23 research outputs found
First Evidence of a HIV-1 M/O Recombinant Form Circulating Outside Cameroon
International audienc
The presence of the Y181C mutation in HIV-1 group O strains is clade dependant
International audienc
Analyse génétique comparée de 19 formes recombinantes VIH-1 inter-groupes M et O et impact évolutif
International audienc
Impact of systematic early tuberculosis detection using Xpert MTB/RIF Ultra in children with severe pneumonia in high tuberculosis burden countries (TB-Speed pneumonia): a stepped wedge cluster randomized trial
Background In high tuberculosis (TB) burden settings, there is growing evidence that TB is common in children with pneumonia, the leading cause of death in children under 5 years worldwide. The current WHO standard of care (SOC) for young children with pneumonia considers a diagnosis of TB only if the child has a history of prolonged symptoms or fails to respond to antibiotic treatments. As a result, many children with TB-associated severe pneumonia are currently missed or diagnosed too late. We therefore propose a diagnostic trial to assess the impact on mortality of adding the systematic early detection of TB using Xpert MTB/RIF Ultra (Ultra) performed on nasopharyngeal aspirates (NPA) and stool samples to the WHO SOC for children with severe pneumonia, followed by immediate initiation of anti-TB treatment in children testing positive on any of the samples. Methods TB-Speed Pneumonia is a pragmatic stepped-wedge cluster randomized controlled trial conducted in six countries with high TB incidence rate (Côte d’Ivoire, Cameroon, Uganda, Mozambique, Zambia and Cambodia). We will enrol 3780 children under 5 years presenting with WHO-defined severe pneumonia across 15 hospitals over 18 months. All hospitals will start managing children using the WHO SOC for severe pneumonia; one hospital will be randomly selected to switch to the intervention every 5 weeks. The intervention consists of the WHO SOC plus rapid TB detection on the day of admission using Ultra performed on 1 nasopharyngeal aspirate and 1 stool sample. All children will be followed for 3 months, with systematic trial visits at day 3, discharge, 2 weeks post-discharge, and week 12. The primary endpoint is all-cause mortality 12 weeks after inclusion. Qualitative and health economic evaluations are embedded in the trial. Discussion In addition to testing the main hypothesis that molecular detection and early treatment will reduce TB mortality in children, the strength of such pragmatic research is that it provides some evidence regarding the feasibility of the intervention as part of routine care. Should this intervention be successful, safe and well tolerated, it could be systematically implemented at district hospital level where children with severe pneumonia are referred. Trial registration ClinicalTrials.gov, NCT03831906. Registered 6 February 2019
Reducing the impact of emerging infections through data sharing
Data sharing has the potential to shift the paradigm of outbreak response in the public health, clinical and scientific communities. Increasing access to more data can address some of the key challenges of the limited, fragmented, poor quality data, which characterise emerging infections. To achieve this, we must design well-governed, equitable, collaborative data sharing models driven by the questions relevant to those directly affected, and ensure that the benefits of sharing are returned to them. We must also implement methodologies that maximize the usability of data to generate evidence
Reducing the impact of emerging infections through data sharing
Data sharing has the potential to shift the paradigm of outbreak response in the public health, clinical and scientific communities. Increasing access to more data can address some of the key challenges of the limited, fragmented, poor quality data, which characterise emerging infections. To achieve this, we must design well-governed, equitable, collaborative data sharing models driven by the questions relevant to those directly affected, and ensure that the benefits of sharing are returned to them. We must also implement methodologies that maximize the usability of data to generate evidence