COMPARATIVE ANALYSIS OF THE FEATURES OF ORGANIZING MEASURES TO COMBAT THE COVID-19 PANDEMIC IN THE HEALTH SYSTEMS OF THE RUSSIAN FEDERATION AND FOREIGN COUNTRIES

The study analyzed available literatures covering the organization of measures to combat the COVID-19 pandemic in the healthcare systems of the Russian Federation and several foreign countries. For the comprehensive assessment of the specifics of organizing measures to combat the COVID-19 pandemic, countries were chosen based on geographical distances from China (the closest is Korea, and the most remote are the Great Britain and Haiti), maximum population on their continent (the United States is in North America, and Brazil in South America), and significant differences in the functioning of the healthcare systems. The peculiarities of organizing measures to combat the COVID-19 pandemic in the considered countries were associated with a complex of political, financial, economic, demographic, and organizational factors, the individual combination of which determined the peculiarities of the development of the epidemic process in each specific case. Moreover, as a priority manifestation of the severity of these factors, the capabilities of the healthcare system, including the availability of services of medical workers, sufficient number of testing equipment, medical protection equipment, hospital beds, and other parameters, should be considered. The main role was played by global state strategies implemented in the healthcare systems of the analyzed countries at the pre-epidemic stage and, in most cases, aimed at optimizing the financial and economic provisions of state guarantees of medical care. The general criteria for the differential diagnosis of COVID-19 in the national recommendations of all the states considered were respiratory symptoms and general infectious intoxication. In addition, fever and respiratory symptoms were accepted as priority criteria for COVID-19 screening. © 2023 Vestnik Rossijskoj Voenno-Medicinskoj Akademii. All rights reserved.

Peacekeeping Operations: Challenges and Opportunities in the Midst of Health Crises

The COVID-19 crisis has brought about significant challenges to international organizations operating in fragile contexts. Among others, the case of United Nations (UN) and its peacekeeping operations (PKOs) counting more than 80, 000 personnel from 121 countries is certainly prominent. Not only do PKOs rely on international personnel's frequent rotations, but they also rely on freedom of movement to carry out their mandate. How have PKOs adapted and responded to the crisis? How do PKOs balance the need to protect vulnerable civilians with support to governments' responses to the crisis and safeguard legitimacy? This chapter explores the impact of the health crisis due to the COVID-19 pandemic on PKOs by focusing on two key aspects. First, it evaluates the current PKO efforts in managing the crisis in light of two previous health emergencies occurring in the midst of PKOs, namely Ebola in Western Africa and cholera in Haiti. It will reflect on the legitimacy costs associated with the risk of UN personnel being seen as vector of the disease. Second, it identifies challenges and opportunities created by the emergency. The key challenges stem from the inevitable delay or interruption of ongoing negotiation processes, and the associated risks of armed groups taking advantage of the uncertain situation. But there are some opportunities to consider. Operational adaptation becomes a need as missions have to prioritize civilians' protection without violating governments' policies on movement. Furthermore, halting frequent personnel rotations has likely increased cohesion within missions among soldiers but also between soldiers and missions' leaders. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Between Protection and Empowerment COVID-19: Haiti's Older People's Perception and Behavior

By proposing a dialogue between the findings of a Rapid Needs Assessment of older people and COVID-19 in Haiti and different components of the human security framework and UN policy brief on the impact of COVID-19 on older persons, this chapter contributes to two ongoing and interconnected efforts to inform the global COVID-19 response and build-back-better initiatives: (1) efforts to make older people visible in COVID-19 response and recovery and (2) efforts to inform COVID-19 response through the lenses of the human security framework. While older people are all too often left behind and left out, the Rapid Needs Assessment of the impact of COVID-19 on the lives of older people in Haiti carried out by HelpAge International and Church World Service (CWS) in 2020 was a first step to make them visible. The study was carried out by CWS in collaboration with four local organizations in a context marked by a prolonged national political crisis, worsening food security situation, rise in insecurity and gang violence, and an above-average hurricane season. A total of 240 people in the capital city of Port-au-Prince and in the remote rural Northwest department was interviewed between July 28 and August 13, 2020. The assessment resulted in the report "COVID-19 Rapid Needs Assessment of Older People, September 2020.” This chapter summarizes the respondents' views on the themes of the COVID-19 awareness and behavior, food and income, health and Water, Sanitation and Hygiene (WASH), as well as the initial feedback received from Haitian civil society representatives and participant rural NGOs. It concludes that a serious and sustained effort is required from member states and organizations to operationalize the full promise of the human security approach to older people, especially in fragile states and developing countries where human insecurities predate COVID-19, are systemic and interconnected. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer 2022.

