HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance

Objectives: In recent years, new technologies and new approaches to scale up HIV testing have emerged. The objective of this paper was to synthesize the body of recent evidence on strategies aimed at increasing the uptake and coverage of HIV testing outside of health care settings in the European Union (EU)/European Economic Area (EEA). Methods: Systematic searches to identify studies describing effective HIV testing interventions and barriers to testing were run in five databases (2010–2017) with no language restrictions; the grey literature was searched for similar unpublished studies (2014–2017). Study selection, data extraction and critical appraisal were performed by two independent reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Eighty studies on HIV testing in non-health care settings were identified, the majority set in Northern Europe. Testing was implemented in 65 studies, with men who have sex with men the risk group most often targeted. Testing coverage and positivity/reactivity rates varied widely by setting and population group. However, testing in community and outreach settings was effective at reaching people who had never previously been tested and acceptability of HIV testing, particularly rapid testing, outside of health care settings was found to be high. Other interventions aimed to increase HIV testing identified were: campaigns (n = 8), communication technologies (n = 2), education (n = 3) and community networking (n = 1). Conclusions: This review has identified several strategies with potential to achieve high HIV testing coverage outside of health care settings. However, the geographical spread of studies was limited, and few intervention studies reported before and after data, making it difficult to evaluate the impact of interventions on test coverage

Intravitreal bevacizumab (Avastin) for choroidal metastasis secondary to breast carcinoma: short-term follow-up

Uveal metastases are the most common intraocular malignancy. The most common primary sites of cancer are from the breast (47%) and lung (21%).1 The treatment for choroidal metastasis depends on many factors including location, multiplicity, and activity of each tumour.1 Bevacizumab (Avastins) is a full-length humanized murine monoclonal antibody against the VEGF molecule, and inhibits angiogenesis and tumour growth.2 In this report, we describe the effect of a single intravitreal injection of bevacizumab (4 mg) in a patient with choroidal metastasis secondary to breast cancerMedicin

Electronic health records to capture primary outcome measures: two case studies in HIV prevention research

BACKGROUND: There is increasing interest in the use of electronic health records (EHRs) to improve the efficiency and cost-effectiveness of clinical trials, including the capture of outcome measures. MAIN TEXT: We describe our experience of using EHRs to capture the primary outcome measure - HIV infection or the diagnosis of HIV infection - in two randomised HIV prevention trials conducted in the UK. PROUD was a clinic-based trial evaluating pre-exposure prophylaxis (PrEP), and SELPHI was an internet-based trial evaluating HIV self-testing kits. The EHR was the national database of HIV diagnoses in the UK, curated by the UK Health Security Agency (UKHSA). In PROUD, linkage to the UKHSA database was performed at the end of the trial and identified five primary outcomes in addition to the 30 outcomes diagnosed by the participating clinics. Linkage also produced an additional 345 person-years follow-up, an increase of 27% over clinic-based follow-up. In SELPHI, new HIV diagnoses were primarily identified via UKHSA linkage, complemented by participant self-report through internet surveys. Rates of survey completion were low, and only 14 of the 33 new diagnoses recorded in the UKHSA database were also self-reported. Thus UKHSA linkage was essential for capturing HIV diagnoses and the successful conduct of the trial. CONCLUSIONS: Our experience of using the UKHSA database of HIV diagnoses as a source of primary outcomes in two randomised trials in the field of HIV prevention was highly favourable and encourages the use of a similar approach in future trials in this disease area

HIV continuum of care in Europe and Central Asia.

OBJECTIVES: The European Centre for Disease Prevention and Control (ECDC) supports countries to monitor progress in their response to the HIV epidemic. In line with these monitoring responsibilities, we assess how, and to what extent, the continuum of care is being measured across countries. METHODS: The ECDC sent out questionnaires to 55 countries in Europe and Central Asia in 2014. Nominated country representatives were questioned on how they defined and measured six elements of the continuum. We present our results using three previously described frameworks [breakpoints; Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets; diagnosis and treatment quadrant]. RESULTS: Forty countries provided data for at least one element of the continuum. Countries reported most frequently on the number of people diagnosed with HIV infection (37; 93%), and on the number in receipt of antiretroviral therapy (ART) (35; 88%). There was little consensus across countries in their approach to defining linkage to, and retention in, care. The most common breakpoint (>19% reduction between two adjacent elements) related to the estimated number of people living with HIV who were diagnosed (18 of 23; 78%). CONCLUSIONS: We present continuum data from multiple countries that provide both a snapshot of care provision and a baseline against which changes over time in care provision across Europe and Central Asia may be measured. To better inform HIV testing and treatment programmes, standard data collection approaches and definitions across the HIV continuum of care are needed. If countries wish to ensure an unbroken HIV continuum of care, people living with HIV need to be diagnosed promptly, and ART needs to be offered to all those diagnosed

Situation of HIV infections and STIs in the United Kingdom in 2007.

