Antiretroviral therapy enrollment characteristics and outcomes among HIV-infected adolescents and young adults compared with older adults--seven African countries, 2004-2013.

Although scale-up of antiretroviral therapy (ART) since 2005 has contributed to declines of about 30% in the global annual number of human immunodeficiency (HIV)-related deaths and declines in global HIV incidence, estimated annual HIV-related deaths among adolescents have increased by about 50% and estimated adolescent HIV incidence has been relatively stable. In 2012, an estimated 2,500 (40%) of all 6,300 daily new HIV infections occurred among persons aged 15-24 years. Difficulty enrolling adolescents and young adults in ART and high rates of loss to follow-up (LTFU) after ART initiation might be contributing to mortality and HIV incidence in this age group, but data are limited. To evaluate age-related ART retention challenges, data from retrospective cohort studies conducted in seven African countries among 16,421 patients, aged ≥15 years at enrollment, who initiated ART during 2004-2012 were analyzed. ART enrollment and outcome data were compared among three groups defined by age at enrollment: adolescents and young adults (aged 15-24 years), middle-aged adults (aged 25-49 years), and older adults (aged ≥50 years). Enrollees aged 15-24 years were predominantly female (81%-92%), commonly pregnant (3%-32% of females), unmarried (54%-73%), and, in four countries with employment data, unemployed (53%-86%). In comparison, older adults were more likely to be male (p<0.001), employed (p<0.001), and married, (p<0.05 in five countries). Compared with older adults, adolescents and young adults had higher LTFU rates in all seven countries, reaching statistical significance in three countries in crude and multivariable analyses. Evidence-based interventions to reduce LTFU for adolescent and young adult ART enrollees could help reduce mortality and HIV incidence in this age group

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Equations for the Drag Force and Aerodynamic Roughness Length of Urban Areas with Random Building Heights

We use a conceptual model to investigate how randomly varying building heights within a city affect the atmospheric drag forces and the aerodynamic roughness length of the city. The model is based on the assumptions regarding wake spreading and mutual sheltering effects proposed by Raupach (Boundary-Layer Meteorol 60:375-395, 1992). It is applied both to canopies having uniform building heights and to those having the same building density and mean height, but with variability about the mean. For each simulated urban area, a correction is determined, due to height variability, to the shear stress predicted for the uniform building height case. It is found that u (*)/u (*R) , where u (*) is the friction velocity and u (*R) is the friction velocity from the uniform building height case, is expressed well as an algebraic function of lambda and sigma (h) /h (m) , where lambda is the frontal area index, sigma (h) is the standard deviation of the building height, and h (m) is the mean building height. The simulations also resulted in a simple algebraic relation for z (0)/z (0R) as a function of lambda and sigma (h) /h (m) , where z (0) is the aerodynamic roughness length and z (0R) is z (0) found from the original Raupach formulation for a uniform canopy. Model results are in keeping with those of several previous studies

Effectiveness of a community-based approach for the investigation and management of children with household tuberculosis contact in Cameroon and Uganda: a cluster-randomised trial.

