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1.
Sexually Transmitted Infections ; 98:A19, 2022.
Article in English | EMBASE | ID: covidwho-1956900

ABSTRACT

Introduction Effective HIV interventions have significantly reduced HIV transmission. However with each new case, effective HIV partner notification(HIV-PN) is pivotal in identifying new HIV transmission networks and is a crucial contribution towards ending new HIV infections in England by 2030. We aimed to review our local PN standards against the BASHH guidelines. Method Using GUMCAD coding and heath adviser/HIV team databases we collected data from all new HIV diagnoses in 2021. Results Overall, there were 24 individuals newly diagnosed with HIV in our clinic in 2021. There were 3(13%) who were experiencing sero-conversion at the time of diagnosis. 22 (92%) were cis-male, 17/24(71%) were MSM, the median age was 44 years (IQR=29-51) and 19(79%) described themselves as being of white ethnicity. We found that 1.88 (BASHH standard=0.88) contacts were reported by the index and 1.13 (BASHH standard=0.8) were tested per index case. The proportion of contactable partners tested according to the patient was 83%(BASHH=85%) and those verified by the clinician was 51%(BASHH=65%). 75%(BASHH=97%) of cases had a documented PN plan and 97%(BASHH=100) had a PEPSE assessment. From the notes review, the reasons why HIV PN was not achieved related to being diagnosed in other services and an absence of health adviser input. During Covid-19 inpatient diagnoses were unable to have HIV-PN initiated on 'red' wards. Discussion Overall we are meeting most of the BASHH standards for HIV PN. Further work is needed as an MDT to ensure this gap in PN follow up is addressed.

