Accelerating progress of Milenium Development Goals 6 on HIV/AIDS in the Republic of Moldova

The Government is committed to maintaining good public health services, so combatting the socially-conditioned diseases, such as HIV/AIDS, remains a priority. Despite the Government’s commitments and effort that has been made in collaboration with the development partners, the incidence of HIV has risen. In 2011, in order to accelerate the sustainable progress of HIV/AIDS, the Governments and relevant stakeholders decided to apply the Development Goals of Millennium Acceleration Framework (MAF), the methodology endorsed by the United Nations Development Group. With the support from UNDP, WHO and other UN institutions, the application of the MAF has helped investigate the social and medical determinants of health and identify the potential barriers within and outside the health system – bottlenecks at socio-economic and institutional levels. MAF is also focused on the needs of socially vulnerable groups of people that bear the brunt of HIV epidemics. Economic and social marginalization, stigmatization and discrimination they face are the underlying reasons of their vulnerability to these diseases

Аспекты обучения работников первичной сети по вопросам контроля туберкулеза в Молдове

Nicolae Testemiţanu State Medical and Pharmaceutical University, Institute of Phthisiopneumology Chiril Draganiuc, Center of Politics and Analysis in Health, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaTuberculosis is a public health problem in Moldova. Primary health care (PHC) workers play an important role in control of tuberculosis (TB). The article describes the results of PHC workers training on problems of tuberculosis control. About 3720 PHC workers (1355 family physicians and 2365 nurses) from Moldova have been trained in problems of classic TB and TB/MDR control. Continuous medical education in form of short training courses, based on interactive instructional methods for adults, and focused on development of knowledge, abilities and attitudes of trainees are efficient for preparation of work force of health care system. Training of more than 50% of PHC workers resulted in improvement of TB control at primary care level proved by improved of prevention, case detection, and completion treatment in ambulatory conditions. However, the control of classic tuberculosis improved and global incidence of TB cases decreased over the past seven years, the control of TB/MDR remains a major problem.Туберкулез является проблемой публичного здоровья в Молдове. Работники первичной медицинской сети играют важную роль в контроле туберкулеза. Статья описывает результаты обучения работников первичной медицинской сети по вопросам контроля туберкулеза. Около 3720 работников первичной медицинской сети из Молдовы (1355 семейных врачей и 2365 семейных медицинских сестер) были обучены по вопросам контроля классического и полилекарственного устойчивого (ПЛУ) туберкулеза. Непрерывное медицинское обучение в форме коротких курсов, основанных на интерактивных методах обучения для взрослых, ориентированных на развитие знаний, практических навыков и отношений являются эффективной формой подготовки работников первичной медицинской сети. Обучение более 50% работников первичной медицинской сети повысило эффективность контроля туберкулеза на уровне первичной медицинской сети через улучшение предупреждения, раннего выявления и лечения туберкулеза в амбулаторных условиях. Несмотря на улучшение контроля классического туберкулеза и снижение глобальной заболеваемости туберкулезом, продолжает оставаться важной проблемой контроль ПЛУ туберкулеза

Vilnius Declaration on chronic respiratory diseases : multisectoral care pathways embedding guided self-management, mHealth and air pollution in chronic respiratory diseases

Correction: Volume: 10 Issue: 1 Article Number: 49 DOI: 10.1186/s13601-020-00357-4 Published: DEC 17 2020Background: Over 1 billion people suffer from chronic respiratory diseases such as asthma, COPD, rhinitis and rhinosinusitis. They cause an enormous burden and are considered as major non-communicable diseases. Many patients are still uncontrolled and the cost of inaction is unacceptable. A meeting was held in Vilnius, Lithuania (March 23, 2018) under the patronage of the Ministry of Health and several scientific societies to propose multisectoral care pathways embedding guided self-management, mHealth and air pollution in selected chronic respiratory diseases (rhinitis, chronic rhinosinusitis, asthma and COPD). The meeting resulted in the Vilnius Declaration that was developed by the participants of the EU Summit on chronic respiratory diseases under the leadership of Euforea. Conclusion: The Vilnius Declaration represents an important step for the fight against air pollution in chronic respiratory diseases globally and has a clear strategic relevance with regard to the EU Health Strategy as it will bring added value to the existing public health knowledge.Peer reviewe

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

___Key messages___ The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer

Assessing tuberculosis control priorities in high-burden settings: a modelling approach

