Implementing emergency department-based HIV testing in a low-resource setting: The value of a structured feasibility assessment tool

Introduction: HIV is a worldwide health problem with continuing high rates of new infections in many parts of the world. This lack of progress in decreasing overall incidence rates has sparked innovative HIV testing strategies, including expansion of testing into the emergency department (ED) setting. Emergency departments have been shown to be high-yield testing venues in the United States and other developed world settings. The feasibility of expanding public health HIV services in the ED in limited-resource countries is unclear.Methods: We performed a cross-sectional feasibility assessment of a convenience sample of four hospitals in the Eastern Cape, South Africa. We administered three adapted interview tools from a previously field-tested survey instrument at each facility (total of 10 interviews) to gather an overview of the health facility, their HIV counselling and testing services, and their laboratory services.Results: All of the health facilities had access to basic commodities such as water and electricity. Many had severe human resource limitations and provided care to wide population catchment areas. In addition, there was little integration of HIV testing into current daily ED operations. Hospital staff identified numerous barriers to future ED testing efforts.Conclusions: Although control of the HIV epidemic requires innovative testing strategies and treatment, specific assessments are warranted on how to incorporate routine HIV testing into an acute care facility like the ED, which typically has many competing priorities. The use of a prospective structured tool incorporating both barriers and benefits can provide valuable field-tested guidance for increased programme planning for HIV testing

Patient acceptance of HIV testing services in rural emergency departments in South Africa

Background: South Africa faces the highest burden of HIV infection globally. The National Strategic Plan on HIV recommends provider-initiated HIV counselling and testing (HCT) in all healthcare facilities. However, HIV continues to overwhelm the healthcare system. Emergency department (ED)-based HCT could address unmet testing needs. Objectives: This study examines the reasons for accepting or declining HCT in South African EDs to inform the development of HCT implementation strategies. Method: We conducted a prospective observational study in two rural EDs, from June to September 2017. Patients presenting to the ED were systematically approached and offered a point-of-care test in accordance with national guidelines. Patients demographics, presenting compaint, medical history and reasons for accepting/declining testing, were recorded. A pooled analysis is presented. Results: Across sites, 2074 adult, non-critical patients in the ED were approached; 1880 were enrolled in the study. Of those enrolled, 19.7% had a previously known positive diagnosis, and 80.3% were unaware of their HIV status. Of those unaware, 90% patients accepted and 10% declined testing. The primary reasons for declining testing were ‘does not want to know status’ (37.6%), ‘in too much pain’ (34%) and ‘does not believe they are at risk’ (19.9%). Conclusions: Despite national guidelines, a high proportion of individuals remain undiagnosed, of which a majority are young men. Our study demonstrated high patient acceptance of ED-based HCT. There is a need for investment and innovation regarding effective pain management and confidential service delivery to address patient barriers. Findings support a routine, non-targeted HCT strategy in EDs. Keywords: HIV counselling and testing; South Africa; emergency department; patient acceptance; implementation research; linkage to care

Implementing emergency department-based HIV testing in a low-resource setting: The value of a structured feasibility assessment tool

Introduction: HIV is a worldwide health problem with continuing high rates of new infections in many parts of the world. This lack of progress in decreasing overall incidence rates has sparked innovative HIV testing strategies, including expansion of testing into the emergency department (ED) setting. Emergency departments have been shown to be high-yield testing venues in the United States and other developed world settings. The feasibility of expanding public health HIV services in the ED in limited-resource countries is unclear. Methods: We performed a cross-sectional feasibility assessment of a convenience sample of four hospitals in the Eastern Cape, South Africa. We administered three adapted interview tools from a previously field-tested survey instrument at each facility (total of 10 interviews) to gather an overview of the health facility, their HIV counselling and testing services, and their laboratory services. Results: All of the health facilities had access to basic commodities such as water and electricity. Many had severe human resource limitations and provided care to wide population catchment areas. In addition, there was little integration of HIV testing into current daily ED operations. Hospital staff identified numerous barriers to future ED testing efforts. Conclusions: Although control of the HIV epidemic requires innovative testing strategies and treatment, specific assessments are warranted on how to incorporate routine HIV testing into an acute care facility like the ED, which typically has many competing priorities. The use of a prospective structured tool incorporating both barriers and benefits can provide valuable field-tested guidance for increased programme planning for HIV testing