BACKGROUND: Globally, the uptake of tuberculosis-preventive treatment (TPT) among children with household tuberculosis contact remains low, partly due to the necessity of bringing children to health facilities for investigations. This study aimed to evaluate the effect on TPT initiation and completion of community-based approaches to tuberculosis contact investigations in Cameroon and Uganda. METHODS: We did a parallel, cluster-randomised, controlled trial across 20 clusters (consisting of 25 district hospitals and primary health centres) in Cameroon and Uganda, which were randomised (1:1) to receive a community-based approach (intervention group) or standard-of-care facility-based approach to contact screening and management (control group). The community-based approach consisted of symptom-based tuberculosis screening of all household contacts by community health workers at the household, with referral of symptomatic contacts to local facilities for investigations. Initiation of TPT (3-month course of rifampicin-isoniazid) was done by a nurse in the household, and home visits for TPT follow-up were done by community health workers. Index patients were people aged 15 years or older with bacteriologically confirmed, drug-susceptible, pulmonary tuberculosis diagnosed less than 1 month before inclusion and who declared at least one child or young adolescent (aged 0-14 years) household contact. The primary endpoint was the proportion of declared child contacts in the TPT target group (those aged 2 months) and ten in the control group. Between Oct 14, 2019 and Jan 13, 2022, 2894 child contacts were declared by 899 index patients with bacteriologically confirmed tuberculosis. Among all child contacts declared, 1548 (81·9%) of 1889 in the intervention group and 475 (47·3%) of 1005 in the control group were screened for tuberculosis. 1400 (48·4%) child contacts were considered to be in the TPT target group: 941 (49·8%) of 1889 in the intervention group and 459 (45·7%) of 1005 in the control group. In the TPT target group, TPT was commenced and completed in 752 (79·9%) of 941 child contacts in the intervention group and 283 (61·7%) of 459 in the control group (odds ratio 3·06 [95% CI 1·24-7·53]). INTERPRETATION: A community-based approach using community health workers can significantly increase contact investigation coverage and TPT completion among eligible child contacts in a tuberculosis-endemic setting. FUNDING: Unitaid. TRANSLATION: For the French translation of the abstract see Supplementary Materials section

Re-membering Mwanga: same-sex intimacy, memory and belonging in postcolonial Uganda

Proponents of Uganda’s Anti-Homosexuality Act 2014 have denounced homosexuality as an import from the West. Yet every June, hundreds of thousands of Christian pilgrims in Uganda commemorate a set of events, the hegemonic textual accounts of which pivot around the practice of native ‘sodomy’. According to these accounts, the last pre-colonial Kabaka (king) Mwanga of Buganda ordered the execution of a number of his male Christian pages in 1886 when, under the influence of their new religion, they refused his desire for physical intimacy. These events have assumed the place of a founding myth for Christianity in Uganda as a result of the Catholic Church’s canonization of its martyred pioneers. This article explores how public commemoration of these events can coexist with the claim that same-sex intimacy is alien to Uganda. Unlike previous scholarship on the martyrdoms, which has focused primarily on colonial discourse, the article pays attention to contemporary Ugandan remembering of the martyrdoms. And against the grain of queer African historical scholarship, which seeks to recover the forgotten past, it explores the critical possibilities immanent within something that is intensively memorialized. The article maps Ugandan public memory of the martyrdoms, unravelling genealogies of homophobia as well as possibilities for sexual dissidence that lurk within public culture

Quantifying the Cost of <i>Shigella</i> Diarrhea in the Enterics for Global Health (EFGH) <i>Shigella</i> Surveillance Study.

BackgroundComparative costs of public health interventions provide valuable data for decision making. However, the availability of comprehensive and context-specific costs is often limited. The Enterics for Global Health (EFGH) Shigella surveillance study-a facility-based diarrhea surveillance study across 7 countries-aims to generate evidence on health system and household costs associated with medically attended Shigella diarrhea in children.MethodsEFGH working groups comprising representatives from each country (Bangladesh, Kenya, Malawi, Mali, Pakistan, Peru, and The Gambia) developed the study methods. Over a 24-month surveillance period, facility-based surveys will collect data on resource use for the medical treatment of an estimated 9800 children aged 6-35 months with diarrhea. Through these surveys, we will describe and quantify medical resources used in the treatment of diarrhea (eg, medication, supplies, and provider salaries), nonmedical resources (eg, travel costs to the facility), and the amount of caregiver time lost from work to care for their sick child. To assign costs to each identified resource, we will use a combination of caregiver interviews, national medical price lists, and databases from the World Health Organization and the International Labor Organization. Our primary outcome will be the estimated cost per inpatient and outpatient episode of medically attended Shigella diarrhea treatment across countries, levels of care, and illness severity. We will conduct sensitivity and scenario analysis to determine how unit costs vary across scenarios.ConclusionsResults from this study will contribute to the existing body of literature on diarrhea costing and inform future policy decisions related to investments in preventive strategies for Shigella