Effectiveness of Dolutegravir in People on Rifampin-Based Tuberculosis Treatment

Background: Tenofovir-lamivudine-dolutegravir (TLD) is the WHO-preferred first-line regimen for people with HIV, but drug-drug interactions between dolutegravir (DTG) and rifampin (RIF) require an additional 50mg DTG (TLD+50) in people receiving tuberculosis (TB)/HIV co-treatment. RIF is a key drug in TB treatment, but is a potent inducer of metabolizing enzymes and efflux transporters, which can markedly lower drug concentrations. There are limited data on the effectiveness of TLD+50 in people with TB/HIV from program settings. Method(s): We conducted a prospective, observational study at 12 sites in 6 countries (Haiti, Kenya, Malawi, South Africa, Uganda, Zimbabwe). Participants received concomitant TLD+50 and RIF-based TB treatment provided as standard of care by HIV and TB treatment programs. Primary outcome was HIV-1 RNA <1000 copies/mL (cpm) at end of TB treatment. New DTG resistance mutations were defined as those present at end of TB treatment but not present at start. Result(s): From 11/2019-6/2021, we enrolled 91 participants with TB/HIV, including 75 ART-naive participants (82%) starting TLD+50 after a median of 15 days on TB treatment, 10 ART-naive participants (11%) starting TLD+50 and RIF together, 5 (5%) starting TB treatment and changing to TLD+50 after a median of 3.3y on TLD, and 1 (1%) starting RIF and TLD+50 after changing from EFV/3TC/TDF. Median age was 37y (IQR 32-43), 35% were female, 100% cis-gender, median CD4 count was 120 cells/mm3 (IQR 50-295), 87% had HIV-1 RNA >1000 copies/mL. Two participants died during TB treatment (week 4 disseminated TB, week 12 suspected COVID-19), 1 interrupted TLD+50 due to jaundice;and 1 discontinued TB treatment due to drug-induced liver injury. Among 89 surviving participants, 6 were lost to follow-up and a further 10 had no HIV-1 RNA result due to missed or remote visits. Primary virologic outcome was therefore assessed in 73 (80%), of whom 69 (95%, Wald 95% CI 89-100%) had HIV-1 RNA <=1000 cpm;68 (93%) had HIV-1 RNA <200 cpm. No sex specific differences in viral suppression were observed. No DTG resistance mutations were detected among 4 participants with HIV-1 RNA >1000 cpm. Conclusion(s): Concomitant RIF-containing TB treatment and TLD+50 was welltolerated and achieved excellent viral suppression in a cohort of predominantly ART-naive people with TB/HIV. These multi-country data from program settings support feasibility and effectiveness of current treatment approaches for TB/ HIV co-infection.

