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Feasibility, acceptability, and effectiveness of non-pharmaceutical interventions against infectious diseases among crisis-affected populations: a scoping review. 在受危机影响的人群中防治传染病的非药物干预措施的可行性、可接受性和有效性:范围审查。
IF 8.1 1区 医学 Q1 Medicine Pub Date : 2022-01-28 DOI: 10.1186/s40249-022-00935-7
Jonathan A Polonsky, Sangeeta Bhatia, Keith Fraser, Arran Hamlet, Janetta Skarp, Isaac J Stopard, Stéphane Hugonnet, Laurent Kaiser, Christian Lengeler, Karl Blanchet, Paul Spiegel

Background: Non-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. Despite being particularly important for crisis-affected populations and those living in informal settlements, who typically reside in overcrowded and resource limited settings with inadequate access to healthcare, guidance on NPI implementation rarely takes the specific needs of such populations into account. We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settlements.

Methods: We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire. We analysed the data to produce descriptive summaries according to a number of categories: date of publication; geographical region of intervention; typology of crisis, shelter, modes of transmission, NPI, research design; study design; and study quality.

Results: Our review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable, despite apparent effectiveness.

Conclusions: Overall, the evidence base was variable, with substantial knowledge gaps which varied between settings and pathogens. Based on the current landscape, robust evidence-based guidance is not possible, and a research agenda is urgently required that focusses on these specific vulnerable populations. Although implementation of NPIs presents unique practical challenges in these settings, it is critical that such an agenda is put in place, and that the lessons learned from historical and present experiences are documented to build a firm evidence base.

背景:非药物干预措施(NPIs)是预防和控制传染病暴发的一套关键措施。尽管对受危机影响的人口和生活在非正规住区的人特别重要,因为这些人通常居住在拥挤和资源有限的环境中,无法获得充分的医疗保健,但关于实施新方案的指导很少考虑到这些人口的具体需求。因此,我们对已发表的证据进行了系统的范围审查,以描述研究前景,并确定有关危机影响人群和非正式定居点的npi的可接受性、可行性和有效性的证据差距。方法:我们系统地回顾了1970年至2020年间发表的同行评议文章,以整理有关npi在受危机影响人群和非正式定居点中的可行性、可接受性和有效性的现有证据。我们使用标准化问卷对每项研究进行质量评估。我们对数据进行了分析,并根据以下几个类别生成了描述性摘要:出版日期;干预的地理区域;危机类型、庇护所、传播方式、新产品导入、研究设计;研究设计;还有学习质量。结果:我们的综述包括了发表在85篇同行评议文章中的158项研究。大多数研究采用了低质量的研究设计。npi的可接受性、可行性和有效性高度依赖于上下文。一般来说,简单和具有成本效益的干预措施,如社区一级的环境清洁和提供水、环境卫生和个人卫生服务,以及分发驱虫蚊帐等个人防护用品,都是高度可行和可接受的。后勤、财政和人力资源方面的限制影响了各项措施的执行和可持续性。社区参与成为促进国家倡议机构有效性的一个重要因素。相反,可能限制人身自由的措施,如病例隔离和病人护理以及埋葬限制,虽然效果明显,但被认为不太可接受。结论:总体而言,证据基础是可变的,在环境和病原体之间存在着巨大的知识差距。根据目前的情况,不可能有强有力的基于证据的指导,迫切需要一个研究议程,重点关注这些特定的弱势群体。虽然在这些情况下实施国家自主行动方案提出了独特的实际挑战,但至关重要的是,必须制定这样一个议程,并记录从历史和当前经验中吸取的教训,以建立坚实的证据基础。
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引用次数: 9
World NTD Day 2022 and a new Kigali Declaration to galvanise commitment to end neglected tropical diseases. 2022年世界热带病日和新的《基加利宣言》,以激励各方承诺消除被忽视的热带病。
IF 8.1 1区 医学 Q1 Medicine Pub Date : 2022-01-28 DOI: 10.1186/s40249-021-00932-2
Thoko Elphick-Pooley, Dirk Engels

The World Health Organization's first roadmap and the London Declaration on neglected tropical diseases (NTDs) have allowed an unprecedented expansion of interventions to control and eliminate this group of infectious diseases that primarily affects vulnerable or marginalised communities. The 2021-2030 NTD roadmap sustains a further acceleration of interventions but also introduces a broader and more ambitious agenda, calling to be accompanied by a new political declaration. Sponsored by the Government of Rwanda, the Kigali Declaration on neglected tropical diseases will be launched in 2022 to renew and reinvigorate commitments to end NTDs, also in the wake of the current setback caused by the COVID-19 pandemic. Starting on World NTD Day 2022, a global campaign "100% Committed" will call on a broad range of stakeholders to sign the declaration and make bold financial and political commitments towards achieving the 2030 roadmap and Sustainable Development Goals' targets for NTDs.

世界卫生组织的首份路线图和《被忽视热带病伦敦宣言》使控制和消除这类主要影响脆弱或边缘化社区的传染病的干预措施得到了前所未有的扩大。《2021-2030年新结核样疾病路线图》支持进一步加快干预措施,但也提出了一个更广泛、更雄心勃勃的议程,要求伴随一项新的政治宣言。在卢旺达政府的赞助下,将于2022年发布《关于被忽视热带病的基加利宣言》,重申并重振终止被忽视热带病的承诺,同时也是在当前COVID-19大流行造成挫折之后。从2022年世界被忽视的热带病日开始,一项“100%承诺”的全球运动将呼吁广泛的利益攸关方签署宣言,并为实现2030年路线图和可持续发展目标中有关被忽视的热带病的具体目标作出大胆的财政和政治承诺。
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引用次数: 6
Social innovation based on collaboration between government and non-governmental organizations in COVID-19 crisis: evidence from Iran. 基于COVID-19危机中政府和非政府组织合作的社会创新:来自伊朗的证据。
IF 8.1 1区 医学 Q1 Medicine Pub Date : 2022-01-25 DOI: 10.1186/s40249-021-00923-3
Mehrnaz Moeenian, Abbas Khamseh, Maziyar Ghazavi

Background: One of the effective ways to attract social collaboration to provide effective, prompt, and coordinated interventions in emergencies is through social innovation. The present study seeks to identify the factors affecting the implementation of the social innovation plan based on the collaboration between government and non-governmental organizations (NGOs) for saving people's lives in crises. The initial idea of this research was obtained from the best practice "Every Home Is a Health Base" which was implemented in Iran.