2.
Campbell Systematic Reviews ; 18(2):43, 2022.
Article in English | English Web of Science | ID: covidwho-1881396

ABSTRACT

Background More than half of the global population is not effectively covered by any type of social protection benefit and women's coverage lags behind. Most girls and boys living in low-resource settings have no effective social protection coverage. Interest in these essential programmes in low and middle-income settings is rising and in the context of the COVID-19 pandemic the value of social protection for all has been undoubtedly confirmed. However, evidence on whether the impact of different social protection programmes (social assistance, social insurance and social care services and labour market programmes) differs by gender has not been consistently analysed. Evidence is needed on the structural and contextual factors that determine differential impacts. Questions remain as to whether programme outcomes vary according to intervention implementation and design. Objectives This systematic review aims to collect, appraise, and synthesise the evidence from available systematic reviews on the differential gender impacts of social protection programmes in low and middle-income countries. It answers the following questions: What is known from systematic reviews on the gender-differentiated impacts of social protection programmes in low and middle-income countries? What is known from systematic reviews about the factors that determine these gender-differentiated impacts? What is known from existing systematic reviews about design and implementation features of social protection programmes and their association with gender outcomes? 1.2.3. Search Methods We searched for published and grey literature from 19 bibliographic databases and libraries. The search techniques used were subject searching, reference list checking, citation searching and expert consultations. All searches were conducted between 10 February and 1 March 2021 to retrieve systematic reviews published within the last 10 years with no language restrictions. Selection Criteria We included systematic reviews that synthesised evidence from qualitative, quantitative or mixed-methods studies and analysed the outcomes of social protection programmes on women, men, girls, and boys with no age restrictions. The reviews included investigated one or more types of social protection programmes in low and middle-income countries. We included systematic reviews that investigated the effects of social protection interventions on any outcomes within any of the following six core outcome areas of gender equality: economic security and empowerment, health, education, mental health and psychosocial wellbeing, safety and protection and voice and agency. Data Collection and Analysis A total of 6265 records were identified. After removing duplicates, 5250 records were screened independently and simultaneously by two reviewers based on title and and 298 full texts were assessed for eligibility. Another 48 records, identified through the initial scoping exercise, consultations with experts and citation searching, were also screened. The review includes 70 high to moderate quality systematic reviews, representing a total of 3289 studies from 121 countries. We extracted data on the following areas of interest: population, intervention, methodology, quality appraisal, and findings for each research question. We also extracted the pooled effect sizes of gender equality outcomes of meta-analyses. The methodological quality of the included systematic reviews was assessed, and framework synthesis was used as the synthesis method. To estimate the degree of overlap, we created citation matrices and calculated the corrected covered area. Main Results Most reviews examined more than one type of social protection programme. The majority investigated social assistance programmes (77%, N = 54), 40% (N = 28) examined labour market programmes, 11% (N = 8) focused on social insurance interventions and 9% (N = 6) analysed social care interventions. Health was the most researched (e.g., maternal health;70%, N = 49) outcome area, followed by economic security and empowerment (e.g., savings;39%, N = 27) and education (e.g., school enrolment and attendance;24%, N = 17). Five key findings were consistent across intervention and outcomes areas: (1) Although pre-existing gender differences should be considered, social protection programmes tend to report higher impacts on women and girls in comparison to men and boys;(2) Women are more likely to save, invest and share the benefits of social protection but lack of family support is a key barrier to their participation and retention in programmes;(3) Social protection programmes with explicit objectives tend to demonstrate higher effects in comparison to social protection programmes without broad objectives;(4) While no reviews point to negative impacts of social protection programmes on women or men, adverse and unintended outcomes have been attributed to design and implementation features. However, there are no one-size-fits-all approaches to design and implementation of social protection programmes and these features need to be gender-responsive and adapted;and (5) Direct investment in individuals and families' needs to be accompanied by efforts to strengthen health, education, and child protection systems. Social assistance programmes may increase labour participation, savings, investments, the utilisation of health care services and contraception use among women, school enrolment among boys and girls and school attendance among girls. They reduce unintended pregnancies among young women, risky sexual behaviour, and symptoms of sexually transmitted infections among women. Social insurance programmes increase the utilisation of sexual, reproductive, and maternal health services, and knowledge of reproductive health;improve changes in attitudes towards family planning;increase rates of inclusive and early initiation of breastfeeding and decrease poor physical wellbeing among mothers. Labour market programmes increase labour participation among women receiving benefits, savings, ownership of assets, and earning capacity among young women. They improve knowledge and attitudes towards sexually transmitted infections, increase self-reported condom use among boys and girls, increase child nutrition and overall household dietary intake, improve subjective wellbeing among women. Evidence on the impact of social care programmes on gender equality outcomes is needed. Authors' Conclusions Although effectiveness gaps remain, current programmatic interests are not matched by a rigorous evidence base demonstrating how to appropriately design and implement social protection interventions. Advancing current knowledge of gender-responsive social protection entails moving beyond effectiveness studies to test packages or combinations of design and implementation features that determine the impact of these interventions on gender equality. Systematic reviews investigating the impact of social care programmes, old age pensions and parental leave on gender equality outcomes in low and middle-income settings are needed. Voice and agency and mental health and psychosocial wellbeing remain under-researched gender equality outcome areas.

5.
CHI Conference on Human Factors in Computing Systems ; 2021.
Article in English | Web of Science | ID: covidwho-1759459

ABSTRACT

The COVID-19 pandemic and subsequent closure of schools forced families across the globe to transition to school at home. This unprecedented context is likely to have a lasting impact on the practice of schooling and the role of online, digital platforms within school contexts. In this paper we present a contextual inquiry of an 'emergency home school context', detailing how nine young families in Melbourne, Australia adapted to the unexpected introduction of school to the home following the government-directed closure of schools. Through an online interview and photo-journal study, we develop an emplaced understanding of the context detailing how the relations between people and places around the home evolved over time. We present fve design considerations for digital platforms to support the emergency home school context, placing focus on the fuid roles, relationships and evolving sense of place.

6.
J Laryngol Otol ; 135(9): 755-758, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1747302

ABSTRACT

BACKGROUND: There are significant drug-drug interactions between human immunodeficiency virus antiretroviral therapy and intranasal steroids, leading to high serum concentrations of iatrogenic steroids and subsequently Cushing's syndrome. METHOD: All articles in the literature on cases of intranasal steroid and antiretroviral therapy interactions were reviewed. Full-length manuscripts were analysed and the relevant data were extracted. RESULTS: A literature search and further cross-referencing yielded a total of seven reports on drug-drug interactions of intranasal corticosteroids and human immunodeficiency virus protease inhibitors, published between 1999 and 2019. CONCLUSION: The use of potent steroids metabolised via CYP3A4, such as fluticasone and budesonide, are not recommended for patients taking ritonavir or cobicistat. Mometasone should be used cautiously with ritonavir because of pharmacokinetic similarities to fluticasone. There was a delayed onset of symptoms in many cases, most likely due to the relatively lower systemic bioavailability of intranasal fluticasone.