Fanmi: A Randomized Trial of Community Cohort Hiv Care for Adolescent Girls, Haiti

Background: Adolescent girls and young women are the epicenter of the global HIV epidemic and in need of multilevel interventions to improve their health outcomes. Method(s): FANMI, a randomized-controlled trial, evaluated the effectiveness of community-based cohort HIV care versus standard of care (SOC) among adolescent and young adults living with HIV (AYALH) in Haiti. Females, 16-24 years who were newly diagnosed with HIV at clinic or community HIV testing sites, or defaulted >6 months from care, were randomized 1:1 to FANMI vs SOC. FANMI was designed to improve convenience, social support and stigma by grouping AYALH in cohorts of 6-10 peers to attend monthly HIV care sessions in a community center with integrated clinical care, group counseling, and social activities led by the same provider. National guideline changes during the study included switching participants to dolutegravir regimens and expanding SOC visits to 6 months. The primary outcome was 12-month retention defined as any visit 9-15 months from enrollment. Secondary outcomes included viral suppression (< 1000 copies/ml), risk behaviors, and acceptability using interviews. Result(s): 120 AYALH enrolled (60 per arm) between May 2018-January 2021. Median age was 21, 91% were newly diagnosed, and median CD4 count was 591 cells/mm3 (IQR 399-788). A total of 78.3% (47/60) FANMI participants vs 85.0% (51/60) in SOC achieved the primary outcome (unadjusted RR=0.92 95%CI 0.78-1.09, p=0.35). Excluding 9 participants who never attended a FANMI/SOC visit after enrollment, 12-month retention was 88.7% (47/53) in FANMI vs 87.9% (51/58) in SOC (RR =1.01 95%CI 0.88-1.15, p=0.90). Participants who presented for HIV testing vs community testing and achieved the primary outcome: 95% vs 70% (FANMI) and 83% vs 88% (SOC). Viral suppression among those retained at 12 months: 44.6% (21/47) in FANMI and 37.3% (19/51) in SOC (RR 1.20 95% CI 0.74-1.9, p=0.45). There were no differences in pregnancy and risk behaviors. Providers preferred FANMI reporting increased time for counseling and peer support. FANMI participants reported high acceptability, decreased stigma, and increased social support with no confidentiality breaches. Limitations included interrupted study operations during the COVID-19 pandemic. Conclusion(s): FANMI was not more effective for AYALH in Haiti but was preferred by providers and highly acceptable to participants. It offers promise as a complementary program for high-risk AYALH in low-income settings facing barriers to clinic-based care.

Perceived Stress, Social Support, and Blood Pressure in Urban Haiti

Introduction: Stress is associated with multiple adverse health outcomes, including hypertension. The impact of stress on health may be moderated by social support. The distribution of stress, support, and their association with hypertension have not been well described in low-income countries that face severe poverty. Over the past decade, Haiti has suffered massive natural disasters including the 2010 earthquake, cholera outbreak, COVID-19 pandemic, and recurrent civil instability-all of which may act as prolonged stressors.Hypothesis: We assessed the hypotheses that 1) there are high levels of both stress and support in Haiti, and 2) high support would moderate the relationship between high stress and hypertension. Method(s): We measured stress and social support using validated instruments in a population-representative cohort of adults living in urban Port-au-Prince, Haiti between March 2019 and April 2021. Stress was measured using the Perceived Stress Scale, while social support was measured using the Multidimensional Scale of Perceived Social Support. For visualization, continuous scores were categorized using equal-width groups (stress: low (1-5), moderate (6-10), high (11-16);support: low (7-21), low-moderate (22-35), moderate (36-49), moderate-high (50-64), high (65-77)). Linear regression models were used to quantify the associations between: 1) stress and support adjusting for age and sex, 2) blood pressure and stress adjusting for age and sex. A formal moderation analysis was conducted to assess if support moderated the relationship between stress and blood pressure. Result(s): Among 2,817 adults, 59.7% female and the median age was 40 years (IQR 28-55). The majority had an income of less than 1 US dollar a day (69.7%). The median stress score was 8 out of 16 points, and median support score was 61 out of 77 points. Stress was higher with older ages (60+ years versus 18-29 years: +0.79 points, 95% CI 0.51 to 1.08) and in females (+0.85 points, 95% CI +0.65 to +1.06). Support was higher in males (+3.29 points, 95% CI 2.19 to 4.39). Support was inversely associated with stress, adjusting for age and sex (-0.04 points, 95% CI -0.04 to -0.03). Stress was not associated with systolic or diastolic blood pressure after adjustment for age and sex. Support did not moderate the association between stress and blood pressure. Conclusion(s): In this urban cohort of Haitian adults living with chronic civil instability, stress was moderate and support was high. While support was associated with lower stress, it did not moderate the relationship between stress and blood pressure. Despite the high levels of instability in Haiti, participants displayed resiliency through high levels of support, which may be an underutilized resource in reducing stress and long-term negative health outcomes.