Methods: The Grounded Theory strategy has been used in this study. The statistical population of the study is health experts from the Ministry of Health and Medical Education of Iran. The study time span is during the first half of 2020. Exploratory analysis was used to identify the factors of social innovation. By selecting and reviewing 68 research in-depth, the initial framework was prepared. Then, through a semi-structured interview with experts, the framework was adapted and reviewed. Based on the analysis of the collected data, 39 open codes were extracted and the factors affecting the implementation of the social innovation were identified.

Results: The eight axis codes as the factors affecting the implementation of the social innovation plan based on the collaboration between government and NGOs are as follows: Paying attention to the components of the NGOs collaboration effectiveness, investment to attract NGOs collaboration, the ability to manage the implementation, the ability of networking, the ability of policymaking, providing the necessary cultural and educational infrastructure; Existence of capable legal organizations to solve the executive problems of the plan and facilitate coordination, and controlling, containing and reducing the effects of the crisis, as consequences.

Conclusions: Lessons learned from the COVID-19 pandemic have shown the world that the current governmental and social structures are not efficient enough to respond quickly to the emergence of global challenges. Social innovation is a solution to this problem. The findings of this study also confirm this and identify the factors affecting the implementation of the social innovation plan based on collaboration between governments and NGOs in crises. The results of this research give governments and policymakers an efficient solution by involving NGOs, especially in times of widespread crises. Also, they can be used in planning for social development.

背景:吸引社会协作,在突发事件中提供有效、及时和协调的干预措施的有效途径之一是通过社会创新。本研究旨在以政府与非政府组织(ngo)在危机中拯救生命的合作为基础,找出影响社会创新计划实施的因素。这项研究的最初想法来自于在伊朗实施的"每个家庭都是一个健康基地"的最佳做法。方法:本研究采用扎根理论策略。本研究的统计对象是伊朗卫生和医学教育部的卫生专家。研究时间跨度为2020年上半年。采用探索性分析的方法,确定社会创新的影响因素。通过对68项深入研究的选择和回顾,初步编制了框架。然后,通过与专家的半结构化访谈,对该框架进行了调整和审查。在对收集到的数据进行分析的基础上,提取了39条开放规范,并对影响社会创新实施的因素进行了识别。结果:政府与非政府组织合作的社会创新计划实施的影响因素为:关注非政府组织合作有效性、吸引非政府组织合作的投资、管理实施能力、网络能力、政策制定能力、提供必要的文教基础设施;存在有能力的法律组织,以解决执行问题的计划和促进协调,并控制,遏制和减少危机的影响,作为后果。结论:从2019冠状病毒病大流行中吸取的教训向世界表明,目前的政府和社会结构不足以有效应对全球挑战的出现。社会创新是解决这一问题的一种方法。本研究的结果也证实了这一点,并确定了基于危机中政府与非政府组织合作的社会创新计划实施的影响因素。这项研究的结果为政府和政策制定者提供了一个有效的解决方案,让非政府组织参与进来,特别是在危机蔓延的时候。此外,它们还可用于规划社会发展。
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引用次数: 4
Update of transmission modelling and projections of gambiense human African trypanosomiasis in the Mandoul focus, Chad. 乍得曼杜勒重点地区冈比亚非洲锥虫病传播模型和预测的更新。
IF 4.8 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2022-01-24 DOI: 10.1186/s40249-022-00934-8
Kat S Rock, Ching-I Huang, Ronald E Crump, Paul R Bessell, Paul E Brown, Inaki Tirados, Philippe Solano, Marina Antillon, Albert Picado, Severin Mbainda, Justin Darnas, Emily H Crowley, Steve J Torr, Mallaye Peka

Background: In recent years, a programme of vector control, screening and treatment of gambiense human African trypanosomiasis (gHAT) infections led to a rapid decline in cases in the Mandoul focus of Chad. To represent the biology of transmission between humans and tsetse, we previously developed a mechanistic transmission model, fitted to data between 2000 and 2013 which suggested that transmission was interrupted by 2015. The present study outlines refinements to the model to: (1) Assess whether elimination of transmission has already been achieved despite low-level case reporting; (2) quantify the role of intensified interventions in transmission reduction; and (3) predict the trajectory of gHAT in Mandoul for the next decade under different strategies.

Method: Our previous gHAT transmission model for Mandoul was updated using human case data (2000-2019) and a series of model refinements. These include how diagnostic specificity is incorporated into the model and improvements to the fitting method (increased variance in observed case reporting and how underreporting and improvements to passive screening are captured). A side-by-side comparison of fitting to case data was performed between the models.

Results: We estimated that passive detection rates have increased due to improvements in diagnostic availability in fixed health facilities since 2015, by 2.1-fold for stage 1 detection, and 1.5-fold for stage 2. We find that whilst the diagnostic algorithm for active screening is estimated to be highly specific (95% credible interval (CI) 99.9-100%, Specificity = 99.9%), the high screening and low infection levels mean that some recently reported cases with no parasitological confirmation might be false positives. We also find that the focus-wide tsetse reduction estimated through model fitting (95% CI 96.1-99.6%, Reduction = 99.1%) is comparable to the reduction previously measured by the decline in tsetse catches from monitoring traps. In line with previous results, the model suggests that transmission was interrupted in 2015 due to intensified interventions.

Conclusions: We recommend that additional confirmatory testing is performed in Mandoul to ensure the endgame can be carefully monitored. More specific measurement of cases, would better inform when it is safe to stop active screening and vector control, provided there is a strong passive surveillance system in place.

