HIV ascertainment through repeat home-based testing in the context of a treatment as prevention trial (ANRS 12249 TasP) in rural South Africa

International audienceBackgroundThe ANRS 12249 TasP cluster-randomised trial evaluates whether HIV testing of all members of a community, followed by immediate antiretroviral treatment (ART) for infected people, will prevent onward sexual transmission and reduce HIV incidence at population level. Ascertaining the HIV status of a high proportion of the population regularly and repeatedly is key to the success of any universal test and treat strategy, as the first step of the HIV cascade.MethodsBetween March 2012 and March 2014, we implemented three six-monthly rounds of home-based HIV counselling and testing in ten local communities (clusters). At each home visit, individual questionnaires were administered and a rapid HIV test offered to all trial participants. We report early results on rates of HIV ascertainment, defined as undergoing a rapid HIV test or HIV-positive self-report.ResultsOf 12,911 eligible individuals (resident in the trial area and ≥16 years), 10,007 were successfully contacted at least once. At first contact, HIV status was ascertained for 7,628 (76.2% [95% CI: 75.4-77.1]) individuals. At second contact, among the 5,885 individuals contacted a second time, HIV status was ascertained for 2,829 (85.0% [95% CI: 83.7-86.2]) of the 3,328 tested negative at first contact and for 543 (45.7% [95% CI: 42.9-48.6]) of the 1,188 who refused a rapid test at first contact. Overall, HIV ascertainment rate was 89.0% (5,239/5,885 [95% CI: 88.2-89.8]) among trial participants contacted twice.ConclusionsRepeat home-based HIV testing is acceptable and feasible in this rural area. Socio-demographic characteristics, behaviours, attitudes, household characteristics and experience of HIV infection and ART in the household will be explored for their association with HIV ascertainment uptake. This will inform whether this intervention reaches the individuals at higher risk in a rural South African region

Access to HIV care in the context of universal test and treat: challenges within the ANRS 12249 TasP cluster-randomized trial in rural South Africa

Introduction: We aimed to quantify and identify associated factors of linkage to HIV care following home-based HIV counselling and testing (HBHCT) in the ongoing ANRS 12249 treatment-as-prevention (TasP) cluster-randomized trial in rural KwaZulu-Natal, South Africa. Methods: Individuals ]16 years were offered HBHCT; those who were identified HIV positive were referred to cluster-based TasP clinics and offered antiretroviral treatment (ART) immediately (five clusters) or according to national guidelines (five clusters). HIV care was also available in the local Department of Health (DoH) clinics. Linkage to HIV care was defined as TasP or DoH clinic attendance within three months of referral among adults not in HIV care at referral. Associated factors were identified using multivariable logistic regression adjusted for trial arm. Results: Overall, 1323 HIV-positive adults (72.9% women) not in HIV care at referral were included, of whom 36.9% (n488) linked to care B3 months of referral (similar by sex). In adjusted analyses (n1222), individuals who had never been in HIV care before referral were significantly less likely to link to care than those who had previously been in care (B33% vs. 42%, pB0.001). Linkage to care was lower in students (adjusted odds-ratio [aOR] 0.47; 95% confidence interval [CI] 0.240.92) than in employed adults, in adults who completed secondary school (aOR0.68; CI 0.490.96) or at least some secondary school (aOR0.59; CI 0.410.84) versus 5 primary school, in those who lived at 1 to 2 km (aOR0.58; CI 0.440.78) or 25 km from the nearest TasP clinic (aOR0.57; CI 0.410.77) versus B1 km, and in those who were referred to clinic after ]2 contacts (aOR0.75; CI 0.580.97) versus those referred at the first contact. Linkage to care was higher in adults who reported knowing an HIV-positive family member (aOR1.45; CI 1.121.86) versus not, and in those who said that they would take ART as soon as possible if they were diagnosed HIV positive (aOR2.16; CI 1.134.10) versus not. Conclusions: Fewer than 40% of HIV-positive adults not in care at referral were linked to HIV care within three months of HBHCT in the TasP trial. Achieving universal test and treat coverage will require innovative interventions to support linkage to HIV care

Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence: the ANRS 12249 TasP (Treatment as Prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa: study protocol for a cluster randomised controlled trial