Clinical and Virological Study of Dengue Cases and the Members of Their Households: The Multinational DENFRAME Project

Dengue is the most important mosquito-borne viral disease in humans. This disease is now endemic in more than 100 countries and threatens more than 2.5 billion people living in tropical countries. It currently affects about 50 to 100 million people each year. It causes a wide range of symptoms, from an inapparent to mild dengue fever, to severe forms, including dengue hemorrhagic fever. Currently no specific vaccine or antiviral drugs are available. We carried out a prospective clinical study in South-East Asia and Latin America, of virologically confirmed dengue-infected patients attending the hospital, and members of their households. Among 215 febrile dengue subjects, 177 agreed to household investigation. Based on our data, we estimated the proportion of dengue-infected household members to be about 45%. At the time of the home visit, almost three quarters of (29/39) presented an inapparent dengue infection. The proportion of inapparent dengue infection was higher in South-East Asia than in Latin America. These findings confirm the complexity of dengue disease in humans and the need to strengthen multidisciplinary research efforts to improve our understanding of virus transmission and host responses to dengue virus in various human populations

Epidemiology of Dengue Virus in Iquitos, Peru 1999 to 2005: Interepidemic and Epidemic Patterns of Transmission

To develop prevention (including vaccines) and control programs for dengue fever, a significant mosquito-borne disease in the tropics, there is an urgent need for comprehensive long term field epidemiological studies. We report results from a study that monitored ∼2,400 school children and some adult family members for dengue infection at 6 month intervals from 1999 to 2005, in the Amazonian city of Iquitos, Peru. At enrollment, ∼80% of the participants had a previous infection with DENV serotypes 1 and 2 or both. During the first 15 months, about 3 new infections for every 100 participants were observed among the study participants. In 2001, DENV-3, a serotype not previously observed in the region, invaded Iquitos in a process characterized by 3 distinct periods: amplification over at least a 5–6 month period, replacement of previously circulating serotypes, and epidemic transmission when incidence peaked. Incidence patterns of new infections were geographically distinct from baseline prevalence rates prior to arrival of DENV-3, but closely mirrored them during the invasion. DENV transmission varied geographically corresponding to elevated mosquito densities. The invasion of a novel serotype is often characterized by 5–6 months of silent transmission before traditional surveillance programs detect the virus. This article sets the stage for subsequent publications on dengue epidemiology

Modelling regional land change scenarios to assess land abandonment and reforestation dynamics in the Pyrenees (France)

International audienceOver the last decades and centuries, European mountain landscapes have experienced substantial transformations. Natural and anthropogenic LULC changes (land use and land cover changes), especially agro-pastoral activities, have directed influenced the spatial organization and composition of European mountain landscapes. For the past 60 years, natural reforestation has been occurring due to a decline in both agricultural production activities and rural population. Stakeholders, to better anticipate future changes, need spatially and temporally explicit models to identiy areas at risk of land change and possible abandonment. This paper presents an integrated approach combining forecasting scenarios and a LULC changes simulation model to assess where LULC changes may occur in the Pyrenees Mountains, based on historical LULC trands and a range of future socio-economic drivers. The proposed methodology considers local specificities of Pyrenan valleys, sub-regional climate and topographical properties, and regional economic policies. Results indicate that some regions are projected to face strong abandonment, regardless of scenario conditions. Overall, high rates of change are associated with administrative regions where land productivity is highly dependent on socio-economic drivers and climatic and environmental conditions limit intensive (agricultural and/or pastoral) production and profitability. The combination of the results for the four scenarios allows assessements of where encroachment (e.g. colonization by shrublands) and reforestation are the most probable. This assessment intends to provide insight into the potential future development of the Pyrenees to help identify areas that are the most sensitive to change and to guide decision makers to help their management decisions

