Individual level perspectives of HIV recent infection testing among female sex workers in Zimbabwe

Issue: In 2022 the United States President’s Emergency Plan for AIDS Relief released a guidance proposing recency testing to be adopted as a key component of new real-time HIV surveillance systems for resource allocation at a local level (1). In response to this, the Foundation of AIDS Research (amfAR) highlighted their concerns regarding ethical and human rights issues relating to consent, risks of harms, inaccuracy of test results and more (2). Through sharing our learnings we aim to contribute to the debate around individual level utility and ethical concerns, and to understanding how we can further support recency testing in real world settings as informed by the perspectives of those being tested. From June to November 2018, we carried out in-depth interviews with fourteen female sex workers (FSWs) recruited from Zimbabwe’s national Sisters with a Voice sex worker programme. We aimed to explore experiences and perspectives of clinic users to assess the feasibility and utility of integrating a Recent Infection Testing Algorithm into routine programme service delivery for FSWs. Participants were aged 25 to 46 years with interviews taking place in Bulawayo, Gweru, Harare, Karoi, and Mutare. Lessons Learnt: In support of amfAR’s concerns, several participants mentioned the potential physical and psychological harm of receiving their recency results including distress and fear of violence from themselves and/or their partners. However, it is hard to disentangle if these harms are linked to the return of the additional recency test or the positive HIV test. Additionally, participants mentioned several benefits to returning recency results including better understanding of their status and health, and incentive to take their HIV medication. We also found that some participants did not properly understand what recency testing was and some reported that they felt obliged to participate out of a sense of duty. These results highlight issues of consent, where even in healthcare settings with large amounts of trust, a structural power imbalance still exists and patients can feel an increased sense of responsibility for their health and that of their community. Recommendations: There is a need for more community engagement to rightly make patients active agents in their healthcare decisions. We think that the choice of whether patients should receive their recency results should reside with the patients themselves. After providing patients with information regarding the risks of receiving their recency results, they should have the ability to decide what is best for them. By deciding what is best for them without involving them in the decision, we exacerbate power imbalances and risk undermining patient’s trust of programmes

ERS/EAACI Statement on severe exacerbations in asthma in adult: facts, priorities and key research questions

International audienceDespite the use of effective medications to control asthma, severe exacerbations in asthma are still a major health risk and require urgent action on the part of the patient and physician to prevent a serious outcome such as hospitalisation or death. Moreover, severe exacerbations are associated with substantial huge healthcare costs, and psychological burden including anxiety and fear for patients and their families. The European Academy of Allergy and Clinical Immunology (EAACI) and the European Respiratory Society (ERS) set up a Task Force (TF) to search for a clear definition of severe exacerbations and to also define research questions and priorities. The statement includes comments from patients who were members of the TF

Using routinely collected blood donation data for expanded HIV and syphilis surveillance in Blantyre District, Malawi

BACKGROUND: WHO recommends all blood donations be screened for transfusion transmissible infections. However, these data are not incorporated into national surveillance systems in Malawi. We set out to use routinely collected data from blood donors in Blantyre district, Malawi, an area of high HIV and syphilis prevalence, to explore current HIV and syphilis prevalence and identify recent sero-conversions among repeat donors. METHODS: We conducted a retrospective cohort analysis of blood donation data collected by the Malawi Blood Transfusion Service (MBTS) between October 1st 2015 and May 31st 2021. All blood donations were routinely screened for WHO-prioritized transfusion-transmissible infections, including HIV and syphilis. We characterized donor demographics as well as screening outcomes, including identifying sero-conversions among repeat donors who previously tested negative. Logistic regression was used to model the impact of individual level covariates on the probability of sero-conversion. RESULTS: A total of 93,199 donations from 5,054 donors were recorded, with 7 donors (0.1%) donating a maximum of 24 times. The majority of donors were male (4,294; 85%) and students (3264; 64.6%) at the time of their first donation. Of those screened for HIV and syphilis, 126 (2.5%, 126/5,049) and 245 (4.9%, 245/5,043) tested positive respectively.Among repeat donors who previously tested negative, 87 HIV sero-conversions and 195 syphilis sero-conversions were identified over the study period, indicating an HIV incidence rate of 6.86 per 1,000 person-years and a syphilis incidence rate of 15.37 per 1,000 person-years. Donors who were female or aged 16-19 at the time of first donation had a higher risk of HIV or syphilis sero-conversion. CONCLUSIONS: Routinely collected data from national blood donation services may be used to enhance existing population-level disease surveillance systems, particularly in high prevalence areas. While blood donors are generally considered a low-risk population for HIV and syphilis, we were able to identify and characterise blood donor populations at increased risk of sero-conversion over the study period. This information will provide insight into priority prevention areas in Blantyre district and help to inform targeted interventions for improved prevention, testing and treatment