背景:近年来,病媒控制、筛查和治疗冈比亚非洲锥虫病(gHAT)感染的计划使乍得曼都勒病区的病例迅速减少。为了体现人类与采采蝇之间传播的生物学特性,我们之前开发了一个机理传播模型,该模型与 2000 年至 2013 年的数据相匹配,表明传播到 2015 年已经中断。本研究概述了对模型的改进,以便(1)评估尽管病例报告数量较少,但是否已经消除了传播;(2)量化强化干预措施在减少传播中的作用;以及(3)预测未来十年不同策略下曼杜尔的 gHAT 传播轨迹:方法:利用人类病例数据(2000-2019 年)和一系列模型改进,更新了我们以前的曼都勒 gHAT 传播模型。其中包括如何将诊断特异性纳入模型,以及对拟合方法的改进(观察到的病例报告差异增加,以及如何捕捉报告不足和被动筛查的改进)。我们对两个模型的病例数据拟合情况进行了并列比较:我们估计,自 2015 年以来,由于固定医疗机构的诊断服务有所改善,被动检测率有所提高,第一阶段检测率提高了 2.1 倍,第二阶段提高了 1.5 倍。我们发现,虽然主动筛查的诊断算法估计具有很高的特异性(95% 可信区间 (CI) 99.9-100%,特异性 = 99.9%),但高筛查率和低感染率意味着最近报告的一些未得到寄生虫学确认的病例可能是假阳性。我们还发现,通过模型拟合(95% CI 96.1-99.6%,Reduction = 99.1%)估算出的重点地区采采蝇减少量与之前通过监测陷阱采采蝇捕获量的减少量相当。与之前的结果一致,该模型表明,由于加强了干预措施,2015 年的传播中断了:我们建议在曼杜尔进行更多的确证测试,以确保能够仔细监测终局。如果有一个强大的被动监测系统,对病例进行更具体的测量将能更好地告知何时停止主动筛查和病媒控制是安全的。
{"title":"Update of transmission modelling and projections of gambiense human African trypanosomiasis in the Mandoul focus, Chad.","authors":"Kat S Rock, Ching-I Huang, Ronald E Crump, Paul R Bessell, Paul E Brown, Inaki Tirados, Philippe Solano, Marina Antillon, Albert Picado, Severin Mbainda, Justin Darnas, Emily H Crowley, Steve J Torr, Mallaye Peka","doi":"10.1186/s40249-022-00934-8","DOIUrl":"10.1186/s40249-022-00934-8","url":null,"abstract":"<p><strong>Background: </strong>In recent years, a programme of vector control, screening and treatment of gambiense human African trypanosomiasis (gHAT) infections led to a rapid decline in cases in the Mandoul focus of Chad. To represent the biology of transmission between humans and tsetse, we previously developed a mechanistic transmission model, fitted to data between 2000 and 2013 which suggested that transmission was interrupted by 2015. The present study outlines refinements to the model to: (1) Assess whether elimination of transmission has already been achieved despite low-level case reporting; (2) quantify the role of intensified interventions in transmission reduction; and (3) predict the trajectory of gHAT in Mandoul for the next decade under different strategies.</p><p><strong>Method: </strong>Our previous gHAT transmission model for Mandoul was updated using human case data (2000-2019) and a series of model refinements. These include how diagnostic specificity is incorporated into the model and improvements to the fitting method (increased variance in observed case reporting and how underreporting and improvements to passive screening are captured). A side-by-side comparison of fitting to case data was performed between the models.</p><p><strong>Results: </strong>We estimated that passive detection rates have increased due to improvements in diagnostic availability in fixed health facilities since 2015, by 2.1-fold for stage 1 detection, and 1.5-fold for stage 2. We find that whilst the diagnostic algorithm for active screening is estimated to be highly specific (95% credible interval (CI) 99.9-100%, Specificity = 99.9%), the high screening and low infection levels mean that some recently reported cases with no parasitological confirmation might be false positives. We also find that the focus-wide tsetse reduction estimated through model fitting (95% CI 96.1-99.6%, Reduction = 99.1%) is comparable to the reduction previously measured by the decline in tsetse catches from monitoring traps. In line with previous results, the model suggests that transmission was interrupted in 2015 due to intensified interventions.</p><p><strong>Conclusions: </strong>We recommend that additional confirmatory testing is performed in Mandoul to ensure the endgame can be carefully monitored. More specific measurement of cases, would better inform when it is safe to stop active screening and vector control, provided there is a strong passive surveillance system in place.</p>","PeriodicalId":13587,"journal":{"name":"Infectious Diseases of Poverty","volume":null,"pages":null},"PeriodicalIF":4.8,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8785021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39857021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epidemiological characteristics and temporal-spatial analysis of overseas imported dengue fever cases in outbreak provinces of China, 2005-2019. 2005-2019年中国境外输入登革热病例流行病学特征及时空分析
IF 8.1 1区 医学 Q1 Medicine Pub Date : 2022-01-24 DOI: 10.1186/s40249-022-00937-5
Xinchang Lun, Yiguan Wang, Chunchun Zhao, Haixia Wu, Caiying Zhu, Delong Ma, Mingfang Xu, Jun Wang, Qiyong Liu, Lei Xu, Fengxia Meng

Background: Overseas imported dengue fever is an important factor in local outbreaks of this disease in the mainland of China. To better prevent and control such local outbreaks, the epidemiological characteristics and temporal-spatial distribution of overseas imported dengue fever cases in provincial-level administrative divisions (PLADs) where dengue fever is outbreak in the mainland of China were explored.

Methods: Using the Chinese National Notifiable Infectious Disease Reporting Information System (CNNDS), we identified overseas imported dengue fever cases in dengue fever outbreak areas in the mainland of China from 2005 to 2019 to draw the epidemic curve and population characteristic distribution of overseas imported cases in each PLAD. Based on spatial autocorrelation analysis of ArcGIS 10.5 and temporal-spatial scanning analysis of SaTScan 9.5, we analyzed the temporal-spatial distribution of overseas imported dengue fever in dengue fever outbreak areas in the mainland of China.

Results: A total of 11,407 imported cases, mainly from Southeast Asia, were recorded from 2005 to 2019 in these 13 PLADs. Of which 62.1% were imported into Yunnan and Guangdong Provinces. Among the imported cases, there were more males than females, mainly from the 21-50 age group. The hot spots were concentrated in parts of Yunnan, Guangdong and Fujian Provinces. We found the cluster of infected areas were expanding northward.

