Barriers to antiretroviral therapy adherence in rural Mozambique

<p>Abstract</p> <p>Background</p> <p>HIV is treated as a chronic disease, but high lost-to-follow-up rates and poor adherence to medication result in higher mortality, morbidity, and viral mutation. Within 18 clinical sites in rural Zambézia Province, Mozambique, patient adherence to antiretroviral therapy has been sub-optimal.</p> <p>Methods</p> <p>To better understand barriers to adherence, we conducted 18 community and clinic focus groups in six rural districts. We interviewed 76 women and 88 men, of whom 124 were community participants (CP; 60 women, 64 men) and 40 were health care workers (HCW; 16 women, 24 men) who provide care for those living with HIV.</p> <p>Results</p> <p>While there was some consensus, both CP and HCW provided complementary insights. CP focus groups noted a lack of confidentiality and poor treatment by hospital staff (42% CP vs. 0% HCW), doubt as to the benefits of antiretroviral therapy (75% CP vs. 0% HCW), and sharing medications with family members (66% CP vs. 0%HCW). Men expressed a greater concern about poor treatment by HCW than women (83% men vs. 0% women). Health care workers blamed patient preference for traditional medicine (42% CP vs. 100% HCW) and the side effects of medication for poor adherence (8% CP vs. 83% CHW).</p> <p>Conclusions</p> <p>Perspectives of CP and HCW likely reflect differing sociocultural and educational backgrounds. Health care workers must understand community perspectives on causes of suboptimal adherence as a first step toward effective intervention.</p

Diagnosis and management of venereal campylobacteriosis in beef cattle

BACKGROUND: Bovine venereal campylobacteriosis is caused by Campylobacter fetus subsp. venerealis and its glycerine-tolerant variant Campylobacter fetus subsp. venerealis biovars intermedius. The disease can be economically important when present in cattle herds, causing poor reproductive performance, embryo mortality and abortion. Sensitive and specific diagnostic tests are required in the diagnosis of infection and to inform and monitor disease control. Current tests include bacterial culture and fluorescent antibody testing of preputial sheath washings and an enzyme-linked immunosorbent assay and an agglutination test on vaginal mucus, although the predictive values of these tests can be inadequate in field investigations. Artificial insemination is often considered as a simple control method for bovine venereal campylobacteriosis, but is impractical for many beef suckler herds where breeding takes place at pasture. Commercial vaccines are unavailable in the UK, while the efficacy of autogenous vaccines using a bacterial isolate from infected animals on a specific farm is at best unproven. Hence, for some infected herds, the development of an alternative control strategy based on segregation of potentially infected and uninfected animals in combination with culling or treatment would be desirable. This approach requires meticulous records and herd health management. CASE PRESENTATION: In this paper we highlight difficulties in diagnosing bovine venereal campylobacteriosis and demonstrate the benefits of good record keeping when investigating poor reproductive performance in a beef suckler herd and establishing a herd-specific approach to bio-containment of the infectious cause. CONCLUSIONS: Bovine venereal campylobacteriosis is an economically important disease that should be considered in investigations of suckler herd subfertility problems. Control of the disease based on segregation of potentially infected and uninfected animals in combination with extensive culling can be achieved without the use of artificial insemination or vaccination, but requires meticulous records and strict adherence to herd biosecurity practices

Determination of presence of Tritrichomonas foetus in uterine lavages from cows with reproductive problems Determinação da presença de Tritrichomonas foetus em lavados uterinos de vacas com problemas reprodutivos

The aim of this study was to determine the presence of Tritrichomonasfoetus in two dairy herds on the Altiplano Cundiboyacense. Twenty-one low-volume uterine lavages from cows with a history of reproductive problems in two dairy herds located in the municipality of Sibaté (Cundinamarca) and Ventaquemada (Boyacá) were evaluated. In the first herd, 10 cows were sampled and in the second, 11 cows, based on three inclusion criteria. The uterine lavages were obtained through infusion of physiological saline solution into the uterine body. The samples were centrifuged and seeded in Tritrichomonas basal medium for 10-15 days at 37 ºC. The protozoa were evaluated on the day of sampling and 10 and 15 days after incubation by means of direct viewing under a dark-field microscope. Positive samples were stained with Wright and Lugol to identify the morphological characteristics. This study showed that T. foetus was present in 61.8% of the animals sampled. The determination that T. foetus was present in 61.8% of the samples analyzed is a significant finding given that in the herds evaluated, this agent had not previously been diagnosed.<br>O objetivo do presente estudo, foi determinar a presença de Tritrichomonas foetus em dois rebanhos leiteiros no Altiplano Cundiboyacense. De vacas com um histórico de problemas reprodutivos, foram avaliados 21 lavados uterinos de pequeno volume, em dois rebanhos leiteiros localizados nos municípios de Sibaté (Cundinamarca) e Ventaquemada (Boyacá). No primeiro rebanho, 10 vacas foram amostradas e no segundo 11, baseado em três critérios de inclusão. Os lavados uterinos foram obtidos mediante infusão de solução salina fisiológica no corpo do útero. As amostras foram centrifugadas e semeadas em meio de cultura básico para Tritrichomonas por 10-15 dias a 37 ºC. Os protozoários foram avaliados no dia da colheita de amostras e 10 e 15 dias após incubação por meio de visualização direta sob um microscópio de campo escuro. As amostras positivas foram coradas com Wright e Lugol para identificar as características morfológicas. Este estudo mostrou que T. foetus estava presente em 61,8% dos animais amostrados. A determinação de que T. foetus estava presente em 61,8% das amostras analisadas é um achado significativo, dado que nos rebanhos avaliados, esse agente não tinha sido previamente diagnosticado

Neospora caninum NC-6 Argentina induces fetopathy in both serologically positive and negative experimentally inoculated pregnant dams

Neospora caninum infection is a major cause of abortion in cattle. The objectives of this study were to genetically characterize the N. caninum NC-6 Argentina isolate using a multilocus microsatellite analysis approach and to study its biological behavior by experimental inoculations into seronegative and seropositive pregnant cattle, evaluating the humoral and cellular immune response elicited and the occurrence of transplacental transmission and fetopathy. Pregnant cows (65 days of gestation) seropositive and seronegative to N. caninum were intravenously inoculated with tachyzoites of the NC-6 Argentina N. caninum strain and slaughtered at 108 ± 2 days of gestation. Serum samples were analyzed for N. caninum antibodies by indirect fluorescent antibody test. The cellular immune response was analyzed by detection of gamma interferon (γIFN) production in blood cells. Tissue samples from dams, fetuses, and placental cotyledons were processed by histopathological and immunohistochemical techniques and examined for N. caninum DNA by PCR. Positive DNA samples were further analyzed by multilocus microsatellite typing for N. caninum. Inoculated animals had significantly higher N. caninum antibody titers and γIFN production than control animals. One seropositive inoculated cow aborted, one seronegative cow had a non-viable fetus, and the remaining fetuses from the experimentally inoculated dams had histopathologic lesions. The PCR was positive in 3/4 fetuses from seronegative inoculated cows and in 2/3 fetuses from seropositive inoculated cows. Multilocus microsatellite analysis revealed that the N. caninum DNA present in fetuses and placentas had an identical pattern to NC-6 Argentina strain. The NC-6 Argentina strain proved to be able to cross the placenta and to induce fetopathy in both the seropositive and seronegative dams