Subject(s)
Adrenal Cortex Hormones/adverse effects , Cushing Syndrome/chemically induced , HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , HIV , Administration, Intranasal , Adrenal Cortex Hormones/administration & dosage , Adult , Cobicistat/administration & dosage , Cobicistat/adverse effects , Drug Interactions , Fluticasone/administration & dosage , Fluticasone/adverse effects , HIV Protease Inhibitors/administration & dosage , Humans , Male , Ritonavir/administration & dosage , Ritonavir/adverse effects
7.
Cancer Epidemiology Biomarkers and Prevention ; 31(1 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1677424

ABSTRACT

Introductory sentences indicating the purposes of the study: We used boot camp translation (BCT), a validated community based participatory strategy, to elicit input from diverse stakeholders (i.e., patients and clinic staff) to develop messaging and patient education materials for follow-up colonoscopy after abnormal fecal testing. BCT is a process that engages participants in translating health information into ideas, messages, and materials that are understandable and relevant to patients. Brief description of pertinent experimental procedures: Colorectal cancer is the second-leading cause of cancer death in the United States, and screening rates are disproportionately low among Latinos. Mailed fecal immunochemical test (FIT) outreach programs have been shown to improve colorectal cancer screening rates in federally qualified health centers (FQHCs), with improvements ranging from 22% - 45%. Patients with an abnormal FIT result have an increased risk of having colorectal cancer, and the risk increases if the necessary follow-up colonoscopy is delayed. Unfortunately, rates of follow-up colonoscopy among adults with an abnormal FIT result are low in FQHCs. As part of the Participatory Research to Advance Colon Cancer Prevention (PROMPT) study, a partnership with a Los Angeles-based FQHC that provides medical services to over 300,000 patients annually (82% Latino), we used BCT to gather input from patients and staff to develop messaging and materials for patients in need of a follow-up colonoscopy after abnormal FIT. Due to the COVID-19 pandemic, we conducted BCT using a digital platform. Eligible patient participants were Latino, ages 50 to 75 years, Spanish-speaking, and willing to participate in three virtual sessions. Recruitment and BCT materials were developed in English and Spanish, but all three sessions were held in Spanish consistent with patient preferences. The sessions included presentations on colorectal cancer screening, effective messaging to improve Latino screening participation, and brainstorming sessions to obtain feedback on messaging and materials. Summary of the new unpublished data: A total of 10 adults (7 patients and 3 clinic staff) participated in the BCT sessions. Key themes learned were 1) increasing awareness about the colonoscopy procedure (why it is important, what the procedure is, how to prepare), 2) using simple and clear wording, including statistics, and using family as a motivator, and 3) providing different patient outreach modalities to broaden reach, such as patient-facing fact sheets, videos in clinic or sent by text. Statement of the conclusions: Using BCT, we successfully incorporated feedback from Spanish-speaking Latino patients to design culturally relevant materials to promote follow-up colonoscopy after abnormal FIT results. Targeted efforts are needed to improve rates of follow-up colonoscopy among patients with abnormal FIT results in FQHC settings. (Final materials, including patient-facing fact sheets and screenshots from short videos, will be showcased in the poster.).

