPartner age and relationship concurrency were associated with NG/CT infection in women but not men. Relative to women in age-disparate relationships, women in both age-disparate and age-homogeneous relationships had higher odds of NG/CT infection (adjusted odds ratio [aOR]=3.82, 95% confidence interval [CI]: 1.46-9.98). Among men and women, partnership concurrency was associated with higher-risk partnerships. In addition, relative to those with a single age-homogeneous partner, those with concurrent age-homogeneous partners had higher odds of condom use (men: aOR=2.85, 95% CI: 1.89-4.31; women: aOR=2.99, 95% CI: 1.52-5.89). Concurrent age-disparate partnerships were associated with condom use among men only (aOR=4.02, 95% CI: 2.54-6.37).ConclusionFindings underscore the importance of targeted HIV prevention efforts for couples in age-disparate and concurrent relationships

Sex specific differences in HIV status disclosure and care engagement among people living with HIV in rural communities in Kenya and Uganda.

Non-disclosure of human immunodeficiency virus (HIV) status can hinder optimal health outcomes for people living with HIV (PLHIV). We sought to explore experiences with and correlates of disclosure among PLHIV participating in a study of population mobility. Survey data were collected from 1081 PLHIV from 2015-16 in 12 communities in Kenya and Uganda participating in a test-and-treat trial (SEARCH, NCT#01864603). Pooled and sex-stratified multiple logistic regression models examined associations of disclosure with risk behaviors controlling for covariates and community clustering. At baseline, 91.0% (n = 984) of PLHIV had disclosed their serostatus. Amongst those who had never disclosed, 31% feared abandonment (47.4% men vs. 15.0% women; p = 0.005). Non-disclosure was associated with no condom use in the past 6 months (aOR = 2.44; 95%CI, 1.40-4.25) and with lower odds of receiving care (aOR = 0.8; 95%CI, 0.04-0.17). Unmarried versus married men had higher odds of non- disclosure (aOR = 4.65, 95%CI, 1.32-16.35) and no condom use in the past 6 months (aOR = 4.80, 95%CI, 1.74-13.20), as well as lower odds of receiving HIV care (aOR = 0.15; 95%CI, 0.04-50 0.49). Unmarried versus married women had higher odds of non-disclosure (aOR = 3.14, 95%CI, 1.47-6.73) and lower odds of receiving HIV care if they had never disclosed (aOR = 0.05, 95%CI, 0.02-0.14). Findings highlight gender differences in barriers to HIV disclosure, use of condoms, and engagement in HIV care. Interventions focused on differing disclosure support needs for women and men are needed and may help facilitate better care engagement for men and women and improve condom use in men

Sex specific differences in HIV status disclosure and care engagement among people living with HIV in rural communities in Kenya and Uganda

Non-disclosure of human immunodeficiency virus (HIV) status can hinder optimal health outcomes for people living with HIV (PLHIV). We sought to explore experiences with and correlates of disclosure among PLHIV participating in a study of population mobility. Survey data were collected from 1081 PLHIV from 2015-16 in 12 communities in Kenya and Uganda participating in a test-and-treat trial (SEARCH, NCT#01864603). Pooled and sex-stratified multiple logistic regression models examined associations of disclosure with risk behaviors controlling for covariates and community clustering. At baseline, 91.0% (n = 984) of PLHIV had disclosed their serostatus. Amongst those who had never disclosed, 31% feared abandonment (47.4% men vs. 15.0% women; p = 0.005). Non-disclosure was associated with no condom use in the past 6 months (aOR = 2.44; 95%CI, 1.40-4.25) and with lower odds of receiving care (aOR = 0.8; 95%CI, 0.04-0.17). Unmarried versus married men had higher odds of non- disclosure (aOR = 4.65, 95%CI, 1.32-16.35) and no condom use in the past 6 months (aOR = 4.80, 95%CI, 1.74-13.20), as well as lower odds of receiving HIV care (aOR = 0.15; 95%CI, 0.04-50 0.49). Unmarried versus married women had higher odds of non-disclosure (aOR = 3.14, 95%CI, 1.47-6.73) and lower odds of receiving HIV care if they had never disclosed (aOR = 0.05, 95%CI, 0.02-0.14). Findings highlight gender differences in barriers to HIV disclosure, use of condoms, and engagement in HIV care. Interventions focused on differing disclosure support needs for women and men are needed and may help facilitate better care engagement for men and women and improve condom use in men

"I was still very young": agency, stigma and HIV care strategies at school, baseline results of a qualitative study among youth in rural Kenya and Uganda.

IntroductionAdolescents and young adults living with HIV (AYAH) have the lowest rates of retention in HIV care and antiretroviral therapy (ART) adherence, partly due to the demands of school associated with this life stage, to HIV-related stigma and to fears of serostatus disclosure. We explore the implications of school-based stigma and disclosure on the development of agency during a critical life stage in rural Kenya and Uganda.MethodsWe conducted a qualitative study in the baseline year of the SEARCH Youth study, a combination intervention using a life-stage approach among youth (15-24 years old) living with HIV in western Kenya and southwestern Uganda to improve viral load suppression and health outcomes. We conducted in-depth, semi-structured interviews in 2019 with three cohorts of purposively selected study participants (youth [n = 83], balanced for sex, life stage and HIV care status; recommended family members of youth [n = 33]; and providers [n = 20]). Inductive analysis exploring contextual factors affecting HIV care engagement revealed the high salience of schooling environments.ResultsStigma within school settings, elicited by non-consensual serostatus disclosure, medication schedules and clinic appointments, exerts a constraining factor around which AYAH must navigate to identify and pursue opportunities available to them as young people. HIV status can affect cross-generational support and cohort formation, as AYAH differ from non-AYAH peers because of care-related demands affecting schooling, exams and graduation. However, adolescents demonstrate a capacity to overcome anticipated stigma and protect themselves by selectively disclosing HIV status to trusted peers and caregivers, as they develop a sense of agency concomitant with this life stage. Older adolescents showed greater ability to seek out supportive relationships than younger ones who relied on adult caregivers to facilitate this support.ConclusionsSchool is a potential site of HIV stigma and also a setting for learning how to resist such stigma. School-going adolescents should be supported to identify helpful peers and selectively disclose serostatus as they master decision making about when and where to take medications, and who should know. Stigma is avoided by fewer visits to the clinic; providers should consider longer refills, discreet packaging and long-acting, injectable ART for students