Background: Antiretroviral therapy (ART) suppresses HIV viral load in all body compartments and so limits the risk of HIV transmission. It has been suggested that ART not only contributes to preventing transmission at individual but potentially also at population level. This trial aims to evaluate the effect of ART initiated immediately after identification/diagnosis of HIV-infected individuals, regardless of CD4 count, on HIV incidence in the surrounding population. The primary outcome of the overall trial will be HIV incidence over two years. Secondary outcomes will include i) socio-behavioural outcomes (acceptability of repeat HIV counselling and testing, treatment acceptance and linkage to care, sexual partnerships and quality of life); ii) clinical outcomes (mortality and morbidity, retention into care, adherence to ART, virologic failure and acquired HIV drug resistance), iii) cost-effectiveness of the intervention. The first phase will specifically focus on the trial's secondary outcomes.Methods/design: A cluster-randomised trial in 34 (2 × 17) clusters within a rural area of northern KwaZulu-Natal (South Africa), covering a total population of 34,000 inhabitants aged 16 years and above, of whom an estimated 27,200 would be HIV-uninfected at start of the trial. The first phase of the trial will include ten (2 × 5) clusters. Consecutive rounds of home-based HIV testing will be carried out. HIV-infected participants will be followed in dedicated trial clinics: in intervention clusters, they will be offered immediate ART initiation regardless of CD4 count and clinical stage; in control clusters they will be offered ART according to national treatment eligibility guidelines (CD4 <350 cells/μL, World Health Organisation stage 3 or 4 disease or multidrug-resistant/extensively drug-resistant tuberculosis). Following proof of acceptability and feasibility from the first phase, the trial will be rolled out to further clusters.Discussion: We aim to provide proof-of-principle evidence regarding the effectiveness of Treatment-as-Prevention in reducing HIV incidence at the population level. Data collected from the participants at home and in the clinics will inform understanding of socio-behavioural, economic and clinical impacts of the intervention as well as feasibility and generalizability. © 2013 Iwuji et al.; licensee BioMed Central Ltd

Nanowire devices for X-ray detection

High spatial resolution X-ray microscopy has become a dedicated tool to study nanocrystals and nanostructure devices in recent years. In general, the spatial resolution of X-ray microscopy depends on the spot size of the X-ray beam and the pixel size of X-ray detectors. High-resolution X-ray detection ideally requires a minimal active region with a sufficient thickness for the X-ray absorption, which leads to nanowire-shaped structures. This thesis made use of semiconductor nanowires to create a single-pixel X-ray detector at nanoscale resolution. The basic interaction between X-rays and nanowire devices can best be investigated by choosing a sample geometry where the nanowire is oriented in-plane with the substrate and orthogonal to the beam. X-ray beam induced current (XBIC), which is the physical process used in X-ray detectors, was used as the primary method to investigate the electrical response from nanowire devices. Different aspects of the XBIC process were investigated in two nanowire materials, InP and InGaP, with two types of doping profiles, n-i-n and p-i-n.The spectrally resolved XBIC measurements shed light on the underlying XBIC signal generation process in nanowire devices, showing that the XBIC signal originates at the atomic level with photoelectric absorption. Then, the X-ray flux variation revealed that the n+-i-n+ doped InGaP nanowire devices were affected by charge trapping leading to photogating and photodoping effects. In contrast, both kinds of p-i-n doped nanowire devices illustrated a linear response as function of the X-ray photon flux, which makes this doping profile more suitable for X-ray detectors. The XBIC measurements of this thesis could reveal the spatially resolved charge collection efficiency (CCE) or internal quantum efficiency (IQE) of the nanowire device. This result emphasizes the key ability of XBIC to be used in the development of nanowire solar cells. Furthermore, calculations based on the finite element method (FEM) was used to get a better understanding of the XBIC results.Although the in-plane nanowire devices can be used for understanding of the XBIC process at the nanoscale, they are not ideal for X-ray detection. The spatial resolution is still limited by the length of the active region, and the diameter of the nanowire limits the absorbing length. A novel fabrication process was therefore developed for a single vertical nanowire device where standing as-grown nanowires were turned into single pixel devices. With this configuration, the incident X-rays can be absorbed along the nanowire axis instead of the diameter. The nanowire used for this device is a p-i-n doped InP nanowire with a diameter of 60 nm as pixel size. Unlike the horizontal NW devices, the flux variation XBIC measurement reveals a sub-linear behaviour.The vertical nanowire device was used to make a high-resolution 3D image of a 90 nm nanofocused X-ray beam by scanning the device in different planes along the beam. The measurements reveal details of the intensity distribution that agree well with calculations based on ptychography. Instead of the nanowire diameter, the spatial detection was limited to about 100 nm due to the stability of the measurement system and X-ray absorption in the top contact. In the future, the device design with as-grown nanowires could scale up into multi-pixel array detectors operating much like conventional X-ray detectors