COVID-19 vaccine acceptance in three rural communes in Haiti: A cross-sectional study.

Vaccines are the most effective mechanism for ending the COVID-19 pandemic. However, reluctance to accept vaccines has hindered the efforts of health authorities to combat the virus. In Haiti, as of July 2021, less than 1% of the country's population has been fully vaccinated in part due to vaccine hesitancy. Our goal was to assess Haitian attitudes toward COVID-19 vaccination and investigate the primary reasons for Moderna vaccine hesitancy. We conducted a cross-sectional survey across three rural Haitian communities, in September 2021. The research team used electronic tablets to collect quantitative data from 1,071 respondents, selected randomly across the communities. We report descriptive statistics and identify variables associated with vaccine acceptance using logistic regression built using a backward stepwise approach. Among 1,071 respondents, the overall acceptance rate was 27.0% (n = 285). The most common reason for vaccine hesitancy was "concern about side effects" (n = 484, 67.1%) followed by "concern about contracting COVID-19 from the vaccine" (n = 472, 65.4%). Three-quarters of respondents (n = 817) identified their healthcare workers as their most trustworthy source for information related to the vaccine. In the bivariate analysis, male gender (p = .06) and no history of drinking alcohol (p < .001) were significantly associated with being more likely to take the vaccine. In the final reduced model, only those with a history of drinking alcohol were significantly more likely to take the vaccine (aOR = 1.47 (1.23, 1.87) p < .001). The acceptance rate for the COVID-19 vaccine is low, and public health experts should design and strengthen vaccination campaigns to combat misinformation and public distrust.

Navigating Hyperspace: A Comparative Analysis of Priests' Use of Facebook

The book was written with the COVID-19 pandemic as a backdrop and discusses the ways in which virtual ministry has impacted how priests do their work, and the Catholic community as whole. The editor, Peter Lah an associate professor at the Faculty of Social Sciences, Pontifical Gregorian University in Rome, devotes several pages to a historical overview of how new technologies have been used in the church over the decades, allowing for lasting change and globalization opportunities. Unlike other chapters in this book, here we see a deeper explanation of social media concepts and an explanation for this overarching study, before diving into the case study. In the final case study, Researcher Olivier Gangola focused on the Archdiocese of Kinshasa in the Democratic Republic of Congo, which is quite large.

URBAN AGRICULTURAL ACTIVITIES, A FOOD SYSTEM RESILIENCE STRATEGY DURING COVID-19 IN HAITI

The COVID-19 crisis is impacting the reconfiguration of food systems at different scales. In poor countries where food insecurity had already been a major problem, the urban population under the lockdown often had to cope alone with shortages of food and access to it. In the poorest country in the Americas, the urban population adapted the food system by intensifying the practice of urban agricultural activities. In this exploratory research, using a sample including urban dwellers that were engaged in urban agriculture and those who were not, we investigated the following question: Did urban agriculture linked to COVID-19 represent an appropriate and innovative strategy for the urban food system resilience? Our results confirm that the Haitian urban population used urban agriculture as an innovative and appropriate food resilience strategy. They produced varieties chosen for their very rapid production character and were able to cope successfully with the crisis, and also have lessons to share with other actors and countries. © Paul B., 2022.

