Pretreatment integrase strand transfer inhibitor resistance in North Carolina from 2010-2016

Objective: We sought to define the prevalence of pretreatment integrase strand transfer inhibitor (INSTI) resistance and assess the transmission networks of those with pretreatment INSTI resistance. Design: A retrospective cohort study of HIV-positive patients with genotypic resistance testing sent to a single referral laboratory in North Carolina between 2010 and 2016. Methods: We linked genotype and public health data for in-care HIV-positive individuals to determine the prevalence of INSTI resistance among treatment-naive (defined as those with a first genotype ≤3 months after diagnosis) and treatment-experienced (defined as those with a first genotype >3 months after diagnosis) patients. We performed molecular and phylogenetic analyses to assess whether pretreatment INSTI resistance mutations represented clustered HIV transmission. Results: Of 8825 individuals who contributed sequences for protease, reverse transcriptase, or INSTI genotypic resistance testing during the study period, 2784 (31%) contributed at least one sequence for INSTI resistance testing. Of these, 840 were treatment-naive individuals and 20 [2.4%, 95% confidence interval (CI): 1.5, 3.6%] had INSTI mutations; only two (0.2%, 95% CI: 0.02, 0.9%) had major mutations. Of 1944 treatment-experienced individuals, 9.6% (95% CI: 8.3, 11.0%) had any INSTI mutation and 7.0% (95% CI: 5.9, 8.3%) had major mutations; the prevalence of INSTI mutations among treatment-experienced patients decreased overtime (P<0.001). In total 12 of 20 individuals with pretreatment INSTI mutations were part of 10 molecular transmission clusters; only one cluster shared identical minor mutations. Conclusion: The prevalence of major pretreatment INSTI resistance is very low. Pretreatment INSTI mutations do not appear to represent clustered HIV transmission

Improvements in Timeliness Resulting from Implementation of Electronic Laboratory Reporting and an Electronic Disease Surveillance System

Electronic laboratory reporting (ELR) reduces the time between communicable disease diagnosis and case reporting to local health departments (LHDs). However, it also imposes burdens on public health agencies, such as increases in the number of unique and duplicate case reports. We assessed how ELR affects the timeliness and accuracy of case report processing within public health agencies

HIV-1 Transmission linkages among persons with incident infection to inform public health surveillance

Background: We evaluated features of HIV transmission networks involving persons diagnosed during incident HIV infection (IHI) to assess network-based opportunities to curtail onward transmission. Methods: Transmission networks were constructed using partial pol sequences reported to North Carolina surveillance among persons with recent (2014–2018) and past (90 days prior to an IHI were further characterized. We assessed named partner outcomes among IHI index persons using contact tracing data. Findings: Of 4,405 HIV diagnoses 2014–2018 with sequences, there were 323 (7%) IHI index persons; most were male (88%), Black (65%), young (68% <30 years), and reported sex with men (MSM) risk (79%). Index persons were more likely to be cluster members compared to non-index persons diagnosed during the same period (72% vs. 49%). In total, 162 clusters were identified involving 233 IHI, 577 recent diagnoses, and 163 past diagnoses. Most IHI cases (53%) had viral linkages to ≥1 previously diagnosed person without evidence of HIV viral suppression in the year prior to the diagnosis of the IHI index. In contact tracing, only 53% IHI cases named an HIV-positive contact, resulting in 0.5 previously diagnosed persons detected per IHI investigated. When combined with viral analyses, the detection rate of viremic previously diagnosed persons increased to 1.3. Interpretation: Integrating public health with molecular epidemiology, revealed that more than half of IHI have viral links to persons with previously diagnosed unsuppressed HIV infection which was largely unrecognized by traditional contact tracing. Enhanced partner services to support engagement and retention in HIV care and improved case finding supported by rapid phylogenetic analysis are tools to substantially reduce onward HIV transmission

COMPARE Forum: The idea of North-South and South-South collaboration

The idea of having a Compare Forum focusing on the above title was first discussed with one of the Editors of Compare during a PhD defence in Oslo in 2011. The PhD dissertation itself was linked to a larger project in which researchers from the North (Norway) and the South (South Africa) had been collaborating in educational research for over 10 years. Despite the fact that North-South collaboration is not a new issue on the agenda (King 1985) it is still a timely topic to explore, particularly given the recent growth and moves towards North-South-South collaboration or even South-South Cooperation in Education and Development (Chisholm and Steiner-Khamsi 2009). Thus, any discussion of research collaboration, whether North-South or South-South, is seen as an ideal topic for comparative education, particularly when exploring why there should be collaboration at all and if so what are some of the challenges. While it may be argued that the difference between North-South and South-South collaboration may simply be a question of geography, King (1985) reminds us that collaboration is not necessarily between equals and that collaboration at times ‘appears to be a process initiated in the North, and in which the South participates, as a counterpart’ (184). Ultimately, the differences go beyond simple geographic location to issues of funding and power, something that each of the contributions will touch upon in their own way. While cooperation may mean working with someone, it does suggest that one partner provides information or resources to the other, while collaboration suggests a more equal partnership in which researchers work alongside each other. For the majority of our contributors, we use collaboration as opposed to cooperation, although the literature is not always so clear on this distinction.Web of Scienc