Conclusions: Based on the analysis of overseas imported dengue cases in 13 PLADs of the mainland of China from 2005 to 2019, we obtained the epidemiological characteristics and spatial distribution of imported dengue cases. Border controls need to pay attention to key population sectors, such as 21-50 years old men and education of key populations on dengue prevention. There is a need to improve the awareness of the prevention and control of imported cases in border areas. At the same time, northern regions cannot relax their vigilance.

背景:境外输入性登革热是中国大陆本地登革热疫情发生的重要因素。为更好地预防和控制登革热本地疫情,对中国大陆登革热疫区境外输入登革热病例的流行病学特征和时空分布进行了调查。方法:利用中国国家法定传染病报告信息系统(CNNDS)对2005 - 2019年中国大陆登革热疫区境外输入登革热病例进行统计,绘制各疫区境外输入病例流行曲线和人口特征分布。基于ArcGIS 10.5空间自相关分析和SaTScan 9.5时空扫描分析,对中国大陆登革热疫区境外输入性登革热的时空分布进行了分析。结果:2005 - 2019年,13个疫区共报告输入性病例11407例,主要来自东南亚。其中62.1%输入云南和广东。输入性病例中男性多于女性,主要集中在21-50岁年龄组。热点集中在云南、广东和福建的部分地区。我们发现感染区正在向北扩展。结论:通过对2005 - 2019年中国大陆13个疫区境外输入登革热病例的分析,掌握了境外输入登革热病例的流行病学特征和空间分布。边境管制需要关注关键人群,如21-50岁的男性,并对关键人群进行登革热预防教育。有必要提高边境地区预防和控制输入性病例的认识。与此同时,北方地区也不能放松警惕。
{"title":"Epidemiological characteristics and temporal-spatial analysis of overseas imported dengue fever cases in outbreak provinces of China, 2005-2019.","authors":"Xinchang Lun,&nbsp;Yiguan Wang,&nbsp;Chunchun Zhao,&nbsp;Haixia Wu,&nbsp;Caiying Zhu,&nbsp;Delong Ma,&nbsp;Mingfang Xu,&nbsp;Jun Wang,&nbsp;Qiyong Liu,&nbsp;Lei Xu,&nbsp;Fengxia Meng","doi":"10.1186/s40249-022-00937-5","DOIUrl":"https://doi.org/10.1186/s40249-022-00937-5","url":null,"abstract":"<p><strong>Background: </strong>Overseas imported dengue fever is an important factor in local outbreaks of this disease in the mainland of China. To better prevent and control such local outbreaks, the epidemiological characteristics and temporal-spatial distribution of overseas imported dengue fever cases in provincial-level administrative divisions (PLADs) where dengue fever is outbreak in the mainland of China were explored.</p><p><strong>Methods: </strong>Using the Chinese National Notifiable Infectious Disease Reporting Information System (CNNDS), we identified overseas imported dengue fever cases in dengue fever outbreak areas in the mainland of China from 2005 to 2019 to draw the epidemic curve and population characteristic distribution of overseas imported cases in each PLAD. Based on spatial autocorrelation analysis of ArcGIS 10.5 and temporal-spatial scanning analysis of SaTScan 9.5, we analyzed the temporal-spatial distribution of overseas imported dengue fever in dengue fever outbreak areas in the mainland of China.</p><p><strong>Results: </strong>A total of 11,407 imported cases, mainly from Southeast Asia, were recorded from 2005 to 2019 in these 13 PLADs. Of which 62.1% were imported into Yunnan and Guangdong Provinces. Among the imported cases, there were more males than females, mainly from the 21-50 age group. The hot spots were concentrated in parts of Yunnan, Guangdong and Fujian Provinces. We found the cluster of infected areas were expanding northward.</p><p><strong>Conclusions: </strong>Based on the analysis of overseas imported dengue cases in 13 PLADs of the mainland of China from 2005 to 2019, we obtained the epidemiological characteristics and spatial distribution of imported dengue cases. Border controls need to pay attention to key population sectors, such as 21-50 years old men and education of key populations on dengue prevention. There is a need to improve the awareness of the prevention and control of imported cases in border areas. At the same time, northern regions cannot relax their vigilance.</p>","PeriodicalId":13587,"journal":{"name":"Infectious Diseases of Poverty","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8785556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39856583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 12
Geographic distribution and prevalence of human echinococcosis at the township level in the Tibet Autonomous Region. 西藏自治区乡镇人包虫病地理分布及流行病学分析。
IF 8.1 1区 医学 Q1 Medicine Pub Date : 2022-01-21 DOI: 10.1186/s40249-022-00933-9
Liying Wang, Gongsang Quzhen, Min Qin, Zehang Liu, Huasheng Pang, Roger Frutos, Laurent Gavotte

Background: Echinococcosis, a zoonotic parasitic disease, is caused by larval stages of cestodes in the Echinococcus genus. Echinococcosis is highly prevalent in ten provinces/autonomous regions of western and northern China. In 2016, an epidemiological survey of Tibet Autonomous Region (TAR) revealed that the prevalence of human echinococcosis was 1.66%, which was much higher than the average prevalence in China (0.24%). Therefore, to improve on the current prevention and control measures, it is important to understand the prevalence and spatial distribution characteristics of human echinococcosis at the township level in TAR.

Methods: Data for echinococcosis cases in 2018 were obtained from the annual report system of echinococcosis of Tibet Center for Disease Control and Prevention. Diagnosis had been performed via B-ultrasonography. The epidemic status of echinococcosis in all townships in TAR was classified according to the relevant standards of population prevalence indices as defined in the national technical plan for echinococcosis control. Spatial scan statistics were performed to establish the geographical townships that were most at risk of echinococcosis.

Results: In 2018, a total of 16,009 echinococcosis cases, whose prevalence was 0.53%, were recorded in 74 endemic counties in TAR. Based on the order of the epidemic degree, all the 692 townships were classified from high to low degrees. Among them, 127 townships had prevalence rates ≥ 1%. The high prevalence of human echinococcosis in TAR, which is associated with a wide geographic distribution, is a medical concern. Approximately 94.65% of the villages and towns reported echinococcosis cases. According to spatial distribution analysis, the prevalence of human echinococcosis was found to be clustered, with the specific clustering areas being identified. The cystic echinococcosis primary cluster covered 88 townships, while that of alveolar echinococcosis's covered 38 townships.

