Role of decentralised governance in implementing the National AIDS Control Programme in Kerala.

SETTING: In alignment with the UN Sustainable Development Goals (SDGs), Kerala State in India aims to end the HIV/AIDS epidemic, using its strong background in local governance to implement the National AIDS Control Programme (NACP). OBJECTIVE: To examine the role of local governments in the implementation of NACP in tune with SDGs. DESIGN: We conducted a state-wide exploratory study using document reviews, key informant and in-depth interviews, which were analysed thematically. RESULTS: Four overarching themes that emerged were 1) preparation for programme implementation, 2) positive impact of local government involvement, 3) convergence with other organisations, and 4) barriers to implementation. Local government commitment to implementing the programme was evidenced by their adoption of the HIV/AIDS policy, facilitative interdepartmental coordination and local innovations. Interventions focused on improving awareness about the disease and treatment, and social, financial and rehabilitative support, which were extended even during the COVID-19 pandemic. Fund shortages and poor visibility of the beneficiaries due to preference for anonymity were challenges to achieving the expected outcomes. CONCLUSION: The NACP is ably supported by local governments in its designated domains of interventions, prevention, treatment, and care and support. The programme can achieve its target to end the AIDS epidemic by overcoming the stigma factor, which still prevents potential beneficiaries from accessing care.

CONTEXTE: En accord avec les Objectifs de développement durable (SDG) des Nations unies, l'État du Kérala en Inde a pour objectif de mettre fin à l'épidémie de VIH/SIDA en s'appuyant sur sa forte expérience de gouvernance locale en matière de mise en œuvre du Programme national de lutte contre le SIDA (NACP). OBJECTIF: Examiner le rôle des gouvernements locaux dans la mise en œuvre du NACP, en accord avec les SDG. MÉTHODES: Nous avons réalisé une étude exploratoire à l'échelle de l'État, par le biais d'analyses documentaires, d'entretiens avec des informateurs clés et d'entretiens approfondis, qui ont ensuite été analysés de manière thématique. RÉSULTATS: Quatre thèmes centraux ont été identifiés : 1) préparation de la mise en place du programme, 2) impact positif de l'implication des gouvernements locaux, 3) convergence avec d'autres organisations, et 4) obstacles à la mise en œuvre. L'engagement des gouvernements locaux à mettre en œuvre le programme se manifestait par l'adoption de la politique de lutte contre le VIH/SIDA, par une coordination interdépartementale facilitée et par des innovations locales. Les interventions portaient sur l'amélioration de la sensibilisation au VIH/SIDA et à son traitement, ainsi qu'aux systèmes de soutien social, financier et de réadaptation disponibles ; ces interventions ont même été maintenues pendant la pandémie de COVID-19. Le manque de financements et la mauvaise visibilité des bénéficiaires en raison d'une volonté d'anonymat représentaient autant d'obstacles empêchant d'atteindre les résultats escomptés. CONCLUSION: Les gouvernements locaux apportent leur soutien efficace au NACP dans les domaines d'intervention qui lui ont été assignés (prévention, traitement, soins et soutien). Le programme peut atteindre son objectif d'éradication de l'épidémie de SIDA s'il parvient à lutter contre la stigmatisation associée à la maladie, qui empêche encore d'éventuels bénéficiaires d'accéder aux soins.

