ABSTRACT
OBJECTIVE: The WHO declared a global pandemic on 11th March 2020 for Coronavirus (COVID-19). During this time, fertility clinics around the world had to adapt very quickly in order to care for patients in a changing landscape with many clinics reducing or halting in-person clinical care during national lockdowns. This provided a unique opportunity for fertility nurses to increase engagement with patients via digital approaches. The purpose of this study was to examine the shift in fertility nursing clinical care pathways from face to face to virtual including the use of electronic patient information/ education delivery, electronic consenting platforms, and telehealth visits. understand the experience of fertility nursing care during the pandemic from a cohort of nursing professionals based in the UK and US. MATERIALSANDMETHODS: Baseline data was collected from the EngagedMD electronic patient information and consenting platform taken (March 2019 to March 2020), and then during the first year of the pandemic (March 11th 2020 [the declaration from the WHO] to April 11th 2021), and via a survey about virtual patient engagement conducted via interviews with nursing staff currently based in fertility clinics in both the US and UK. Descriptive statistics were analysed for all the data. RESULTS: There was an increase from baseline of 105.32% in the use of electronic consent forms during the pandemic, an increase of 60.016% of patients who had been educated with electronic patient information modules and an increase of 102.33% of fertility nurses implementing an electronic consenting or electronic patient education tool into their clinical patient pathway. All respondents (n=28) reported that the use of electronic consenting, electronic patient information and telehealth services changed the way in which they care for fertility patients. 62% (n=17) reported that as a direct result of implementing virtual care pathways, they had saved nursing time. CONCLUSIONS: Evidence collected from both data sources shows that there has been a significant shift in the way that fertility nurses are caring for their patients during the pandemic. There has been a change in the way that fertility nurses provide patient care due to the need to adapt during this global pandemic. The use of electronic and virtual platforms to educate, consult and consent fertility patients has increased at a much higher level than previous years. The results suggest that the role of the fertility nurse practitioner has changed to include the implementation of virtual care pathways and that care may continue to be provided this way in the future. IMPACT STATEMENT: Patient care can be delivered at a high level in a virtual way and the use of electronic platforms should be considered to save nursing administration time and to provide patients with better access to resources and information.
ABSTRACT
Background: The kinetics and functional profiles (granzyme-B production) of HIV-specific T-cell responses support that those targeting the early viral gene product Nef disproportionately recognize residual antigen expression during long-term antiretroviral therapy (ART). Here, we leveraged this insight to test whether SARS-CoV2 mRNA vaccines-which activate TLR and inflammatory signaling pathways-would reactivate latent HIV, stimulating T-cell responses with these characteristics. Methods: T-cell responses to individual HIV gene products were measured by IFN-g or granzyme B ELISPOT, and by activation induced marker (AIM) assays at baseline and ∼2 weeks after SARS-CoV-2 mRNA vaccine prime and boost, in 13 long-term ART treated adults. Total and unspliced HIV mRNA, as well as intact and defective (IPDA) HIV DNA were measured in parallel by digital droplet PCR (ddPCR). Results: We observed transient increases Nef-specific T-cell responses following vaccine prime by granzyme B ELISPOT (3.1-fold increase, p=0.002) and a trend by AIM assay (1.5-fold increase, p=0.06). Such increases were not observed in granzyme B responses to late gene products nor in any IFN-g responses. Both unspliced and total HIV mRNA decreased significantly across the study, unspliced-1.6-fold decrease p = 0.03;total-1.5-fold decrease p = 0.05. Changes in total HIV mRNA correlated inversely with Nef-specific granzyme B-producing (spearman's ρ =-0.73, p = 0.006) and Nef-specific CD8+ AIM T-cell responses (ρ =-0.76, p = 0.006) following vaccine prime. These reductions in HIV RNA were not accompanied by significant changes in total or intact HIV DNA. Conclusion: Consistent with our hypothesis, a restricted profile of HIV-specific T-cell responses showed significant increases following SARS-CoV-2 vaccine prime, each of which were then correlated with reductions in HIV RNA. This supports that vaccination promoted productive interactions between Nef-specific CTL and HIV-infected cells in vivo. We propose three scenarios for why this was not reflected in reductions in intact or total HIV DNA: i) meaningful depletions in inducible proviruses occurred but were lost against the background of non-inducible proviruses ii) interactions with CTL involved only a fraction of inducible proviruses, or iii) substantive proviral depletions occurred, but were counterbalanced by clonal expansion of HIV-infected cells.
ABSTRACT
Household water insecurity may exacerbate the COVID-19 pandemic and exact an even greater toll on people, especially in Africa, Asia and Latin America, simply because too many people do not have access to safe and secure water services, including water supply and sanitation, at home. Recent studies have shown that as many as a quarter of households in the Global South may be unable to practise necessary hand hygiene. Megacities may be at particular risk of being unable to manage the COVID-19 pandemic due to sheer population density as well as a lack of reliable clean water and sanitation. Problems of water insecurity are not restricted to the Global South but extend into higher-income countries as well. The steady decline in provision of public sanitation around the world, even in wealthy countries, makes adequate hygiene an even more intractable problem.