Background: In the context of WHO's End TB strategy, there is a need to focus future control efforts on those interventions and innovations that would be most effective in accelerating declines in tuberculosis burden. Using a modelling approach to link the tuberculosis care cascade to transmission, we aimed to identify which improvements in the cascade would yield the greatest effect on incidence and mortality. Methods: We engaged with national tuberculosis programmes in three country settings (India, Kenya, and Moldova) as illustrative examples of settings with a large private sector (India), a high HIV burden (Kenya), and a high burden of multidrug resistance (Moldova). We collated WHO country burden estimates, routine surveillance data, and tuberculosis prevalence surveys from 2011 (for India) and 2016 (for Kenya). Linking the tuberculosis care cascade to tuberculosis transmission using a mathematical model with Bayesian melding in each setting, we examined which cascade shortfalls would have the greatest effect on incidence and mortality, and how the cascade could be used to monitor future control efforts. Findings: Modelling suggests that combined measures to strengthen the care cascade could reduce cumulative tuberculosis incidence by 38% (95% Bayesian credible intervals 27–43) in India, 31% (25–41) in Kenya, and 27% (17–41) in Moldova between 2018 and 2035. For both incidence and mortality, modelling suggests that the most important cascade losses are the proportion of patients visiting the private health-care sector in India, missed diagnosis in health-care settings in Kenya, and drug sensitivity testing in Moldova. In all settings, the most influential delay is the interval before a patient's first presentation for care. In future interventions, the proportion of individuals with tuberculosis who are on high-quality treatment could offer a more robust monitoring tool than routine notifications of tuberculosis. Interpretation: Linked to transmission, the care cascade can be valuable, not only for improving patient outcomes but also in identifying and monitoring programmatic priorities to reduce tuberculosis incidence and mortality

COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study

Background To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic. Methods This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network—the Paediatric Tuberculosis Network European Trials Group (ptbnet)—that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission. Findings 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5–12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11, range 1–34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72–14·87; p=0·0035), male sex (2·12, 1·06–4·21; p=0·033), pre-existing medical conditions (3·27, 1·67–6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16–21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir–ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20–1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support. Interpretation COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed

Correction to: Vilnius Declaration on chronic respiratory diseases: multisectoral care pathways embedding guided self-management, mHealth and air pollution in chronic respiratory diseases (Clinical and Translational Allergy, (2019), 9, 1, (7), 10.1186/s13601-019-0242-2)

© 2020, The Author(s). Following publication of the original article [1], in issue was identified with distinguishing the 1st from the 41st authors, both named ‘A. Valiulis’. This caused errors with correctly linking these authors on third party indexing websites. The author names for the 1st and 41st author have been expanded to Arunas Valiulis and Algirdas Valiulis in the author list of this Correction article, in order to circumvent the linking errors. In addition, the presentation of affiliation 1 has been corrected. Affiliation 1 was originally presented as ‘Department of Public Health, Clinic of Children’s Diseases, and Institute of Health Sciences, Vilnius University Institute of Clinical Medicine, Vilnius, Lithuania.’ This affiliation is corrected in the affiliation list of this Correction article to ‘Department of Public Health, Institute of Health Sciences, and Clinic of Children’s Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Vilnius, Lithuania’

Tuberculosis disease in children and adolescents on therapy with antitumor necrosis factor - A agents: A collaborative, multicenter paediatric tuberculosis network European Trials Group (ptbnet) Study

Background. In adults, anti–tumor necrosis factor-α (TNF-α) therapy is associated with progression of latent tuberculosis (TB) infection (LTBI) to TB disease, but pediatric data are limited. Methods. Retrospective multicenter study within the Paediatric Tuberculosis Network European Trials Group, capturing patients <18 years who developed TB disease during anti–TNF-α therapy. Results. Sixty-six tertiary healthcare institutions providing care for children with TB participated. Nineteen cases were identified: Crohn’s disease (n = 8; 42%) and juvenile idiopathic arthritis (n = 6; 32%) were the commonest underlying conditions. Immune-based TB screening (tuberculin skin test and/or interferon-γ release assay) was performed in 15 patients before commencing anti–TNF-α therapy but only identified 1 LTBI case; 13 patients were already receiving immunosuppressants at the time of screening. The median interval between starting anti–TNF-α therapy and TB diagnosis was 13.1 (IQR, 7.1–20.3) months. All cases presented with severe disease, predominantly miliary TB (n = 14; 78%). One case was diagnosed postmortem. TB was microbiologically confirmed in 15 cases (79%). The median duration of anti-TB treatment was 50 (IQR, 46–66) weeks. Five of 15 (33%) cases who had completed TB treatment had long-term sequelae. Conclusions. LTBI screening is frequently false-negative in this patient population, likely due to immunosuppressants impairing test performance. Therefore, patients with immune-mediated diseases should be screened for LTBI at the point of diagnosis, before commencing immunosuppressive medication. Children on anti–TNF-α therapy are prone to severe TB disease and significant long-term morbidity. Those observations underscore the need for robust LTBI screening programs in this high-risk patient population, even in low-TB-prevalence settings