8.
HIV Medicine ; 22(SUPPL 2):64, 2021.
Article in English | EMBASE | ID: covidwho-1409357

ABSTRACT

Background: Using the WHO TDR list, we aimed to determine from our clinic database;the prevalence of TDR, non-B subtype and associated features in our large tertiary HIV department (∼2500 patients) from 2014-2020. Method: Using the WHO TDR list, we aimed to determine from our clinic database;the prevalence of TDR, non-B subtype and associated features in our large tertiary HIV department (∼2500 patients) from 2014-2020. Results: Of the 218 new diagnoses, 217 had a resistance test attempted (1 stored due to COVID-19). 212/217 had an available genotype (5 failed to amplify). 191/212(90%) were MSM, 12/212(6%) cis-female, 80/212(38%) non-UK born and the median age was 36 years (IQR = 29-46). The overall prevalence of TDR was 17/212(8%;95%CI = 5.0-12.4), seven (3%) had a NRTI mutation, six (3%) had at least one nNRTI mutation and 4(2%) had a PI mutation. There were no dual/triple class/INI mutations. There was no significant change in the prevalence of TDR over the study period. The overall prevalence of non-B subtype was 53/212(25%;95%CI = 19.6-31.2), and was not more frequently seen in non-UK born individuals (OR = 1.24;CI = 0.66-2.33, P = 0.51). Patients with TDR were older [45.v.36 years, P = 0.006] and have non-B subtype (OR = 2.96;CI = 1.08-8.13, P = 0.03). Although overall rates of bacterial STIs was high (34%), having a bacterial STI was not associated with TDR(OR = 1.77;95%CI = 0.66-4.82, P = 0.26). Conclusion: TDR is associated with age and non-B subtype in our population. HIV TDR is not decreasing locally and remains a small but significant concern despite effective HIV prevention strategies, which may not reach hidden populations affected by HIV. Continued efforts to reduce HIV transmission must target hidden populations and we must maintain adequate surveillance of TDR.

10.
Sexually Transmitted Infections ; 97(SUPPL 1):A65-A66, 2021.
Article in English | EMBASE | ID: covidwho-1379633

ABSTRACT

Background HIV-1 transmitted drug resistance (TDR) is associated with sexually transmitted infections (STIs) and sexual clusters including MSM and non-MSM. TDR can lead to antiretroviral failure, and therefore UK guidelines recommend TDR testing in all new HIV patients. Subtype B is most common in urbanised western populations however is decreasing in proportion. Within the UK TDR is estimated to be 7.5% and non-B subtype 51%. Methods Using the WHO TDR list, we aimed to determine from our clinic database;the prevalence of TDR, non-B subtype and associated features in our large tertiary HIV department (∼2500 patients) from 2014-2020. Results Of the 218 new diagnoses, 217 had a resistance test attempted (1 stored due to COVID-19). 212/217 had an available genotype (5 failed to amplify).. 191/212(90%) were MSM, 12/212(6%) cis-female, 80/212(38%) non-UK born and the median age was 36 years (IQR=29-46). The overall prevalence of TDR was 17/212(8%;95%CI=5.0-12.4), seven (3%) had a NRTI mutation, six (3%) had at least one nNRTI mutation and 4(2%) had a PI mutation. There were no dual/triple class/INI mutations. There was no significant change in the prevalence of TDR over the study period. The overall prevalence of non-B subtype was 53/212(25%;95% CI=19.6-31.2), and was not more frequently seen in non- UK born individuals (OR=1.24;CI=0.66-2.33,p=0.51). Patients with TDR were older [45.v.36 years, p=0.006] and have non-B subtype (OR=2.96;CI=1.08-8.13,p=0.03). Although overall rates of bacterial STIs was high (34%), having a bacterial STI was not associated with TDR (OR=1.77;95%CI=0.66-4.82,p=0.26). Conclusion TDR is associated with age and non-B subtype in our population. HIV TDR is not decreasing locally and remains a small but significant concern despite effective HIV prevention strategies, which may not reach hidden populations affected by HIV. Continued efforts to reduce HIV transmission must target hidden populations and we must maintain adequate surveillance of TDR.