Effects of COVID-19 on maternal and child health in Haiti

Haiti has a history of natural disasters that have played a part in the country's weak infrastructure, poor quality health care, and short life expectancy. The purpose of this qualitative case study was to understand the experiences of health care professionals providing prenatal, perinatal, and postpartum health care services before and during the COVID-19 pandemic in Haiti to gain an understanding of the gaps in disaster response in reproductive health care. The theoretical bases for this study were community resilience theory and reproductive justice theory. Data were collected from interviews with 10 health care professionals working in Haiti providing reproductive health care services. Data were transcribed and manually coded into two data sets: pre-COVID-19 conditions and post-COVID-19 conditions based on the research questions. Five themes emerged from pre-COVID-19/post-COVID-19 similarities: partnerships directly impact health outcomes, impact of disparities and the need for equity, poor infrastructure and educational impact, lack of reproductive health care, and limited health care delivery. Seven themes emerged from the pre-COVID-19/post-COVID-19 differences: decrease in social support in all regions, decrease of community support, lack of reproductive health care and increased home births, increased disease prevention and limited consequences of COVID-19, decrease in all health care funding sources, very limited health care delivery and minimal quality care, and negative impact of fear. Findings indicated that disaster relief interventions have not evolved to protect peri- and postnatal women after a disaster. Findings may inform future disaster relief policy and programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Exploring the Impact of Crisis and Trauma on the Mental Health and Psychological Well-Being of University Students in Northern Haiti

In recent decades, Haiti has been subject to man-made and natural disasters that have left its citizens vulnerable to a range of shocks. With a weak state unable to protect its populace, Haitians are exposed to some of the highest levels of poverty and violence in the Western Hemisphere. In recent years, Haitians have experienced two crises that this study analyzes: the instability and political violence of "peyi lòk” as well as the global pandemic of COVID-19. This community-based assessment explores the impact of these two crises on the mental health and psychological well-being of 38 Haitian university students in the understudied northern part of the country. Results indicate that both crises had similarities related to their psychological effects on young people, most nota-bly in terms of traumatic experiences related to threats or violence, forced confinement, and large increases in population-wide uncertainty. Additionally, the extreme violence of "peyi lòk” and the widespread unpredictability of COVID-19 and its effects in the early days of the pandemic resulted in high levels of stress and fear. Both crises also resulted in extreme economic hardship for students, with many reporting difficulties accessing basic needs such as food and water. This study highlights how converging population-level crises in "complex emergencies” can heighten trauma and compromise mental health. © 2023, Tech Science Press. All rights reserved.

Summary of national data of class A, B and C communicable diseases in China, December 2022

In December 2022 (from 00: 00, 1 December to 24: 00, 31 December), except COVID-19, a total of 278 907 cases of notifiable communicable diseases, including 2 384 deaths, were reported in China (except Hong Kong, Macao Special Administrative Regions and Taiwan Province, the same below). In communicable diseases in class A, no cases and no deaths were reported. In communicable diseases in class B, no cases and no deaths of severe acute respiratory syndrome, poliomyelitis, human infection with highly pathogenic avian influenza virus, diphtheria and human infection with avian influenza A (H7N9) virus were reported. For the remaining 21 communicable diseases except COVID-19 in class B, a total of 148 573 cases were reported, a decrease of 29% compared with last month (210 178 cases) and a decrease of 46% compared with the same period in 2021 (273 361 cases). The first 5 diseases in terms of reported case number were viral hepatitis, pulmonary tuberculosis, syphilis, gonorrhea and AIDS, accounting for 96% of the total reported cases in class B. A total of 2 384 deaths were reported, an increase of 28% (521 deaths) compared with last month (1 863 deaths) and a decrease of 14% compared with the same period in 2021 (2 763 deaths). In class C communicable diseases, a total of 130 334 cases were reported, a decrease of 33% compared with last month (195 072 cases) and a decrease of 69% compared with the same period in 2021 (420 015 cases). The first 3 diseases in terms of reported case number were influenza, other infectious diarrhea, and hand foot and mouth disease (HFMD), accounting for 96% of the total reported cases in class C. Compared with last month, except filariasis which had no incidence, the reported case number of leprosy was same, and the disease with reported case increase was echinococcosis (47 cases, 48%), the reported cases of other diseases all decreased, the first 3 diseases with reported case decreases were HFMD (22 886 cases, 45%), other infectious diarrhea (21 962 cases, 43%) and influenza (14 775 cases, 18%). Compared with the same period in 2021, except filariasis which had no incidence, the reported cases of other diseases all decreased, the first 3 diseases with reported case decreases were influenza (181 158 cases, 73%), other infectious diarrhea (53 502 cases, 65%) and HFMD (46 674 cases, 63%). No death caused by class C communicable disease was reported, same to last month and a decrease of 7 deaths compared with the same period in 2021 (7 deaths).