Ціноутворення земель техногенного походження як чинник формування рівня їх споживчих властивостей

Визначено засади ціноутворення як головного чинника обгрунтування рівня відтворення екологічної та господарської цінності земель техногенного походження, встановлено вплив грошової оцінки на формування їх цільового споживчого ринку, представлено принципи поєднання екологічних та економічних складових оцінки рекультивованого ґрунту.Определены основы ценообразования как главного фактора обоснования уровня восстановления экологической и хозяйственной ценности земель техногенного происхождения, определено влияние денежной оценки на формирование их целевого потребительского рынка, представлены принципы объединения экологических и экономических составляющих оценки рекультивированного грунта.Defined pricing principles as the main factor of level playing ground environmental and economic values of land anthropogenic origin, the effect of monetary valuation of forming their target consumer market, representing a combination of ecological principles and economic evaluation of reclaimed soil constituents

Chamaret – Rouergue

En 2022, l’opération de prospection-inventaire sur l’est du plateau du Rouvergue a permis d’observer 50 structures sur la partie sud de la parcelle 409, section OC. Les empierrements sur les parcelles 263, 408 n’ont pas encore été étudiés.La plupart des structures, dont les pierres sont issues du sous-sol des parcelles, peuvent être identifiées comme des murs de clôtures, des enclos, des cabanes (bories) ou jas, des clapiers et des amas de pierre en attente d’utilisation. Un plan schématique..

La Garde-Adhémar – Le Jarus

Suite au creusement d’un fossé dans un terrain agricole, le 23 avril 2014, une découverte fortuite de vestiges archéologiques a été faite dans la plaine de La Garde-Adhémar. Une intervention rapide a permis d’observer dans la tranchée des murs, des sols et des portions de pavements mosaïqués appartenant à une villa gallo-romaine

POSTMODERN ART EDUCATION PARADIGM IN THAILAND

    The study of Postmodern Art Education Paradigm in Thailand aims to appoint the learning directions which can be the ideas of reforming the arts learning to be suit to the changing of global trends by viewing the contexts of Thai society and culture which are an important basis to creative learning.    The purposes of the study    1. To study the processes of learning postmodern art education time of Thai society.    2. To study the processes of learning art in basic education and higher education.    3. To study the concepts and the ways to manage the course syllabus of the visual arts of basic education and higher education in Thai society.    4. To analyze the contexts and Thai society that relates to the paradigm reforming of the art learning in Thai society.    The results showed that    The postmodern art education paradigm in Thailand showed the relationship between Thai society, contemporary arts and culture, wisdom knowledge, and community and environmental of current postmodern arts which were concerned in the learning processes. This paradigm was a tool using in developing emotion, intelligence, body, completed human which were from various learning as follow characteristics.    Course Syllabus : The quality of course syllabus is the opportunity in learning by giving a variety of equity, openness, flexibility, integration of knowledge, main contents understanding with intellectual dimension to the local environment, culture, religion which related between local and international.    The Art Teachers : The teachers have knowledge in providing the learning of arts and a democracy. They also have opened attitudes with understanding arts as displacing including the creation of various arts learning activities, and interested in technology with the flexibility in theoretically art.    The Students : The students are aware of the various thinking processes with the opinion to arts as a matter of attitude which anyone can think of. They have freedom in expression, creative thinking and decisive critical to the value of art and culture of local communities and internationally. They also have positive attitude toward the arts with involving to the natural environment which is maintained by everybody. Moreover, they have self-development as well as living together in peace with others.    Learning Activities : The postmodern art education have organized learning experience in a variety of strategies, contents, forms, materials which relates to the dimension of wisdom, traditional arts, local focus. In addition, thinking processes are more important than the result of works. Moreover, the students take an important role in learning with the flexible activities depending on space and time.    Media Learning Materials : The postmodern media has variety materials such as the physical media, audio media, and other materials for learning which are not included in the framework of the theoretical arts. The media is applied and presented to the local community with combination of technology as a center of learning.    Learning Resources : The postmodern arts integrate the knowledge of art in both local and international which not limited to the classroom. Therefore, the use of environment and museum in the community; for example, Natural River, forest, temple and the local wisdom together with technology can give knowledge from learning.    Course Syllabus Management : This part shows that the administrators need to accept the new knowledge that has changed rapidly and continuous improvement which relate to participation in operations thought, design approach. The administrators should change the attitude of the education system base on a variety of science knowledge that associate with a holistic approach.Keywords: Paradigm, Art Education, Postmoder