11.
Sexually Transmitted Infections ; 97(Suppl 1):A141-A142, 2021.
Article in English | ProQuest Central | ID: covidwho-1301713

ABSTRACT

BackgroundHIV pre-exposure prophylaxis (PrEP) is an effective, safe strategy to prevent HIV. PrEP can be used either daily or as an event based dosing (EBD) regimen by men who have sex with men (MSM) having condom-less anal sex, however clinicians with expertise delivering daily PrEP often lack confidence delivering EBD-PrEP. During the COVID-19 pandemic, MSM appear to have tailored their sexual behaviour in-line with local social restrictions including the way they use PrEP.MethodWe aimed to investigate the proportion of MSM using EBD-PrEP between October-December 2020 and to survey clinician confidence in delivering EBD-PrEP through an online questionnaire.Results551 MSM were seen who were eligible for PrEP in the study period, of which 448 were prescribed PrEP (64-declined, 2-stopped, 8-new patients and 29-repeat attenders accessed PrEP from another source). The median age of PrEP users was 37 years (IQR=29–48). Overall, 94/448 (21%,95%CI=17–25) of MSM were using EBD-PrEP. New starters were significantly more likely to use EBD-PrEP compared to existing PrEP users (34%.v.13%, χ2=27.6, p<0.00001). There was no significant difference in age between daily and EBD-PrEP users (37years. v.41years,p=0.2). There were 33/38 clinicians who responded to the online survey. Clinicians felt equally confident at delivering daily PrEP as EBD-PrEP (Likert scores=4.4/5 v 4.2/5, p=0.2). However, potential barriers identified to providing EBD-PrEP by clinicians were;assessing which MSM would be suitable for using EBD-PrEP, having access to appropriate information for patients to support their understanding of using EBD PrEP;and clinician knowledge and belief in the efficacy of EBD-PrEP.ConclusionThe uptake by MSM and clinician confidence in discussing EBD-PrEP appears to have increased since the start of the COVID-19 pandemic. Giving MSM greater choice in how PrEP is used will optimise its effect on reducing HIV transmission. More research is needed to support both MSM and clinicians to deliver EBD-PrEP.

12.
BMC Nephrol ; 22(1): 92, 2021 03 15.
Article in English | MEDLINE | ID: covidwho-1136211

ABSTRACT

BACKGROUND: Acute kidney injury (AKI) is a common manifestation among patients critically ill with SARS-CoV-2 infection (Coronavirus 2019) and is associated with significant morbidity and mortality. The pathophysiology of renal failure in this context is not fully understood, but likely to be multifactorial. The intensive care unit outcomes of patients following COVID-19 acute critical illness with associated AKI have not been fully explored. We conducted a cohort study to investigate the risk factors for acute kidney injury in patients admitted to and intensive care unit with COVID-19, its incidence and associated outcomes. METHODS: We reviewed the medical records of all patients admitted to our adult intensive care unit suffering from SARS-CoV-2 infection from 14th March 2020 until 12th May 2020. Acute kidney injury was defined using the Kidney Disease Improving Global Outcome (KDIGO) criteria. The outcome analysis was assessed up to date as 3rd of September 2020. RESULTS: A total of 81 patients admitted during this period. All patients had acute hypoxic respiratory failure and needed either noninvasive or invasive mechanical ventilatory support. Thirty-six patients (44%) had evidence of AKI (Stage I-33%, Stage II-22%, Renal Replacement Therapy (RRT)-44%). All patients with AKI stage III had RRT. Age, diabetes mellitus, immunosuppression, lymphopenia, high D-Dimer levels, increased APACHE II and SOFA scores, invasive mechanical ventilation and use of inotropic or vasopressor support were significantly associated with AKI. The peak AKI was at day 4 and mean duration of RRT was 12.5 days. The mortality was 25% for the AKI group compared to 6.7% in those without AKI. Among those received RRT and survived their illness, the renal function recovery is complete and back to baseline in all patients. CONCLUSION: Acute kidney injury and renal replacement therapy is common in critically ill patients presenting with COVID-19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay. Recovery of renal function was complete in all survived patients.


Subject(s)
Acute Kidney Injury/etiology , COVID-19/complications , APACHE , Acute Kidney Injury/epidemiology , Acute Kidney Injury/mortality , Acute Kidney Injury/therapy , COVID-19/epidemiology , Cohort Studies , Critical Illness , Female , Hospital Mortality , Humans , Incidence , Intensive Care Units , Male , Middle Aged , Organ Dysfunction Scores , Recovery of Function , Renal Replacement Therapy/statistics & numerical data , Respiration, Artificial/adverse effects , Risk Factors , Water-Electrolyte Balance
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