Mission POCUS in Haiti.

Introduction: Point-of-care ultrasound (POCUS) has enhanced patient care and safety around the world. Clinicians can now use a small diagnostic ultrasound imaging device to answer some binary clinical questions and manage patients more effectively. Since the COVID-19 pandemic, there has been a significant adoption of POCUS by clinicians worldwide. Materials and Methods: A basic cardiac POCUS training was conducted in Haiti with focus on physics, instrumentation, and basic echocardiography. Results: The Mission POCUS team trained 15 Haitian physicians interested in better serving their patients with the implementation of POCUS cardiac in their patient assessment. Conclusion: POCUS skills will empower clinicians from around the world to make rapid and accurate diagnosis and help save lives by diagnosing life threatening conditions and manage patient appropriately. Our experience in Haiti showed that a short POCUS training course can help improve the knowledge of physicians.

Galenic preparations for the prevention of the spread of COVID-19

Background: A.P.P.A. Project is the main activity of the nonprofit organisation Aid Progress Pharmacist Agreement (A.P.P.A.) which is the result of the cooperation between the University of Turin and Italian Pharmacists and it operates in the field of International Health Cooperation. The objective of the Project is the realisation of Galenic laboratories within healthcare facilities located in Developing Countries. Seven Projects are currently on-going in Madagascar, Angola, Chad and Haiti. Purpose(s): In view of the pandemic caused by COVID19, and to reduce its spread as much as possible in the hospitals where the Project is active, the goal was to implement specific procedures on site for the production of alcoholic solutions, liquid soaps and disinfectant gels in accordance with WHO guidelines. Method(s): The A.P.P.A. labs have been promptly equipped with standard procedures for the preparation of disinfectant formulations. The procedures have been developed in a very simple way to allow their introduction on site even remotely and without a specific training path that requires to be carried out in person. Result(s): Since the manual skills have been acquired during the preparation of Galenic formulations over time, local operators had no difficulty with the new formulations;if necessary specific indications are given by email or by phone calls. In the labs where these formulations had already been introduced in the past for the prevention of nosocomial infections, the setting up has been enhanced by the reorganisation of the production activities. Conclusion(s): The Galenic preparation, also in these contexts, resulted a good strategy for healthcare personnel and for hospitalised patients.

Interprofessional collaboration (IPC): A comparative analysis of global standards for pharmacy practice

