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J Int AIDS Soc ; 25(7): e25967, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1958775

ABSTRACT

INTRODUCTION: Globally, over half of the estimated new HIV infections now occur among key populations, including men who have sex with men, sex workers, people who inject drugs, transgender individuals, and people in prisons and other closed settings, and their sexual partners. Reaching epidemic control will, for many countries, increasingly require intensified programming and targeted resource allocation to meet the needs of key populations and their sexual partners. However, insufficient funding, both in terms of overall amounts and the way the funding is spent, contributes to the systematic marginalization of key populations from needed HIV services. DISCUSSION: The Joint United Nations Programme on HIV/AIDS (UNAIDS) has recently highlighted the urgent need to take action to end inequalities, including those faced by key populations, which have only been exacerbated by the COVID-19 pandemic. To address these inequalities and improve health outcomes, key population programs must expand the use of a trusted access platform, scale up differentiated service delivery models tailored to the needs of key populations, rollout structural interventions and ensure service integration. These critical program elements are often considered "extras," not necessities, and consequently costing studies of key population programs systematically underestimate the total and unitary costs of services for key populations. Findings from a recent costing study from the LINKAGES project suggest that adequate funding for these four program elements can yield benefits in program performance. Despite this and other evidence, the lack of data on the true costs of these elements and the costs of failing to provide them prevents sufficient investment in these critical elements. CONCLUSIONS: As nations strive to reach the 2030 UNAIDS goals, donors, governments and implementers should reconsider the true, but often hidden costs in future healthcare dollars and in lives if they fail to invest in the community-based and community-driven key population programs that address structural inequities. Supporting these efforts contributes to closing the remaining gaps in the 95-95-95 goals. The financial and opportunity cost of perpetuating inequities and missing those who must be reached in the last mile of HIV epidemic control must be considered.


Subject(s)
COVID-19 , HIV Infections , Sexual and Gender Minorities , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/prevention & control , Homosexuality, Male , Humans , Male , Pandemics/prevention & control
2.
Open Forum Infectious Diseases ; 8(SUPPL 1):S343-S344, 2021.
Article in English | EMBASE | ID: covidwho-1746513

ABSTRACT

Background. Multi-system inflammatory syndrome in children (MIS-C) is a rare consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C shares features with common infectious and inflammatory syndromes and differentiation early in the course is difficult. Identification of early features specific to MIS-C may lead to faster diagnosis and treatment. We aimed to determine clinical, laboratory, and cardiac features distinguishing MIS-C patients within the first 24 hours of admission to the hospital from those who present with similar features but ultimately diagnosed with an alternative etiology. Methods. We performed retrospective chart reviews of children (0-20 years) who were admitted to Vanderbilt Children's Hospital and evaluated under our institutional MIS-C algorithm between June 10, 2020-April 8, 2021. Subjects were identified by review of infectious disease (ID) consults during the study period as all children with possible MIS-C require an ID consult per our institutional algorithm. Clinical, lab, and cardiac characteristics were compared between children with and without MIS-C. The diagnosis of MIS-C was determined by the treating team and available consultants. P-values were calculated using two-sample t-tests allowing unequal variances for continuous and Pearson's chi-squared test for categorical variables, alpha set at < 0.05. Results. There were 128 children admitted with concern for MIS-C. Of these, 45 (35.2%) were diagnosed with MIS-C and 83 (64.8%) were not. Patients with MIS-C had significantly higher rates of SARS-CoV-2 exposure, hypotension, conjunctival injection, abdominal pain, and abnormal cardiac exam (Table 1). Laboratory evaluation showed that patients with MIS-C had lower platelet count, lymphocyte count and sodium level, with higher c-reactive protein, fibrinogen, B-type natriuretic peptide, and neutrophil percentage (Table 2). Patients with MIS-C also had lower ejection fraction and were more likely to have abnormal electrocardiogram. Conclusion. We identified early features that differed between patients with MIS-C from those without. Development of a diagnostic prediction model based on these early distinguishing features is currently in progress.

3.
Aktuelle Dermatologie ; 47(12):552-557, 2021.
Article in German | Web of Science | ID: covidwho-1585713

ABSTRACT

Background The spread of COVID-19 infections since the end of 2019 has led to far-reaching restrictions on public life. In order to avoid overloading the German health system, elective medical treatments were severely restricted in the medical sector during the first lockdown in spring 2020. Patients and methods In this study, the influence of the lockdown in spring 2020 on the number of patients in a dermatological university outpatient clinic was analyzed and compared with the corresponding periods of the previous years 2018 and 2019. The patient data was taken from the hospital's internal documentation system according to standardized criteria. Results In spring 2020 there was a significant decrease in patients by 28.3 % compared to 2018 and by 28.7 % compared to 2019, especially patients who presented to the university outpatient department for the first time were particularly affected. Above all, there was a decline in the number of patients with chronic inflammatory diseases and tumor diseases. Age-specific differences were not found, except older patients with malignant diseases in particular presented less frequently during lockdown. Non-binary minorities presented less frequently in 2020 compared to the two previous years. Conclusions The results of the study showed a decrease in the willingness of patients with dermatological diseases to introduce themselves during the lockdown. Illnesses could remain undetected for longer and, as a result of the later start of treatment, lead to more severe disease courses and poorer therapeutic options. Especially in patients with malignant diseases, this can lead to a poorer prognosis.

4.
Pediatric Diabetes ; 22(SUPPL 30):33, 2021.
Article in English | EMBASE | ID: covidwho-1571042

ABSTRACT

Introduction: An increase in newly diagnosed type 1 diabetes (T1D) has been posited during the COVID-19 pandemic, but data have been conflicting. Objectives: We aimed to determine trends in newly diagnosed T1D and severity of presentation at diagnosis for pediatric and adolescent patients during COVID-19 year (2020) as compared to the previous year (2019) in a multi-center data analysis across the United States. Methods: This retrospective multi-center study included data from seven large U.S. clinical centers recruited from the T1D Exchange Quality Improvement Collaborative (T1DX-QI). Data on diagnosis, diabetic ketoacidosis (DKA), and clinical characteristics were collected from January 1 to December 31, 2020, compared to the prior year. Chi-square tests were used to compare differences in patient characteristics during the pandemic compared to the pre-pandemic comparison group. Results: Across seven member sites, there were 1399 newly diagnosed patients with T1D in 2020, compared to 1277 in 2019 (p=0.007). Of the newly diagnosed patients, a greater number, presented in DKA in 2020 compared to 2019 (599/1399 (42.8%) v. 493/1277 (38.6%), p<0.001), and a higher proportion of these patients presented with severe DKA (p=0.01) as characterized by a pH<7.1 or bicarbonate of <5mmol/L. The mean age at diagnosis was not different, but there were fewer females (p=0.004), and fewer NH White youth diagnosed in 2020 (p<0.001). Newly diagnosed T1D patients in 2020 were less likely to have private insurance (p=0.001). Monthly data trends demonstrated a higher number of new diagnoses of T1D over the spring and summer months (April to September) of 2020 compared to 2019 (p=0.007). Conclusions: We found an increase in newly diagnosed T1D and a greater proportion of newly diagnosed T1D patients presenting in DKA at diagnosis during the COVID-19 pandemic compared to the prior year. Future longitudinal studies are needed to confirm these findings with population level data and determine the long-term impact of COVID-19 on diabetes trends.

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