Detection of anti-correlation of hot and cold baryons in galaxy clusters

The largest clusters of galaxies in the Universe contain vast amounts of dark matter, plus baryonic matter in two principal phases, a majority hot gas component and a minority cold stellar phase comprising stars, compact objects, and low-temperature gas. Hydrodynamic simulations indicate that the highest-mass systems retain the cosmic fraction of baryons, a natural consequence of which is anti-correlation between the masses of hot gas and stars within dark matter halos of fixed total mass. We report observational detection of this anti-correlation based on 4 elements of a 9 x 9-element covariance matrix for nine cluster properties, measured from multi-wavelength observations of 41 clusters from the Local Cluster Substructure Survey. These clusters were selected using explicit and quantitative selection rules that were then encoded in our hierarchical Bayesian model. Our detection of anti-correlation is consistent with predictions from contemporary hydrodynamic cosmological simulations that were not tuned to reproduce this signal.Peer reviewe

Are venue-based strategies the ticket to the last mile in HIV prevention in Malawi

Background: In 2016, Blantyre District had the highest adult HIV prevalence in Malawi (17% overall; 22% in women) and the lowest viral suppression rate (60%). In response, the MOH expanded prevention and treatment strategies. We hypothesized that social venues patronized by people with high sexual partnerships rates could identify sub-groups currently missed. Methods: We conducted cross-sectional bio-behavioral surveys of representative samples of individuals seeking care in government clinics (n=2313) and social venue patrons (n=1802) Jan-Mar 2022. Clinics were randomly selected from government clinics providing HIV testing. Venues were randomly sampled from urban and rural strata with oversampling of rural venues. Sampling weights were based on 2-stage sampling probabilities. We followed national testing protocols for rapid tests, recency testing and viral load measurements. Acute infections were identified by pooling dried blood spots from persons with an HIV- rapid test. Results: Compared to the clinic population, the venue population was more likely to: be male (68% vs 28%); aged >25 years (61% vs 51%); unmarried (62% vs 40%); drink alcohol daily (43% vs 8%); have more sexual partners in the last year (mean 16 vs 2); report a new sex partner in the past 4 weeks (42% vs 14%); and report transactional sex (52% vs 12%). HIV prevalence (Table 1) was higher among the venue population (19% vs 9%); the proportion HIV+ suppressed was similar (78%). Among women recruited at venues, prevalence increased by age: 0% among age 15-17 to 41% among age 18-21. At venues, factors associated with HIV infection include female sex (39% vs 10%); having a new partner in the past 4 weeks (28% vs 13%) and transactional sex (25% vs 13%). Acute and recent infections were uncommon. Clinic participants who reported visiting venues were less likely to have a suppressed viral load than other PLHIV clinic participants (53% vs 81%). Among both populations, reporting a genital sore in the past 4 weeks was associated with non-suppression (40% vs 20% in clinic; 48% vs 20% in venues). Conclusions: Lower HIV prevalence and greater viral suppression suggests that Blantyre’s HIV epidemic is slowing. Strategies to further reduce transmission should include outreach to venues with higher prevalence of unsuppressed infection and to young women at venues. Testing for acute or recent infection yielded few cases and thus did not provide sufficient value to warrant the cost

The Tara Pacific expedition—A pan-ecosystemic approach of the “-omics” complexity of coral reef holobionts across the Pacific Ocean

Coral reefs are the most diverse habitats in the marine realm. Their productivity, structural complexity, and biodiversity critically depend on ecosystem services provided by corals that are threatened because of climate change effects—in particular, ocean warming and acidification. The coral holobiont is composed of the coral animal host, endosymbiotic dinoflagellates, associated viruses, bacteria, and other microeukaryotes. In particular, the mandatory photosymbiosis with microalgae of the family Symbiodiniaceae and its consequences on the evolution, physiology, and stress resilience of the coral holobiont have yet to be fully elucidated. The functioning of the holobiont as a whole is largely unknown, although bacteria and viruses are presumed to play roles in metabolic interactions, immunity, and stress tolerance. In the context of climate change and anthropogenic threats on coral reef ecosystems, the Tara Pacific project aims to provide a baseline of the “-omics” complexity of the coral holobiont and its ecosystem across the Pacific Ocean and for various oceanographically distinct defined areas. Inspired by the previous Tara Oceans expeditions, the Tara Pacific expedition (2016–2018) has applied a pan-ecosystemic approach on coral reefs throughout the Pacific Ocean, drawing an east–west transect from Panama to Papua New Guinea and a south–north transect from Australia to Japan, sampling corals throughout 32 island systems with local replicates. Tara Pacific has developed and applied state-of-the-art technologies in very-high-throughput genetic sequencing and molecular analysis to reveal the entire microbial and chemical diversity as well as functional traits associated with coral holobionts, together with various measures on environmental forcing. This ambitious project aims at revealing a massive amount of novel biodiversity, shedding light on the complex links between genomes, transcriptomes, metabolomes, organisms, and ecosystem functions in coral reefs and providing a reference of the biological state of modern coral reefs in the Anthropocene

