A critical analysis of Peru's HIV grant proposals to the Global Fund.

Peru has applied to six of the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) rounds for funding, achieving success on four occasions. The process of proposal development has, however, been criticised, especially concerning the use of evidence, relevance/consistency and performance indicators. We aimed to analyse the Peruvian Global Fund proposals according to those dimensions, providing feedback to improve future local efforts and inform global discussions around Global Fund procedures. We analysed the content of four HIV-focused proposals (rounds 2, 5, 6 and 8) regarding epidemic context, needs identification and prioritisation and monitoring and evaluation systems. Peruvian proposals submitted after round 1 were described as resulting from collaborative inputs involving formerly unrepresented sectors, principally 'vulnerable populations'. However, difficulties arose regarding the amount and quality of evidence about the epidemiological context; limited consideration of social determinants of the epidemic; lack of theory-driven interventions, and little synergy across projects and the inclusion of weak monitoring and evaluation systems, with poor indicators and measurement procedures. Prioritising the development of analytical and technical skills to generate Global Fund proposals would enhance the country's capacity to produce and utilise evidence, improve the technical-political interface, strengthen information systems and lead to more informed decision making and accountability

Investigación Científica y Políticas Públicas en Salud: Memoria de las I Jornadas Científicas en Salud Pública

La presente Memoria recoge las principales ponencias presentadas durante las sesiones plenarias de las Primeras Jornadas Científicas en Salud Pública llevadas a cabo los días 13 y 14 de Julio del 2006. Las Jornadas Científicas en Salud Pública (JCSP) tuvieron como objetivo reunir a investigadores, docentes, gestores, profesionales de las ciencias de la salud y sociales, funcionarios nacionales y regionales del campo sanitario y social, organizaciones sociales, y agentes comunitarios de salud del país, con el fi n de promover el intercambio científico-académico en el campo de la salud pública en el Perú y analizar las experiencias de investigación y/o evaluación de programas y su impacto en diversas áreas de la salud pública y las políticas públicas. Las jornadas buscaron introducir y discutir el panorama actual de la salud pública en el ámbito nacional, regional e internacional, aportar a la agenda actual de preocupaciones y experiencias de investigación y evaluación en este campo desde la perspectiva de los diversos actores sociales, e iniciar un debate acerca de las posibilidades y limitaciones de las relaciones entre investigación y políticas públicas en salud a partir de experiencias concretas

Situación de la Atención Integral de PVVS en cuatro Ciudades del Perú: acceso a los Servicios de Salud de las Personas que viven con VIH/SIDA (PVVS)

Desde el primer caso de VIH/sida, el Estado peruano, la sociedad civil organizada y la academia, han desarrollado múltiples esfuerzos conjuntos en la lucha contra la epidemia del VIH/sida (1,2). Estos esfuerzos, en los últimos 6 años, han sido impulsados con fondos invertidos por los proyectos del Fondo Mundial que sumarán, desde su inicio en 2004, hasta su finalización en 2012, aproximadamente $77 millones de dólares (3). Este fondo permitió, entre otras cosas, poner en marcha el Programa Nacional para el Tratamiento Antirretroviral de Gran Actividad (TARGA) de forma gratuita en los establecimientos públicos de salud. En la actualidad los proveedores del TARGA, en el sistema de salud peruano (Ministerio de Salud, Seguridad Social, Policía, Fuerzas Armadas y el sector privado), ofrecen servicios de salud a las personas que viven con el VIH/sida (PVVS), incluyendo los servicios de diagnóstico, consejería, prevención y profilaxis para infecciones oportunistas; así como el seguimiento clínico, viral e inmunológico antes y durante el tratamiento. La mayoría de los servicios existentes se implementaron inicialmente, como ya hemos dicho, en el marco de las actividades patrocinadas por el Fondo Mundial de Lucha contra el Sida, la Tuberculosis y la Malaria (FMSTM); en la actualidad éstos son financiados con fondos del Estado. En este contexto se consideró importante evaluar el impacto de estas iniciativas conjuntas tomando en cuenta la prestación de los servicios de salud relacionados al TARGA y su efecto en la morbilidad y la mortalidad de las PVVS. La investigación en VIH/sida en el Perú ha sido un campo productivo; sin embargo, la mayoría de las investigaciones se han centrado en aspectos clínicos y epidemiológicos (4-9). Únicamente un número limitado de estudios ha explorado otras dimensiones de la salud de las personas que viven con VIH (que se atienden en los centros de salud públicos), tales como el acceso a la atención en VIH, sus determinantes sociales y las experiencias relacionadas al TARGA (10,11). El presente estudio tiene como objetivos: 1) Evaluar el acceso a la atención de salud de las PVVS. 2) Explorar la relación entre las características socio-demográficas y socio-económicas de las PVVS, como determinantes potenciales para el acceso de servicios de salud. Asimismo, se exploró la cobertura de los actuales programas de salud en el Perú que brindan atención para VIH desde la óptica de sus beneficiarios efectivos

¿Somos iguales? Using a structural violence framework to understand gender and health inequities from an intersectional perspective in the Peruvian Amazon.