In the United Kingdom (UK) in 2007, an estimated 77,400 persons were living with human immunodeficiency virus (HIV) of whom 28% are unaware of their infection. A total of 7,734 persons were newly diagnosed with HIV infection in 2007, of which 31% were diagnosed late. This highlights the need for wider HIV testing, especially in those areas with a high diagnosed prevalence, as recommended in recent national guidelines. Among newly diagnosed cases of HIV in 2007, 41% acquired their infection through sex between men (four in five of whom acquired their infection in the UK) and 55% through heterosexual contact (four in five of whom acquired their infection abroad, mainly in sub-Saharan Africa). Young persons aged 16 to 24 years are disproportionally affected by sexually transmitted diseases (STIs) accounting for 65% of genital chlamydia infections, 50% of cases of genital warts and 50% of cases of gonorrhoea that were diagnosed in 2007

Design and Tests of 500kW RF Windows for the ITER LHCD System

In the frame of a R\&D effort conducted by CEA toward the design and the qualification of a 5 GHz LHCD system for the ITER tokamak, two 5 GHz 500 kW/5 s windows have been designed, manufactured and tested at high power in collaboration with the National Fusion Research Institute (NFRI). The window design rely on a symmetrical pill-box concept with a cylindrical beryllium oxide ceramic brazed on an actively water cooled copper skirt. The ceramic RF properties have been measured on a test sample to get realistic values for guiding the design. Low power measurements of the manufactured windows show return losses below-32 dB and insertion losses between-0.01 dB and-0.05 dB, with an optimum frequency shifted toward lower frequencies. High power tests conducted at NFRI show unexpected total power loss for both windows. The ceramic temperature during RF pulses has been found to reach unexpected high temperature, preventing these windows to be used under CW conditions. A post-mortem RF analysis of samples taken from one window shows that the dielectric properties of the ceramic were not the ones measured on the manufacturer sample, which partly explain the differences with the reference modelling

Design and RF measurements of a 5 GHz 500 kW window for the ITER LHCD system

International audienceCEA/IRFM is conducting R&D efforts in order to validate the critical RF components of the 5 GHz ITER LHCD system, which is expected to transmit 20 MW of RF power to the plasma. Two 5 GHz 500 kW BeO pill-box type window prototypes have been manufactured in 2012 by the PMB Company, in close collaboration with CEA/IRFM. Both windows have been validated at low power, showing good agreement between measured and modeling, with a return loss better than 32 dB and an insertion loss below 0.05 dB. This paper reports on the window RF design and the low power measurements. The high power tests up to 500kW have been carried out in March 2013 in collaboration with NFRI. Results of these tests are also reported. In the current ITER LHCD design, 20 MW Continuous Wave (CW) of Radio-Frequency power at 5 GHz are expected to be generated and transmitted to the plasma. In order to separate the vacuum vessel pressure from the cryostat waveguide pressure, forty eight 5 GHz 500kW CW windows are to be assembled on the waveguides at the equatorial port flange. For nuclear safety reasons, forty eight additional windows could be located in the cryostat section, to separate and monitor the cryostat waveguide pressure from the exterior transmission line pressure. These windows are identified as being one of the main critical components for the ITER LHCD system since first ITER LHCD studies [1] [2] [3] or more recently [4] [5] , and clearly require an important R&D effort. In this context and even if the LHCD system is not part of the construction baseline, the CEA/IRFM is conducting a R&D effort in order to validate a design and the performances of these RF windows. In order to begin the assessment of this need, two 5 GHz 500 kW/5 s pill-box type windows prototypes have been manufactured in 2012 by the PMB Company in close collaboration with the CEA/IRFM [6]. The section 2 of this paper reports the RF and mechanical design of a 5 GHz window. Some features of the mechanical design and the experimental RF measurements at low power are reported in section 3. High power results, made in collaboration with NFRI, are detailed in section 4. The development of CW windows is discussed in the conclusion. 2-RF AND MECHANICAL DESIGN The proposed 5 GHz RF window is based on a pill-box design [2] , i.e. a ceramic brazed in portion of a circular waveguide, connected on either side to a rectangular waveguide section. Typical design rules of thumb of such device are circular section diameter about the same size of the diagonal of the rectangular waveguide (cf. FIGURE 1). Without taking into account the ceramic, the circular section length is approximately half a guided wavelength of the circular TE 11 mode, in order for the device to act as a half-wave transformer. Once optimized, taking into account the ceramic, matching is correct only for a narrow band of frequency and is very sensitive to the device dimensions and the ceramic relative permittivity. The heat losses in the ceramic, which have to be extracted by an active water cooling, depends on the inside electric field topology and of ceramic dielectric loss (loss tangent). Undesirable modes due to parasitic resonances can be excited in the ceramic volume, raising the electric field an