LoCuSS : scaling relations between galaxy cluster mass, gas, and stellar content

We present a simultaneous analysis of galaxy cluster scaling relations between weak-lensing mass and multiple cluster observables, across a wide range of wavelengths, that probe both gas and stellar content. Our new hierarchical Bayesian model simultaneously considers the selection variable alongside all other observables in order to explicitly model intrinsic property covariance and account for selection effects. We apply this method to a sample of 41 clusters at 0.15 <z <0.30, with a well-defined selection criteria based on RASS X-ray luminosity, and observations from Chandra/XMM, SZA, Planck, UKIRT, SUSS, and Subaru. These clusters have well-constrained weak-lensing mass measurements based on Subaru/SuprimeCam observations, which serve as the reference masses in our model. We present 30 scaling relation parameters for 10 properties. All relations probing the intracluster gas are slightly shallower than self-similar predictions, in moderate tension with prior measurements, and the stellar fraction decreases with mass. K-band luminosity has the lowest intrinsic scatter with a 95th percentile of 0.16, while the lowest scatter gas probe is gas mass with a fractional intrinsic scatter of 0.16 +/- 0.03. We find no distinction between the core-excised X-ray or high-resolution Sunyaev-Zel'dovich relations of clusters of different central entropy, but find with modest significance that higher entropy clusters have higher stellar fractions than their lower entropy counterparts. We also report posterior mass estimates from our likelihood model.Peer reviewe

Real-life biomarker response to anti-IL5 and anti-IgE therapies in severe asthma patients

Funding: This study was conducted by the Observational and Pragmatic Research Institute (OPRI) Pte Ltd and was partially funded by Optimum Patient Care Global and AstraZeneca Ltd. No funding was received by OPRI for its contribution.Peer reviewedPostprin

Biomarker-defined clusters by level of Type 2 inflammatory involvement in severe asthma

Peer reviewedPostprin

An Integrated Biorefinery Concept for Conversion of Sugar Beet Pulp into Value-added Chemicals and Pharmaceutical Intermediates

Over 8 million tonnes of sugar beet are grown annually in the UK. Sugar beet pulp (SBP) is the main by-product of sugar beet processing which is currently dried and sold as a low value animal feed. SBP is a rich source of carbohydrates, mainly in the form of cellulose and pectin, including D-glucose (Glu), L-arabinose (Ara) and D-galacturonic acid (GalAc). This work describes the technical feasibility of an integrated biorefinery concept for fractionation of SBP and conversion of these monosaccharides into value-added products. SBP fractionation is initially carried out by steam explosion under mild conditions to yield soluble pectin and insoluble cellulose fractions. The cellulose is readily hydrolysed by cellulases to release Glu that can then be fermented by a commercial Yeast strain to produce bioethanol with a high yield. The pectin fraction can be either fully hydrolysed, using physico-chemical methods, or selectively hydrolysed, using cloned arabinases and galacturonases, to yield Ara-rich and GalAc-rich streams. These monomers can be separated using either Centrifugal Partition Chromatography (CPC) or ultrafiltration into streams suitable for subsequent enzymatic upgrading. Building on our previous experience with transketolase (TK) and transaminase (TAm) enzymes, the conversion of Ara and GalAc into higher value products was explored. In particular the conversion of Ara into L-gluco-heptulose (GluHep), that has potential therapeutic applications in hypoglycaemia and cancer, using a mutant TK is described. Preliminary studies with TAm also suggest GluHep can be selectively aminated to the corresponding chiral aminopolyol. Current work is addressing upgrading of the remaining SBP monomer, GalAc, and modelling of the biorefinery concept to enable economic and Life Cycle Analysis (LCA)