Addressing social issues in a universal HIV test and treat intervention trial (ANRS 12249 TasP) in South Africa: methods for appraisal

Background: The Universal HIV Test and Treat (UTT) strategy represents a challenge for science, but is also a challenge for individuals and societies. Are repeated offers of provider-initiated HIV testing and immediate antiretroviral therapy (ART) socially-acceptable and can these become normalized over time? Can UTT be implemented without potentially adding to individual and community stigma, or threatening individual rights? What are the social, cultural and economic implications of UTT for households and communities? And can UTT be implemented within capacity constraints and other threats to the overall provision of HIV services? The answers to these research questions will be critical for routine implementation of UTT strategies. Methods/design: A social science research programme is nested within the ANRS 12249 Treatment-as-Prevention (TasP) cluster-randomised trial in rural South Africa. The programme aims to inform understanding of the (i) social, economic and environmental factors affecting uptake of services at each step of the continuum of HIV prevention, treatment and care and (ii) the causal impacts of the TasP intervention package on social and economic factors at the individual, household, community and health system level. We describe a multidisciplinary, multi-level, mixed-method research protocol that includes individual, household, community and clinic surveys, and combines quantitative and qualitative methods. Discussion: The UTT strategy is changing the overall approach to HIV prevention, treatment and care, and substantial social consequences may be anticipated, such as changes in social representations of HIV transmission, prevention, HIV testing and ART use, as well as changes in individual perceptions and behaviours in terms of uptake and frequency of HIV testing and ART initiation at high CD4. Triangulation of social science studies within the ANRS 12249 TasP trial will provide comprehensive insights into the acceptability and feasibility of the TasP intervention package at individual, community, patient and health system level, to complement the trial's clinical and epidemiological outcomes. It will also increase understanding of the causal impacts of UTT on social and economic outcomes, which will be critical for the long-term sustainability and routine UTT implementation. Trial registration: Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974

La inclusión de las familias desfavorecidas en el ámbito educativo: La etnia gitana en el contexto escolar.

Con la implantación de la Ley Orgánica 2/2006, de 3 de mayo, de Educación el aprendizaje por competencias se vincula a la adaptación del individuo en la sociedad con el objetivo de conseguir un desarrollo integral del alumno en todas sus dimensiones. La Constitución Española de 1978 reconoce el principio de equidad y garantiza la igualdad de oportunidades, así como la inclusión educativa y la no discriminación. Diversos estudios relacionan el absentismo con la discriminación y a su vez lo vinculan con el fracaso escolar. Estos principios señalan la importancia de fomentar desde las aulas programas y proyectos que trabajen por acabar con esta situación de marginación y discriminación en la lucha por la inclusión e integración de todo el alumnado. Tradicionalmente y antes de la aparición del fenómeno migratorio, que se produce desde finales del siglo XX, la cultura gitana era el único grupo considerado como marginal y desfavorecido. En cuanto a su formación, según datos facilitados por la Fundación del Secretariado Gitano, el 70% de las personas mayores de 16 años no poseen ni los estudios básicos obligatorios. Ello implica un riesgo de marginación contra el que se intenta acabar desde distintas asociaciones para fomentar la escolarización y acabar con el absentismo de este grupo cultura.El presente trabajo se compone de dos apartados. El primero o parte teórica estudia la inclusión, la igualdad de oportunidades, las familias desfavorecidas y la etnia gitana en el mundo educativo con el fin de conocer el estado de la cuestión y situarse en un momento concreto. El segundo apartado o parte empírica realiza una propuesta de intervención didáctica centrada en la realidad del alumno gitano y que está enfocada o dirigida a facilitar la inclusión de este alumnado en la dinámica escolar con una finalidad clara: acabar con el absentismo escolar. Para ello se ha utilizado tanto materiales como técnicas que promuevan la motivación, pero también habilidades para fomentar la tolerancia dentro de la diversidad y de la interculturalidad.<br /