Human Papillomaviruses and genital co-infections in gynaecological outpatients

<p>Abstract</p> <p>Background</p> <p>High grade HPV infections and persistence are the strongest risk factors for cervical cancer. Nevertheless other genital microorganisms may be involved in the progression of HPV associated lesions.</p> <p>Methods</p> <p>Cervical samples were collected to search for human Papillomavirus (HPV), bacteria and yeast infections in gynaecologic outpatients. HPV typing was carried out by PCR and sequencing on cervical brush specimens. <it>Chlamydia trachomatis </it>was identified by strand displacement amplification (SDA) and the other microorganisms were detected by conventional methods.</p> <p>Results</p> <p>In this cross-sectional study on 857 enrolled outpatients, statistical analyses revealed a significant association of HPV with <it>C. trachomatis </it>and <it>Ureaplasma urealyticum (</it>at high density) detection, whereas no correlation was found between HPV infection and bacterial vaginosis, <it>Streptococcus agalactiae</it>, yeasts, <it>Trichomonas vaginalis </it>and <it>U. urealyticum</it>. <it>Mycoplasma hominis </it>was isolated only in a few cases both in HPV positive and negative women and no patient was infected with <it>Neisseria gonorrhoeae</it>.</p> <p>Conclusion</p> <p>Although bacterial vaginosis was not significantly associated with HPV, it was more common among the HPV positive women. A significant association between HPV and <it>C. trachomatis </it>was found and interestingly also with <it>U. urealyticum </it>but only at a high colonization rate. These data suggest that it may be important to screen for the simultaneous presence of different microorganisms which may have synergistic pathological effects.</p

Beyond outputs: pathways to symmetrical evaluations of university sustainable development partnerships

As the United Nations Decade of Education for Sustainable Development (2005–2014) draws to a close, it is timely to review ways in which the sustainable development initiatives of higher education institutions have been, and can be, evaluated. In their efforts to document and assess collaborative sustainable development program outcomes and impacts, universities in the North and South are challenged by similar conundrums that confront development agencies. This article explores pathways to symmetrical evaluations of transnationally partnered research, curricula, and public-outreach initiatives specifically devoted to sustainable development. Drawing on extensive literature and informed by international development experience, the authors present a novel framework for evaluating transnational higher education partnerships devoted to sustainable development that addresses design, management, capacity building, and institutional outreach. The framework is applied by assessing several full-term African higher education evaluation case studies with a view toward identifying key limitations and suggesting useful future symmetrical evaluation pathways. University participants in transnational sustainable development initiatives, and their supporting donors, would be well-served by utilizing an inclusive evaluation framework that is infused with principles of symmetry

Near Real-Time Identification of Recent Human Immunodeficiency Virus Transmissions, Transmitted Drug Resistance Mutations, and Transmission Networks by Multiplexed Primer ID–Next-Generation Sequencing in North Carolina

Background: The identification of recent human immunodeficiency virus (HIV) 1 infections among people with new HIV diagnoses is important to both tailoring and assessing the impact of HIV-1 prevention strategies. Methods: We developed a multiplexed Primer ID-next-generation sequencing approach to identify recent infections by measuring the intrahost viral diversity over multiple regions of the HIV-1 genome, in addition to detecting drug resistance mutations (DRMs) and phylogenetically linked clusters. We summarize the field implementation of this all-in-one platform among persons with newly diagnosed HIV-1 by the North Carolina State Laboratory of Public Health in 2018. Results: Overall, recent infection was identified in 94 (35%) of 268 patients with new HIV diagnoses. People <30 years old, and people who inject drugs were more likely to have diagnoses of recent infection. The reverse-transcriptase region K103N was the most commonly detected DRM (prevalence, approximately 15%). We found a total of 28 clusters, and persons with recent infection were more likely to be cluster members than were those with chronic infections (P =. 03). Conclusions: We demonstrate the rapid identification of recent infection and pretreatment DRMs coupled with cluster analysis that will allow prioritization of linkage to care, treatment, and prevention interventions to those at highest risk of onward transmission

A origem das parcerias público-privada na governança global da educação

Durante a última década, a globalização da governança educacional por meio de parcerias público-privadas (PPP) tem gerado considerável debate quanto ao seu significado, propósito, status e resultados. Este debate é particularmente aquecido no setor da educação por causa da ampla aceitação da educação como atividade complexa, social e política que deve permanecer, em grande parte, se não totalmente, no setor público, servindo a interesses públicos. O artigo analisa a rápida expansão das parcerias público-privadas em educação (PPPE) articulada à introdução de regras de mercado no setor. Neste estudo nos concentramos sobre o papel de uma rede de desenvolvimento global, fundamental na globalização de um tipo particular de PPPE, indicando que a ideia de PPP encaixa-se em um projeto mais amplo de reconstituição da educação pública no âmbito do setor de serviços, a ser governada como parte da construção de uma sociedade de mercado.Over the past decade, the globalization and governing of education through Public Private Partnerships (PPPs) have generated considerable debate as to their meaning, purpose, status and outcomes. This debate is particularly heated in the education sector because of the widely-held view that education is a complex social and political activity that should remain largely, if not wholly, in the public sector serving public interests. The article analyses the rapid expansion of Education Public Private Partnerships (EPPPs) and the associated introduction of market rules into the education sector. We focus on the role of a key global development network in globalizing a particular kind of ePPPs, and show that the EPPP idea fi ts into a wider project of reconstituting public education as an education services industry to be governed as part of the construction of a market society