Evaluating the spatial uncertainty of future land abandonment in a mountain valley (Vicdessos, Pyrenees-France) : insights form model parameterization and experiments

International audienceEuropean mountains are particularly sensitive to climatic disruptions and land use changes. The latter leads to high rates of natural reforestation over the last 50 years. Faced with the challenge of predicting possible impacts on ecosystem services, LUCC models offer new opportunities for land managers to adapt or mitigate their strategies. Assessing the spatial uncertainty of future LUCC is crucial for the defintion of sustainable land use strategies. However, the sources of uncertainty may differ, including the input parameters, the model itself, and the wide range of possible futures. The aim of this paper is to propose a method to assess the probability of occurrence of future LUCC that combines the inherent uncertainty of model parameterization and the ensemble uncertainty of the future based scenarios. For this purpose, we used the Land Change Modeler tool to simulate future LUCC on a study site located in the Pyrenees Mountains (France) and 2 scenarios illustratins 2 land use strategies. The model was parameterized with the same driving factors used for its calibration. The defintion of static vs. dynamic and quantitative vs. qualitative (discretized) driving factors, and their combination resulted in 4 parameterizations. The combination of model outcomes produced maps of spatial uncertainty of future LUCC. This work involves literature to future-based LUCC studies. It goes beyond the uncertainty of simulation models by integrating the unceertainty of the future to provide maps to help decision makers and land managers

Effect of wet curing duration on long-term performance of concrete in tidal zone of marine environment

A proper initial curing is a very simple and inexpensive alternative to improve concrete cover quality and accordingly extend the service life of reinforced concrete structures exposed to aggressive species. A current study investigates the effect of wet curing duration on chloride penetration in plain and blended cement concretes which subjected to tidal exposure condition in south of Iran for 5 years. The results show that wet curing extension preserves concrete against high rate of chloride penetration at early ages and decreases the difference between initial and long-term diffusion coefficients due to improvement of concrete cover quality. But, as the length of exposure period to marine environment increased the effects of initial wet curing became less pronounced. Furthermore, a relationship is developed between wet curing time and diffusion coefficient at early ages and the effect of curing length on time-to-corrosion initiation of concrete is addressed.Peer reviewedCivil and Environmental Engineerin

Direct and indirect effects of climate and fishing on changes in coastal ecosystem services: a historical perspective from the North Sea

Humanity depends on the marine environment for a range of vital ecosystem services, at global (e.g. climate regulation), regional (e.g. commercial fisheries) and local scales (e.g. coastal defence and recreation). At the same time, marine ecosystems have been exploited for centuries, and many systems today are under stress from multiple sources. Recent studies have shown how both climate change and fishing have caused long-term changes in the marine environment. However, there is still poor understanding of how these changes influence change in coastal ecosystem services. In this paper, an integrated modelling approach is used to assess how the final delivery of marine ecosystem services to coastal communities is influenced by the direct and indirect effects of changes in ecosystem processes brought about by climate and human impacts, using fisheries of the North Sea region as a case study. Partial least squares path analysis is used to explore the relationships between drivers of change, marine ecosystem processes and services (landings). A simple conceptual model with four variables—climate, fishing effort, ecosystem process and ecosystem services—is applied to the English North Sea using historic ecological, climatic and fisheries time series spanning 1924–2010 to identify the multiple pathways that might exist. As expected, direct and indirect links between fishing effort, ecosystem processes and service provision were significant. However, links between climate and ecosystem processes were weak. This paper highlights how path analysis can be used for analysing long-term temporal links between ecosystem processes and services following a simplified pathway