Introduction: Globally, disparities exist in healthcare quality, accessibility and regulation (Das, & Gertler, 2007). Consequently, few countries have governing bodies overlooking healthcare-professional (HCP) practice (Epstein, & Bing, 2011). Research has suggested that HCP regulation depended on nations' human development index (HDI), gross domestic product (GDP), and safety (Ozturk, & Topcu, 2014). IPC enables partnership working between HCPs to ensure patient-centred care (Gregory, & Austin, 2016). This study thematically analysed pharmacy professional standards' documents of various countries and investigated whether nations' developmental parameters influenced pharmacy regulation. Objectives * To compare global pharmacy professional standards on IPC. * To synthesise a thematic framework to evaluate literature on IPC. * To iInvestigate the relationship between HDI, GDP, global peace index (GPI), and pharmacy regulation. Method(s): A group (N = 8) of countries were studied based on 2018 HDI classification;(N = 4) 'very high' (Australia, Hong Kong, Canada, United Kingdom) and (N = 4) 'low' (Solomon Islands, Haiti, Yemen, South Sudan). Pharmacy professional standards' documents were screened to extract IPC-related themes via a constant comparative method. This facilitated thematic framework synthesis;'pharmacists' attitudes' and 'patient outcomes' were measures of IPC. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), (N = 17) peer-reviewed journal articles from 2010-2019 studying pharmacists in sample countries were selected. Key terms searched on Medline/PubMed databases were: 'IPC', 'pharmacist' and 'professional standards'. Literature was then reviewed with reference to the thematic framework and development metrics (HDI/GDP/GPI). This study did not require ethics approval. Result(s): Of the countries (N = 8) studied, only HDI-classified 'very high' had professional standards' documents, frequently incorporating IPC. Key themes were: 'shared decision-making', 'continuity-of-care', and 'effective communication'. Seven studies referred to these themes and confirmed IPC benefits: fewer medication-related errors4. The number of IPC standards and HDI-rank for 'very high' countries, except Hong Kong, were positively correlated, suggesting possible economic impact on pharmacy sector progress. Two studies found cultural influences on Hong Kong pharmacists' attitudes as contributory to a hierarchical than IPC-approach to healthcare provision5. HDI and GPI had a strong negative correlation (r = -0.83), potentially explaining low pharmacist density and GDP healthcare expenditure in HDI-classified low. Conclusion(s): Results denote that IPC improved patient safety (Gregory, & Austin, 2016). Global differences existed in pharmacists' attitudes and IPC training. These correlated with growing gaps in HDI and GPI between HDI-classified 'very high' and 'low' countries. Qualitative analysis highlighted the need for elaboration of 'continuity-of-care' and inclusion of 'understanding roles/responsibilities of team members' in the United Kingdom's professional standards set by the General Pharmaceutical Council. Future work could study 2021/inequality-adjusted HDI data, 'high'/'medium' HDI countries to improve validity alongside COVID19 impact on GDP and pharmacy practice.

Surveillance of Severe Viral Respiratory Infections among Children Presenting to Hopital Saint Damien in Haiti

Background. Learning the burden and seasonality of respiratory viral infections in children in resource-limited settings is critical for hospital infection care and prevention and national public health programs. We built a prospective surveillance program of severe acute respiratory illness (SARI) in hospitalized children at Hopital Saint Damien - Nos Petits Freres et Soeurs to gather local evidence and support informed clinical and policy decision-making. The COVID-19 pandemic erupted as we were launching our project, requiring the use of available point-of-care diagnostics. Methods. Children < 18 years of age with cough, history of fever >= 38 Cdegree, of < 10 days evolution, and requiring hospitalization were included in the study. We obtained a nasopharyngeal swab and collected demographic and clinical data for eligible patients. Samples were tested using antigen test on-site for influenza A (Flu A) and B (Flu B), respiratory syncytial virus (RSV), and SARS-CoV-2. Afterwards, all specimens (both negative and positive) were stored and shipped for molecular studies. Results. We obtained and tested 167 samples from patients since April 30, 2021, through January 31, 2022. Single isolates were detected in 88 samples (53%), multiple isolates in 20 samples (12%), and no isolates in 59 samples (35%). Positive cases for RSV, Flu A, and Flu B peaked between November and January. Rhinovirus 1A (RhV) was detected throughout the study period, with peaks around August-September and was the most often detected viral isolate (49, 38%), followed by RSV (37, 29%). Co-infections were seen with RSV, Flu A, RhV, and SARS-CoV-2. Molecular studies detected 7 isolates of Flu A not detected by rapid test, 1 isolate of Flu B, and 1 isolate of SARS-CoV-2. However, it failed to detect 2 isolates of Flu A detected by rapid test, 1 isolate of Flu B, and 1 isolate of SARS-CoV-2. Conclusion. Our study captured circulating respiratory viruses in children with SARI in Haiti during the COVID-19 pandemic. Preliminary data suggest an increase in respiratory viruses between August and January. Improving point-of-care diagnostics can better inform providers of the local epidemiology of respiratory viruses and support clinical decision-making, such as good use of antibiotics. However, we confirmed the sensitivity of molecular testing. (Figure Presented).