Conclusions: This study shows spatial distributions of echinococcosis with different epidemic degrees in 692 townships of TAR and high-risk cluster areas at the township level. Our findings indicate that strengthening the echinococcosis prevention and control strategies in TAR should directed at townships with a high prevalence and high-risk clustering areas.

背景:棘球绦虫病是一种人畜共患的寄生虫病,由棘球绦虫属的绦虫幼虫期引起。棘球蚴病在中国西部和北部的10个省/自治区高度流行。2016年西藏自治区流行病学调查显示,人类包虫病患病率为1.66%,远高于全国平均水平(0.24%)。因此,了解西藏自治区乡镇层面人棘球蚴病的流行情况和空间分布特征,对完善现有的防控措施具有重要意义。方法:2018年棘球蚴病病例数据来源于西藏疾病预防控制中心棘球蚴病年度报告系统。经b超诊断。根据《国家棘球蚴病防治技术计划》规定的人群流行指数相关标准,对西藏自治区各乡镇棘球蚴病流行状况进行分类。进行空间扫描统计,确定棘球蚴病风险最高的地理乡镇。结果:2018年,西藏自治区74个包虫病流行县共报告包虫病病例16009例,患病率0.53%。692个乡镇按流行程度排序,由高到低进行分类。其中,患病率≥1%的乡镇有127个。西藏自治区人类棘球蚴病的高流行率与广泛的地理分布有关,这是一个令人关切的医学问题。约94.65%的乡镇报告了棘球蚴病病例。通过空间分布分析,发现人类棘球蚴病的流行呈聚集性,并确定了特定的聚集区。囊性包虫病原发聚集性覆盖88个乡镇,肺泡性包虫病原发聚集性覆盖38个乡镇。结论:本研究揭示了西藏自治区692个乡镇和乡镇一级高危聚集区棘球蚴病不同流行程度的空间分布情况。研究结果提示,加强西藏自治区棘球蚴病防控策略应针对高流行区和高危聚集区乡镇。
{"title":"Geographic distribution and prevalence of human echinococcosis at the township level in the Tibet Autonomous Region.","authors":"Liying Wang,&nbsp;Gongsang Quzhen,&nbsp;Min Qin,&nbsp;Zehang Liu,&nbsp;Huasheng Pang,&nbsp;Roger Frutos,&nbsp;Laurent Gavotte","doi":"10.1186/s40249-022-00933-9","DOIUrl":"https://doi.org/10.1186/s40249-022-00933-9","url":null,"abstract":"<p><strong>Background: </strong>Echinococcosis, a zoonotic parasitic disease, is caused by larval stages of cestodes in the Echinococcus genus. Echinococcosis is highly prevalent in ten provinces/autonomous regions of western and northern China. In 2016, an epidemiological survey of Tibet Autonomous Region (TAR) revealed that the prevalence of human echinococcosis was 1.66%, which was much higher than the average prevalence in China (0.24%). Therefore, to improve on the current prevention and control measures, it is important to understand the prevalence and spatial distribution characteristics of human echinococcosis at the township level in TAR.</p><p><strong>Methods: </strong>Data for echinococcosis cases in 2018 were obtained from the annual report system of echinococcosis of Tibet Center for Disease Control and Prevention. Diagnosis had been performed via B-ultrasonography. The epidemic status of echinococcosis in all townships in TAR was classified according to the relevant standards of population prevalence indices as defined in the national technical plan for echinococcosis control. Spatial scan statistics were performed to establish the geographical townships that were most at risk of echinococcosis.</p><p><strong>Results: </strong>In 2018, a total of 16,009 echinococcosis cases, whose prevalence was 0.53%, were recorded in 74 endemic counties in TAR. Based on the order of the epidemic degree, all the 692 townships were classified from high to low degrees. Among them, 127 townships had prevalence rates ≥ 1%. The high prevalence of human echinococcosis in TAR, which is associated with a wide geographic distribution, is a medical concern. Approximately 94.65% of the villages and towns reported echinococcosis cases. According to spatial distribution analysis, the prevalence of human echinococcosis was found to be clustered, with the specific clustering areas being identified. The cystic echinococcosis primary cluster covered 88 townships, while that of alveolar echinococcosis's covered 38 townships.</p><p><strong>Conclusions: </strong>This study shows spatial distributions of echinococcosis with different epidemic degrees in 692 townships of TAR and high-risk cluster areas at the township level. Our findings indicate that strengthening the echinococcosis prevention and control strategies in TAR should directed at townships with a high prevalence and high-risk clustering areas.</p>","PeriodicalId":13587,"journal":{"name":"Infectious Diseases of Poverty","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2022-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39847562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Scaling-up filariasis lymphoedema management into the primary health care system in Kerala State, Southern India: a case study in healthcare equity. 扩大丝虫病淋巴水肿管理纳入印度南部喀拉拉邦初级卫生保健系统:卫生保健公平的案例研究。
IF 8.1 1区 医学 Q1 Medicine Pub Date : 2022-01-18 DOI: 10.1186/s40249-022-00936-6
Suma T Krishnasastry, Charles D Mackenzie, Rajeev Sadanandan

Background: Lymphatic filariasis (LF) remains one of the world's most debilitating parasitic infections and is a major contributor to poor health in many endemic countries. The provision of continuing care for all those affected by LF and its consequences is an important component of the United Nations' Sustainable Development Goals. The aim of this study is to integrate lymphedema care into the primary health care system of the State by developing lymphedema clinics at each district, through training of health personnel to fulfill WHO recommendation for morbidity management and disability prevention.

Methods: Selected health care providers from all the districts in Kerala State of India participated in intensive training sessions endorsed by the State's health administration. The six training sessions (from 5 June 2017 to 25 May 2018) included appropriate self-care information and development of individual plans for each participating institution to provide instruction and care for their lymphoedema patients. The learning achieved by attendees was assessed by pre- and post-training tests. The number of lymphoedema patients receiving care and instruction from the post-training activities of each participating institution was assessed from local records, 6 months after the conclusion of the training sessions.