Agricultural Information Worldwide, vol. 6, 2014

Agricultural Information Worldwide, Volume 6, 2014In this issue: FROM THE EDITOR’S DESK / Jim Morris-Knower (3); Conference Reflections / Antoinette Paris Greider (4). ARTICLES: Keynote Address: The State of Information Literacy Policy: A Global Priority / Sharon Weiner (5); Framing of Climate Change News in Four National Daily Newspapers in Southern Nigeria / Agwu Ekwe Agwu, Chiebonam Justina Amu (11); Access and Use of Information Communication Technologies by Women Staff of Public Extension Service in the North Central Zone of Nigeria / Agwu Ekwe Agwu, Elizabeth Ene Ogbonnah (18); Providing User Preferred Information Resources for a New Faculty of Agriculture, Nnamdi Azikiwe Univeristy, Awka, Nigeria / Chinwe V. Anunobi, Andrew U. Ogbonna (25); Diffusion of Scientific Knowledge in Agriculture: The Case for Africa / Shimelis Assefa, Daniel Gelaw Alemneh, Abebe Rorissa (34); The Use of Social Media in Agricultural Research Workflows in Ghana and Kenya / Justin Chisenga, Richard Kedemi, Joel Sam (48); Towards Mobile Agricultural Information Services in Zimbabwean Libraries: Challenges and Opportunities for Small Sacle Farmers in Utilizing ICTs for Sustainable Food Production / Collence Takaingenhamo Chisita, Thembani Malapela (58); Agriculture and Natural Resource Scientists' Biodiversity Information Needs: Barriers and Facilitators to Use and Access in the U.S. Southeast / Miriam L.E. Steiner Davis, Carol Tenopir, Suzie Allard (66); French Agricultural Research Institute Paves the Way to Open Access: Feedback from CIRAD / Marie-Claude Deboin, Cécile Fovet-Rabot (77); Exploring Relevance of Agro Input Dealers in Disseminating and Communicating of Soil Fertility Management Knowledge: The Case of Siaya and Trans Nzoia Counties, Kenya / T. B. Etyang, J. J. Okello, S. Zingore, P. F. Okoth, F. S. Mairura, A. Mureithi, B. S. Waswa (82); Plantwise Knowledge Bank: Building Sustainable Data and Information Processes to Support Plant Clinics in Kenya / Cambria Finegold, MaryLucy Oronje, Margo C. Leach, Teresia Karanja, Florence Chege, Shaun L.A. Hobbs (96); Innovation in Extension Services for Improved Farmer Access to Agricultural Information in Uganda / Patrick Kasangaki (102); Managing a Web Portal Adapting to New Technologies / Soonho Kim, Kathryn Pace Kincheloe, Yuan Gao, Valdete Berisha (107); Library Outreach to University Farm Staff / Emily MacKenzie, Natalie Waters (114); Enhancing Access to Research in Institutional Repositiories through API / Ryan Miller, Indira Yerramareddy (118); Building Capacity of Smallholder Farmers in Agribusiness and Entrepreneurship Skills in Northern Uganda / Basil Mugonola, Callistus Baliddawa (122); The Data Landscpe of the Coral Triangle / Jeanette Norris (127); Agricultural Information Access Among Smallholder Farmers: Comparative Assessment of Peri-Urban and Rural Settings in Kenya / Dorine Odongo (133); From Local to Global: Launching the New Rangelands West Portals and Database / Jeanne L. Pfander, Barbara S. Hutchinson, Valeria Pesce, Matt Rahr (138); Seed Village Programme: An Innovative Approach for Small Farmers / Dheeraj Singh, M. K. Chaudhary, M. L. Meena, M. M. Roy (143); Transformation of Indian Agricultural Libraries in a Digital and Collaborative Era: A Case Study / Neena Singh, Anil Chikate (147); Collaboration for Impact / Indira Yerramareddy, Luz Marina Alvaré, Katarlah Taylor (157