BACKGROUND: In the Peruvian Amazon, historical events of colonization and political marginalization intersect with identities of ethnicity, class and geography in the construction of gender and health inequities. Gender-based inequalities can manifest in poor health outcomes via discriminatory practices, healthcare system imbalances, inequities in health research, and differential exposures and vulnerabilities to diseases. Structural violence is a comprehensive framework to explain the mechanisms by which social forces such as poverty, racism and gender inequity become embodied as individual experiences and health outcomes, and thus may be a useful tool in structuring an intersectional analysis of gender and health inequities in Amazonian Peru. OBJECTIVE: The aim of this paper is to explore the intersection of gender inequities with other social inequalities in the production of health and disease in Peru's Amazon using a structural violence approach. DESIGN: Exploratory qualitative research was performed in two Loreto settings - urban Iquitos and the rural Lower Napo River region - between March and November 2015. This included participant observation with prolonged stays in the community, 46 semi-structured individual interviews and three group discussions. Thematic analysis was performed to identify emerging themes related to gender inequalities in health and healthcare and how these intersect with layered social disadvantages in the reproduction of health and illness. We employed a structural violence approach to construct an intersectional analysis of gender and health inequities in Amazonian Peru. RESULTS: Our findings were arranged into five interrelated domains within a gender, structural violence and health model: gender as a symbolic institution, systemic gender-based violence, interpersonal violence, the social determinants of health, and other health outcomes. Each domain represents one aspect of the complex associations between gender, gender inequity and health. Through this model, we were able to explore: gender, health and intersectionality; structural violence; and to highlight particular local gender and health dynamics. Intersecting influences of poverty, ethnicity, geography and gender served as significant barriers to healthcare in both rural and urban settings

On the Metric Dimension of Cartesian Products of Graphs

A set S of vertices in a graph G resolves G if every vertex is uniquely determined by its vector of distances to the vertices in S. The metric dimension of G is the minimum cardinality of a resolving set of G. This paper studies the metric dimension of cartesian products G*H. We prove that the metric dimension of G*G is tied in a strong sense to the minimum order of a so-called doubly resolving set in G. Using bounds on the order of doubly resolving sets, we establish bounds on G*H for many examples of G and H. One of our main results is a family of graphs G with bounded metric dimension for which the metric dimension of G*G is unbounded

Mitochondrial Superoxide Dismutase Overexpression and Low Oxygen Conditioning Hormesis Improve the Performance of Irradiated Sterile Males

The Sterile Insect Technique (SIT) is a successful autocidal control method that uses ionizing radiation to sterilize insects. However, irradiation in normal atmospheric conditions can be damaging for males, because irradiation generates substantial biological oxidative stress that, combined with domestication and mass-rearing conditions, may reduce sterile male sexual competitiveness and quality. In this study, biological oxidative stress and antioxidant capacity were experimentally manipulated in Anastrepha suspensa using a combination of low-oxygen conditions and transgenic overexpression of mitochondrial superoxide dismutase (SOD2) to evaluate their role in the sexual behavior and quality of irradiated males. Our results showed that SOD2 overexpression enhances irradiated insect quality and improves male competitiveness in leks. However, the improvements in mating performance were modest, as normoxia-irradiated SOD2 males exhibited only a 22% improvement in mating success compared to normoxia-irradiated wild type males. Additionally, SOD2 overexpression did not synergistically improve the mating success of males irradiated in either hypoxia or severe hypoxia. Short-term hypoxic and severe-hypoxic conditioning hormesis, per se, increased antioxidant capacity and enhanced sexual competitiveness of irradiated males relative to non-irradiated males in leks. Our study provides valuable new information that antioxidant enzymes, particularly SOD2, have potential to improve the quality and lekking performance of sterile males used in SIT programs

Kidney function in tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis users: a systematic review and meta-analysis of published literature and a multi-country meta-analysis of individual participant data