Results: One hundred and eighty-four medical personnel (91 doctors and 93 nurses) from 82 medical institutions were trained which quickly led to the establishment of active lymphoedema clinics providing the essential package of care (EPC) for lymphoedema patients at all the participating institutions. Six months after the training sessions the number of previously unidentified lymphoedema patients registered and receiving care at these clinics ranged from 296 to almost 400 per clinic, with a total of 3,477 new patients receiving training in EPC.

Conclusions: Generalist health personnel, when appropriately trained, can provide quality lymphoedema care in public health settings and patients when provided services close to their home, are willing to access them. This is a feasible strategy for integrating long term care for LF patients into the national health system, and is a clear example of moving towards equity in health care for the medically underserved, and thus successfully addresses a major goal of the global program to eliminate lymphatic filariasis.

背景:淋巴丝虫病(LF)仍然是世界上最使人衰弱的寄生虫感染之一,也是许多流行国家健康状况不佳的主要原因。为所有受暴力冲突及其后果影响的人提供持续护理是联合国可持续发展目标的一个重要组成部分。这项研究的目的是通过培训卫生人员以实现世卫组织关于发病率管理和残疾预防的建议,在每个地区建立淋巴水肿诊所,将淋巴水肿护理纳入国家的初级卫生保健系统。方法:从印度喀拉拉邦所有地区选出的卫生保健提供者参加了由该邦卫生行政部门批准的强化培训课程。从2017年6月5日至2018年5月25日的六次培训课程包括适当的自我保健信息,并为每个参与机构制定个人计划,为其淋巴水肿患者提供指导和护理。通过培训前和培训后的测试来评估学员的学习情况。在培训结束6个月后,根据当地记录评估每个参与机构培训后活动中接受护理和指导的淋巴水肿患者的数量。结果:来自82家医疗机构的184名医务人员(91名医生和93名护士)接受了培训,并迅速在所有参与机构建立了主动淋巴水肿诊所,为淋巴水肿患者提供基本护理包(EPC)。培训课程结束6个月后,在这些诊所登记和接受治疗的以前未确诊的淋巴水肿患者的数量从每家诊所296人到近400人不等,总共有3,477名新患者接受了EPC培训。结论:全科卫生人员经过适当的培训后,可以在公共卫生机构提供高质量的淋巴水肿护理,而当提供的服务离患者家很近时,患者也愿意获得这些服务。这是将淋巴丝虫病患者的长期护理纳入国家卫生系统的一项可行战略,也是向医疗服务不足人群的卫生保健公平迈进的一个明显例子,从而成功地实现了消除淋巴丝虫病全球规划的一个主要目标。
{"title":"Scaling-up filariasis lymphoedema management into the primary health care system in Kerala State, Southern India: a case study in healthcare equity.","authors":"Suma T Krishnasastry,&nbsp;Charles D Mackenzie,&nbsp;Rajeev Sadanandan","doi":"10.1186/s40249-022-00936-6","DOIUrl":"https://doi.org/10.1186/s40249-022-00936-6","url":null,"abstract":"<p><strong>Background: </strong>Lymphatic filariasis (LF) remains one of the world's most debilitating parasitic infections and is a major contributor to poor health in many endemic countries. The provision of continuing care for all those affected by LF and its consequences is an important component of the United Nations' Sustainable Development Goals. The aim of this study is to integrate lymphedema care into the primary health care system of the State by developing lymphedema clinics at each district, through training of health personnel to fulfill WHO recommendation for morbidity management and disability prevention.</p><p><strong>Methods: </strong>Selected health care providers from all the districts in Kerala State of India participated in intensive training sessions endorsed by the State's health administration. The six training sessions (from 5 June 2017 to 25 May 2018) included appropriate self-care information and development of individual plans for each participating institution to provide instruction and care for their lymphoedema patients. The learning achieved by attendees was assessed by pre- and post-training tests. The number of lymphoedema patients receiving care and instruction from the post-training activities of each participating institution was assessed from local records, 6 months after the conclusion of the training sessions.</p><p><strong>Results: </strong>One hundred and eighty-four medical personnel (91 doctors and 93 nurses) from 82 medical institutions were trained which quickly led to the establishment of active lymphoedema clinics providing the essential package of care (EPC) for lymphoedema patients at all the participating institutions. Six months after the training sessions the number of previously unidentified lymphoedema patients registered and receiving care at these clinics ranged from 296 to almost 400 per clinic, with a total of 3,477 new patients receiving training in EPC.</p><p><strong>Conclusions: </strong>Generalist health personnel, when appropriately trained, can provide quality lymphoedema care in public health settings and patients when provided services close to their home, are willing to access them. This is a feasible strategy for integrating long term care for LF patients into the national health system, and is a clear example of moving towards equity in health care for the medically underserved, and thus successfully addresses a major goal of the global program to eliminate lymphatic filariasis.</p>","PeriodicalId":13587,"journal":{"name":"Infectious Diseases of Poverty","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2022-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8764796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39707381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
GPS-based fine-scale mapping surveys for schistosomiasis assessment: a practical introduction and documentation of field implementation. 基于gps的血吸虫病评估精细测绘调查:实地实施的实用介绍和文件。
IF 8.1 1区 医学 Q1 Medicine Pub Date : 2022-01-15 DOI: 10.1186/s40249-021-00928-y
Lydia Trippler, Mohammed Nassor Ali, Shaali Makame Ame, Said Mohammed Ali, Fatma Kabole, Jan Hattendorf, Stefanie Knopp

Background: Fine-scale mapping of schistosomiasis to guide micro-targeting of interventions will gain importance in elimination settings, where the heterogeneity of transmission is often pronounced. Novel mobile applications offer new opportunities for disease mapping. We provide a practical introduction and documentation of the strengths and shortcomings of GPS-based household identification and participant recruitment using tablet-based applications for fine-scale schistosomiasis mapping at sub-district level in a remote area in Pemba, Tanzania.

