Feasibility of Establishing HIV Case-Based Surveillance to Measure Progress Along the Health Sector Cascade: Situational Assessments in Tanzania, South Africa, and Kenya.

BACKGROUND: To track the HIV epidemic and responses to it, the World Health Organization recommends 10 global indicators to collect information along the HIV care cascade. Patient diagnosis and medical record data, harnessed through case-based surveillance (CBS), can be used to measure 8 of these. While many high burden countries have well-established systems for monitoring patients on HIV treatment, few have formally adopted CBS. OBJECTIVE: In response to the need for improved strategic HIV information and to facilitate the development of CBS in resource-limited countries, we aimed to conduct situational assessments of existing data collection systems in Tanzania, South Africa, and Kenya. METHODS: We developed a standardized protocol and a modularized data collection tool to be adapted for the particular focus of the assessments within each country. The three countries were selected based on their stage of readiness for CBS. The assessment included three parts: a desk review of relevant materials on HIV surveillance and program monitoring, stakeholder meetings, and site visits. RESULTS: In all three countries, routine HIV program monitoring is conducted, and information on new HIV diagnoses and persons accessing HIV care and treatment services is collected. Key findings from the assessments included substantial stakeholder support for the development of CBS, significant challenges in linking data within and between systems, data quality, the ability to obtain data from multiple sources, and information technology infrastructure. Viral load testing capacity varied by country, and vital registry data were not routinely linked to health systems to update medical records. CONCLUSIONS: Our findings support the development of CBS systems to systematically capture routinely collected health data to measure and monitor HIV epidemics and guide responses. Although there were wide variations in the systems examined, some of the current program and patient monitoring systems can be adapted to function effectively for CBS, especially if supported by an improved patient registration system with shared unique health identifiers

Prevalence of transfusion-transmitted Chagas disease among multitransfused patients in Brazil

<p>Abstract</p> <p>Background</p> <p>Blood transfusion has always been an important route for Chagas Disease (CD) transmission. The high prevalence of CD in Latin America and its lifelong asymptomatic clinical picture pose a threat for the safety of the blood supply. The outcome of measures designed to improve transfusion safety can be assessed by evaluating the prevalence of CD among multitransfused patients</p> <p>Methods</p> <p>In order to assess the impact of CD control measures on the safety of the blood supply, an observational cross-sectional study was designed to determine the prevalence of CD in 351 highly transfused patients, in which vectorial transmission was excluded. This study compared patients that received transfusion products before (n = 230) and after (n = 121) 1997, when measures to control transfusion-transmitted CD were fully implemented in Brazil.</p> <p>Results</p> <p>The study group consisted of 351 patients exposed to high numbers of blood products during their lifetime (median number of units transfused = 51, range 10–2086). A higher prevalence of transfusion-transmitted CD (1.30%) was observed among multitransfused patients that received their first transfusion before 1997, compared with no cases of transfusion-transmitted CD among multitransfused patients transfused after that year. The magnitude of the exposure to blood products was similar among both groups (mean number of units transfused per year of exposure = 25.00 ± 26.46 and 23.99 ± 30.58 respectively; P = 0.75, Mann-Whitney test).</p> <p>Conclusion</p> <p>Multiple initiatives aimed to control vector and parental transmission of CD can significantly decrease transfusion-transmitted CD in Brazil. Our data suggest that mandatory donor screening for CD represents the most important measure to interrupt transmission of CD by blood transfusions.</p

Enquête d'épidémiologie d'intervention concernant des infections sexuellement transmissibles dans le sud-ouest de Madagascar (des Biol. Med)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Infections sexuellement transmissibles et hépatites virales dans la région de Tuléar, capitale du Sud-Ouest de Madagascar

La région de Tuléar à Madagascar est très défavorisée. Nous avons estimé les séroprévalences et facteurs de risque associés au VIH, aux virus des hépatites B (VHB) et C (VHC), à la syphilis et à Chlamydia trachomatis (Ct), et exploré connaissances et attitudes liées. Deux études transversales furent réalisées auprès de travailleuses du sexe (TDS) et de femmes enceintes (FE). Les analyses incluaient la recherche d'anticorps anti VIH, syphilis, Ct, VHC. 2 questionnaires furent utilisés. Les analyses statistiques incluaient des régressions logistiques. Les autorités malgaches participèrent activement à cette étude. 316 TDS et 396 FE furent recrutées. Si aucun cas de séropositivité au VIH ne fut détecté, les autres analytes étaient hautement prévalents. L'utilisation du préservatif était insuffisante, malgré une connaissance correcte du VIH. Ce travail confirme la faible distribution actuelle du VIH à Madagascar, et souligne l'urgence sanitaire que représentent la syphilis et le VHBLYON1-BU.Sciences (692662101) / SudocSudocFranceF