STOPCoV: SAFETY and EFFICACY of PREVENTATIVE COVID VACCINES

Background: In attempts to rapidly immunize a greater proportion of the Ontario population against COVID, public health officials recommended extending the interval between vaccine doses and allowed "mixing of vaccine types". The impact of these decisions on the antibody response to the vaccine, particularly in the community dwelling elderly population is unknown. Methods: The STOPCoV study is designed to compare the IgG antibody response to spike protein and receptor binding domain (RBD) after COVID vaccination in those aged ≥ 70 years relative to a cohort aged 30-50 years. This prospective decentralized observational study is conducted remotely on a digital platform (www.stopcov.ca). Participants signed an e-consent, completed questionnaires and will submit dried blood spot (DBS) specimens 6-8 times over 48 weeks after the second vaccine dose. DBS samples were analyzed for IgG antibodies to spike and RBD by an in-house ELISA. We report here the ratio-normalized levels of anti-spike and anti-RBD IgG antibodies prior to and at 2 weeks after the second vaccine with comparisons between age groups. Linear regression models were used to determine the effect of age on the ratio normalized RBD antibody levels 2 weeks post second dose of vaccine after adjusting for potential confounders determined a priori. Results: 1286 persons enrolled between May 17 and July 31, 2021. 1194 participants (853 > 70 years;341 aged 30-50) completed at least one study related task. 761 (64.1%) are female. Most received an mRNA vaccine, with 863 (74%) receiving the same vaccine brand, and 196 (17%) receiving mixed brands over 2 doses. Two weeks after the second vaccine dose, the median interquartile rangeanti-spike antibody level was 0.76 [0.45, 1.16] for those ≥70 compared to 1.3 [0.98, 1.56] for those 30-50 (p<0.001). The median anti-RBD antibody levels were 0.28 [0.15, 0.53] and 0.66 [0.41, 1.08] (p<0.001) for the older and younger cohorts respectively. After adjusting for gender, cardiovascular disease, cancer, diabetes, transplant or immune suppression, body mass index, vaccine brand, and time between doses, participants ≥70 had lower levels of anti-RBD antibodies at 2 weeks after 2nd dose (β=-0.14, 95% confidence interval-0.19,-0.08, p<0.0001). Conclusion: High antibody levels against COVID-19 are attainable after 2 doses of mRNA vaccines. Levels were higher with Moderna than Pfizer. Delay of the second dose to 4 months or mixing of brands had minimal impact on the antibody level but levels are lower in the elderly.

Diagnosis Prediction Model for COVID-19

In worldwide COVID-19 makes a threat against humans. The new strain of the COVID-19 virus has not been previously identified in humans.The first case in Wuhan, China and now it has spread over the world. In India, 11.2 million people were infected and 158k people dead. In this situation, we need fact and accurate methods and techniques which can identify or predict the disease at the earliest. Machine learning techniques can greatly contribute to this. This model using Machine learning techniques like SVM-RFE and XGBoost for the prediction of COVID-19 disease.Experimentation results show that this method can fastly predict disease with better accuracy. © 2021 IEEE.

Role of surfactant protein d (sp-d) in COVID-19

Rationale: Surfactant protein D (SP-D) is a major immune protective molecule produced in the respiratory epithelium. SP-D binds to specific pathogen surfaces through its carbohydrate recognition (lectin) domain, that helps in their neutralization and clearance by phagocytes. SP-D also acts as an anti-inflammatory molecule. We hypothesized that SP-D plays a protective role in COVID-19. Methods: Polar+, a novel quantum computing algorithm for molecular pruning, and classical in silico modeling were used to investigate potential binding sites between SP-D and SARS CoV2. Electronegativity and topologically oriented molecular pruning, calculation of electronic force-fields and electrostatic binding combined with protein-protein docking, geometric fitting and assessment of protein glycosylation sites were employed. SP-D-/- mouse lung was used to study expression of the SARS-CoV-2 viral entry molecules TMPRSS2 and ACE2. Plasma from COVID-19 patients was studied for SP-D leakage, cytokine levels and lipid mediators. Results: We found that SP-D potentially binds to the same SARS CoV-2 glycoprotein (S protein) that it utilizes to bind the cellular receptor, ACE2, with high affinity. However, SP-D binds to subunit 2, instead of subunit 1 (that ACE2 utilizes). Additional studies will need to determine if SP-D binding affects S protein and ACE2 interactions. We also found that SP-D-/- mice had increased expression of the TMRSS2 gene in the lung and that both TMPRSS2 and ACE2 mRNA levels were increased during lung injury, amplified by the lack of SP-D. SP-D leakage from the lung to the circulation was significantly increased in COVID- 19 patients and correlated with expression of pro-neutrophilic inflammatory markers. Conclusions: We speculate that SP-D aids in the protection from SARS CoV2 infection by both acting as a potential natural decoy to prevent coronavirus entry into airway epithelial cells and by attenuating the expression of the viral entry receptor TMPRSS2. Oxidative lung injury results in SP-D leak into the circulation denoting disease severity in COVID-19 patients. (AH) .