Methods: A community-based household survey for urogenital schistosomiasis assessment was conducted from November 2020 until February 2021 in 20 small administrative areas in Pemba. For the survey, 1400 housing structures were prospectively and randomly selected from shapefile data. To identify pre-selected structures and collect survey-related data, field enumerators searched for the houses' geolocation using the mobile applications Open Data Kit (ODK) and MAPS.ME. The number of inhabited and uninhabited structures, the median distance between the pre-selected and recorded locations, and the dropout rates due to non-participation or non-submission of urine samples of sufficient volume for schistosomiasis testing was assessed.

Results: Among the 1400 randomly selected housing structures, 1396 (99.7%) were identified by the enumerators. The median distance between the pre-selected and recorded structures was 5.4 m. A total of 1098 (78.7%) were residential houses. Among them, 99 (9.0%) were dropped due to continuous absence of residents and 40 (3.6%) households refused to participate. In 797 (83.1%) among the 959 participating households, all eligible household members or all but one provided a urine sample of sufficient volume.

Conclusions: The fine-scale mapping approach using a combination of ODK and an offline navigation application installed on tablet computers allows a very precise identification of housing structures. Dropouts due to non-residential housing structures, absence, non-participation and lack of urine need to be considered in survey designs. Our findings can guide the planning and implementation of future household-based mapping or longitudinal surveys and thus support micro-targeting and follow-up of interventions for schistosomiasis control and elimination in remote areas. Trial registration ISRCTN, ISCRCTN91431493. Registered 11 February 2020, https://www.isrctn.com/ISRCTN91431493.

背景:血吸虫病的精细制图以指导干预措施的微观目标,在消除环境中具有重要意义,在这些环境中传播的异质性往往很明显。新颖的移动应用程序为绘制疾病地图提供了新的机会。我们提供了基于gps的家庭识别的优点和缺点的实际介绍和文件,并利用基于平板电脑的应用程序在坦桑尼亚彭巴偏远地区的街道一级进行精细血吸虫病测绘。方法:于2020年11月至2021年2月在奔巴省20个小行政区开展以社区为基础的泌尿生殖系统血吸虫病评估入户调查。在调查中,从shapefile数据中前瞻性和随机选择了1400个住宅结构。为了确定预先选定的结构并收集与调查相关的数据,实地统计员使用移动应用程序开放数据工具包(ODK)和MAPS.ME搜索房屋的地理位置。评估了有人居住和无人居住的建筑物的数量、预选地点和记录地点之间的中位数距离,以及因未参与或未提交足够量的尿样进行血吸虫病检测而导致的辍学率。结果:在随机抽取的1400个住宅构筑物中,有1396个(99.7%)被普查人员识别。预选结构与记录结构之间的中位数距离为5.4 m。住宅1098栋(78.7%)。其中,99户(9.0%)因居民持续缺席而被淘汰,40户(3.6%)因拒绝参与而被淘汰。在959个参与调查的住户中,797个(83.1%)住户中所有合资格成员或除一户外全部提供足量尿液样本。结论:使用ODK和安装在平板电脑上的离线导航应用程序相结合的精细制图方法可以非常精确地识别房屋结构。在调查设计中需要考虑由于非住宅房屋结构、缺勤、不参与和尿量不足而导致的退学。我们的研究结果可以指导未来以家庭为基础的测绘或纵向调查的规划和实施,从而支持偏远地区控制和消除血吸虫病的微观目标和后续干预措施。试验注册号ISRCTN, ISCRCTN91431493。2020年2月11日注册,https://www.isrctn.com/ISRCTN91431493。
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引用次数: 1
High prevalence of urinary schistosomiasis in a desert population: results from an exploratory study around the Ounianga lakes in Chad. 沙漠人群尿路血吸虫病高发:乍得乌尼昂加湖周边探索性研究结果
IF 8.1 1区 医学 Q1 Medicine Pub Date : 2022-01-07 DOI: 10.1186/s40249-021-00930-4
Wendelin Moser, Annour Adoum Batil, Rebekka Ott, Moussa Abderamane, Ruth Clements, Rahel Wampfler, Sven Poppert, Peter Steinmann, Fiona Allan, Helena Greter

Background: Researching a water-borne disease in the middle of the Sahara desert might not seem the most relevant concern. However, nomadic Sahelian pastoralists health concerns regarding their livestock and anecdotal reports about trematode infections of Fasciola spp. and Schistosoma spp. in desert-raised animals justified an exploratory study focusing on the lakes of Ounianga in Northern Chad. The aim was to test whether trematode parasites such as Schistosoma spp. occur in human populations living around the Sahara desert lakes of Ounianga Kebir and Ounianga Serir in northern Chad.

Methods: The study was carried out in January 2019 and comprised of three components. First, a cross sectional survey based on a random sample drawn from the population to detect infections with S. haematobium and S. mansoni; second, focus group discussions exploring disease priorities, access to health and health seeking behaviour; and third, surveying water contact sites for intermediate host snails. Samples of trematode parasites and snails were confirmed on species level by molecular genetic methods. For parasitological and malacological surveys descriptive statistics were performed. Qualitative data analysis included the full review of all transcripts, followed by a descriptive and explorative thematic analysis.

Results: Among 258 participants, the overall S. haematobium prevalence using urine filtration was 39.2% [95% confidence interval (CI): 33.5-45.1%], with 51.5% of the infected suffering from heavy infection. The intermediate host snail of S. haematobium (Bulinus truncatus) occurred at water contact sites near both study villages, revealing the potential for local transmission. Although a positive S. mansoni point-of-care circulating cathodic antigen (POC-CCA) test result was obtained from 8.6% (95% CI 5.7-12.8%) of the samples, no intermediate host snails of S. mansoni were found, and the relevance of S. mansoni remains uncertain. Qualitative findings underline the importance of morbidity caused by urinary schistosomiasis, and the lack of access to diagnostics and treatment as a major health concern.

Conclusions: This research revealed a high prevalence of urinary schistosomiasis in the population living around the lakes of Ounianga in the Sahara, a United Nations Educational, Scientific and Cultural Organization (UNESCO) world heritage site in Chad. Despite the high public health importance of the associated morbidity expressed by the population, there is no access to diagnostics and treatment. Further work is needed to develop and test a context-adapted intervention.