BACKGROUND: Previous WHO guidance on tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis (PrEP) suggests measuring creatinine levels at PrEP initiation and regularly afterwards, which might represent barriers to PrEP implementation and uptake. We aimed to systematically review published literature on kidney toxicity among tenofovir disoproxil fumarate-based oral PrEP users and conducted an individual participant data meta-analysis (IPDMA) on kidney function among PrEP users in a global implementation project dataset. METHODS: In this systematic review and meta-analysis we searched PubMed up to June 30, 2021, for randomised controlled trials (RCTs) or cohort studies that reported on graded kidney-related adverse events among oral PrEP users (tenofovir disoproxil fumarate-based PrEP alone or in combination with emtricitabine or lamivudine). We extracted summary data and conducted meta-analyses with random-effects models to estimate relative risks of grade 1 and higher and grade 2 and higher kidney-related adverse events, measured by elevated serum creatinine or decline in estimated creatinine clearance or estimated glomerular filtration rate. The IPDMA included (largely unpublished) individual participant data from 17 PrEP implementation projects and two RCTs. Estimated baseline creatinine clearance and creatinine clearance change after initiation were described by age, gender, and comorbidities. We used random-effects regressions to estimate the risk in decline of creatinine clearance to less than 60 mL/min. FINDINGS: We identified 62 unique records and included 17 articles reporting on 11 RCTs with 13 523 participants in meta-analyses. PrEP use was associated with increased risk of grade 1 and higher kidney adverse events (pooled odds ratio [OR] 1·49, 95% CI 1·22-1·81; I2=25%) and grade 2 and higher events (OR 1·75, 0·68-4·49; I2=0%), although the grade 2 and higher association was not statistically significant and events were rare (13 out of 6764 in the intervention group vs six out of 6782 in the control group). The IPDMA included 18 676 individuals from 15 countries (1453 [7·8%] from RCTs) and 79 (0·42%) had a baseline estimated creatinine clearance of less than 60 mL/min (increasing proportions with increasing age). Longitudinal analyses included 14 368 PrEP users and 349 (2·43%) individuals had a decline to less than 60 mL/min creatinine clearance, with higher risks associated with increasing age and baseline creatinine clearance of 60·00-89·99 mL/min (adjusted hazard ratio [aHR] 8·49, 95% CI 6·44-11·20) and less than 60 mL/min (aHR 20·83, 12·83-33·82). INTERPRETATION: RCTs suggest that risks of kidney-related adverse events among tenofovir disoproxil fumarate-based oral PrEP users are increased but generally mild and small. Our global PrEP user analysis found varying risks by age and baseline creatinine clearance. Kidney function screening and monitoring might focus on older individuals, those with baseline creatinine clearance of less than 90 mL/min, and those with kidney-related comorbidities. Less frequent or optional screening among younger individuals without kidney-related comorbidities may reduce barriers to PrEP implementation and use. FUNDING: Unitaid, Bill & Melinda Gates Foundation, WHO

Laterally Orienting C. elegans Using Geometry at Microscale for High-Throughput Visual Screens in Neurodegeneration and Neuronal Development Studies

C. elegans is an excellent model system for studying neuroscience using genetics because of its relatively simple nervous system, sequenced genome, and the availability of a large number of transgenic and mutant strains. Recently, microfluidic devices have been used for high-throughput genetic screens, replacing traditional methods of manually handling C. elegans. However, the orientation of nematodes within microfluidic devices is random and often not conducive to inspection, hindering visual analysis and overall throughput. In addition, while previous studies have utilized methods to bias head and tail orientation, none of the existing techniques allow for orientation along the dorso-ventral body axis. Here, we present the design of a simple and robust method for passively orienting worms into lateral body positions in microfluidic devices to facilitate inspection of morphological features with specific dorso-ventral alignments. Using this technique, we can position animals into lateral orientations with up to 84% efficiency, compared to 21% using existing methods. We isolated six mutants with neuronal development or neurodegenerative defects, showing that our technology can be used for on-chip analysis and high-throughput visual screens

Microbiome variation in corals with distinct depth distribution ranges across a shallow-mesophotic gradient (15-85 m)

Mesophotic coral ecosystems (MCEs) are generally poorly studied, and our knowledge of lower MCEs (below 60 m depth) is largely limited to visual surveys. Here, we provide a first detailed assessment of the prokaryotic community associated with scleractinian corals over a depth gradient to the lower mesophotic realm (15-85 m). Specimens of three Caribbean coral species exhibiting differences in their depth distribution ranges (Agaricia grahamae, Madracis pharensis and Stephanocoenia intersepta) were collected with a manned submersible on the island of Cura double dagger ao, and their prokaryotic communities assessed using 16S rRNA gene sequencing analysis. Corals with narrower depth distribution ranges (depth-specialists) were associated with a stable prokaryotic community, whereas corals with a broader niche range (depth-generalists) revealed a higher variability in their prokaryotic community. The observed depth effects match previously described patterns in Symbiodinium depth zonation. This highlights the contribution of structured microbial communities over depth to the coral's ability to colonize a broader depth range.Austrian Science Fund (FWF); Catlin Group Limited; Global Change Institute; Eddie Bauer Grant for Expeditions by The Explorers Club; Marie Curie Fellowship [FP7-299320]; Lise Meitner Program of the Austrian Science Fund (FWF) [M1363-B20]info:eu-repo/semantics/publishedVersio