背景:研究撒哈拉沙漠中部的一种水传播疾病似乎不是最相关的问题。然而,萨赫勒游牧牧民对其牲畜的健康担忧,以及关于沙漠饲养动物中吸虫和血吸虫病吸虫感染的传闻报道,证明了对乍得北部乌尼加湖进行探索性研究的合理性。目的是测试生活在乍得北部的Ounianga Kebir和Ouninga Serir撒哈拉沙漠湖泊周围的人群中是否存在血吸虫等吸虫寄生虫。方法:该研究于2019年1月进行,由三个部分组成。首先,根据从人群中随机抽取的样本进行横断面调查,以检测埃及血吸虫和曼氏血吸虫的感染;第二,重点小组讨论,探讨疾病优先事项、获得健康的机会和寻求健康的行为;第三,调查中间宿主蜗牛的水接触点。通过分子遗传学方法在物种水平上确认了吸虫寄生虫和蜗牛的样本。寄生虫学和软化学调查进行了描述性统计。定性数据分析包括对所有转录本的全面审查,然后进行描述性和探索性主题分析。结果:在258名参与者中,使用尿液过滤的总埃及链球菌患病率为39.2%[95%置信区间(CI):33.5-4.1%],51.5%的感染者患有严重感染。埃及血吸虫(Bulinus truncatus)的中间宿主蜗牛出现在两个研究村庄附近的水接触点,揭示了本地传播的可能性。尽管8.6%(95%置信区间5.7-12.8%)的样本中获得了阳性的曼氏血吸虫护理点循环阴极抗原(POC-CCA)检测结果,但未发现曼氏血吸虫的中间宿主蜗牛,曼氏血吸虫相关性仍不确定。定性研究结果强调了尿血吸虫病发病率的重要性,以及缺乏诊断和治疗是一个主要的健康问题。结论:这项研究表明,生活在联合国教育、科学及文化组织(教科文组织)乍得世界遗产撒哈拉Ounianga湖周围的人群中,尿血吸虫病的发病率很高。尽管人口所表达的相关发病率对公共卫生具有高度重要性,但却无法获得诊断和治疗。还需要进一步的工作来制定和测试适应环境的干预措施。
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引用次数: 2
Treatment outcomes of HIV patients with hepatitis B and C virus co-infections in Southwest China: an observational cohort study. 中国西南地区HIV患者合并乙型和丙型肝炎病毒感染的治疗结果:一项观察性队列研究
IF 8.1 1区 医学 Q1 Medicine Pub Date : 2022-01-06 DOI: 10.1186/s40249-021-00921-5
Jingya Jia, Qiuying Zhu, Luojia Deng, Guanghua Lan, Andrew Johnson, Huanhuan Chen, Zhiyong Shen, Jianjun Li, Hui Xing, Yuhua Ruan, Jing Li, Hui Lu, Sten H Vermund, Jinhui Zhu, Han-Zhu Qian

Background: Antiretroviral therapy (ART) has reduced mortality among people living with HIV (PLWH) in China, but co-infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) may individually or jointly reduce the effect of ART. This study aimed to evaluate the impacts of HBV/HCV coinfections on treatment drop-out and mortality among PLWH on ART.

Methods: A retrospective cohort study analysis of 58 239 people living with HIV (PLWH) who initiated antiretroviral therapy (ART) during 2010-2018 was conducted in Guangxi Province, China. Data were from the observational database of the National Free Antiretroviral Treatment Program. Cox proportional hazard models were fitted to evaluate the effects of baseline infection of HBV or HCV or both on death and treatment attrition among PLWH.

Results: Our study showed high prevalence of HBV (11.5%), HCV (6.6%) and HBV-HCV (1.5%) co-infections. The overall mortality rate and treatment attrition rate was 2.95 [95% confidence interval (CI) 2.88-3.02] and 5.92 (95% CI 5.82-6.01) per 100 person-years, respectively. Compared with HIV-only patients, HBV-co-infected patients had 42% higher mortality [adjusted hazard ratio (aHR) = 1.42; 95% CI 1.32-1.54], HCV-co-infected patients had 65% higher mortality (aHR = 1.65; 95% CI 1.47-1.86), and patients with both HCV and HBV co-infections had 123% higher mortality (aHR = 2.23; 95% CI 1.87-2.66).

Conclusions: HBV and HCV coinfection may have an additive effect on increasing the risk of all-cause death among PLWH who are on ART. It is suggested that there is need for primary prevention and access to effective hepatitis treatment for PLWH.

背景:抗逆转录病毒治疗(ART)降低了中国HIV感染者(PLWH)的死亡率,但乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)的合并感染可能单独或共同降低抗逆转录病毒治疗的效果。本研究旨在评估HBV/HCV合并感染对抗逆转录病毒治疗中PLWH治疗退出和死亡率的影响。方法:对2010-2018年在中国广西省开始抗逆转录病毒治疗(ART)的58239名HIV感染者(PLWH)进行回顾性队列研究分析。数据来自国家免费抗逆转录病毒治疗计划的观察性数据库。采用Cox比例风险模型来评估HBV或HCV基线感染或两者同时感染对PLWH患者死亡和治疗损耗的影响。结果:我们的研究显示HBV(11.5%)、HCV(6.6%)和HBV-HCV(1.5%)合并感染的患病率很高。总死亡率和治疗损耗率分别为2.95[95%可信区间(CI) 2.88-3.02]和5.92 (95% CI 5.82-6.01) / 100人年。与仅感染hiv的患者相比,hbv合并感染患者的死亡率高出42%[校正危险比(aHR) = 1.42;95% CI 1.32-1.54], hcv合并感染患者的死亡率高出65% (aHR = 1.65;95% CI 1.47-1.86), HCV和HBV合并感染的患者死亡率高出123% (aHR = 2.23;95% ci 1.87-2.66)。结论:HBV和HCV合并感染可能会增加接受抗逆转录病毒治疗的艾滋病毒感染者全因死亡的风险。建议有必要对PLWH进行一级预防和获得有效的肝炎治疗。
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引用次数: 10
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Infectious Diseases of Poverty
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