Leveraging PEPFAR-Supported Health Information Systems for COVID-19 Pandemic Response.

Since 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has supported implementation and maintenance of health information systems for HIV/AIDS and related diseases, such as tuberculosis, in numerous countries. As the COVID-19 pandemic emerged, several countries conducted rapid assessments and enhanced existing PEPFAR-funded HIV and national health information systems to support COVID-19 surveillance data collection, analysis, visualization, and reporting needs. We describe efforts at the US Centers for Disease Control and Prevention (CDC) headquarters in Atlanta, Georgia, USA, and CDC country offices that enhanced existing health information systems in support COVID-19 pandemic response. We describe CDC activities in Haiti as an illustration of efforts in PEPFAR countries. We also describe how investments used to establish and maintain standards-based health information systems in resource-constrained settings can have positive effects on health systems beyond their original scope.

Lòk: Pandemics and (Im)mobility in Northern Haiti

Rumors of a new respiratory disease began to reach northern Haiti through reports from relatives from the diaspora;the subject soon took over radio stations, virtual communication apps, and everyday conversations in rural neighborhoods and popular markets. The need for social distancing, however, was met with skepticism—not out of disbelief in its effectiveness, but out of resignation to a situation that did not seem new. In this article, I look at the history of past epidemics in Haiti and how these experiences shaped the way people reacted to the arrival of COVID-19 in the country. Through ethnographic data and recent conversations with Haitian friends, I argue that the general feeling of immobility caused by the pandemic intensified a political and existential situation defined as lòk. Nevertheless, it was through a popular epidemiology centered around the household (lakou) that people were able to cope with this new virus. While discussing creative forms of dealing with this sense of stagnation, I try to show that mobility is a form of vitality, creating and structuring life even in situations of radical uncertainty.

REFOULEMENT AS PANDEMIC POLICY

A year and a half into a near-total shutdown of the United States border to asylum seekers, United States Border Patrol agents were recorded riding on horseback, swinging whips in the faces of Haitian refugees, and beating them back across the border into Mexico from Del Rio, Texas.1 The refugees were fleeing political instability and forced displacement-in July of 2021, Haitian President Jovenel Moise was assassinated,2 and a month later, a devastating earthquake killed thousands of people and destroyed 53,000 homes.3 Upon arriving in the United States, instead of being granted temporary refuge, the asylum seekers were forced to live in encampments along the United StatesMexico border, waiting and hoping for an opportunity to make their case for asylum-an opportunity that would never come.4 Many of them were expelled from the United States en masse before they were ever able to ask for asylum, and thousands more were left in limbo in Mexico.5 During this humanitarian crisis, Department of Homeland Security ("DHS") Secretary Alejandro Mayorkas issued a warning to Haitians: "If you come to the United States illegally, you will be returned. A. COVID, Border Closures, and Impact on Asylum Seekers On December 31, 2019, China reported the first cases of what would soon be recognized as the novel coronavirus COVID-19.8 On January 21, 2020, the United States Centers for Disease Control ("CDC") confirmed the first United States COVID case, which originated from a person who had traveled to Washington state from Wuhan, China.9 In early February, the United States and other countries formally imposed global air travel and quarantine restrictions.10 On March 11, the World Health Organization ("WHO") officially declared COVID-19 to be a global pandemic, and by midMarch 2020, U.S. states and localities began widely issuing stay-at-home orders to slow the spread of the disease.11 Across the globe, nations closed their borders to human migration and movement. A Pew Research Report found that, by April of 2020, 91% of the world's population was living in a country with some sort of COVID travel restriction.12 Canada closed its borders to foreign tourism.13 The European Union restricted incoming nonessential travel14 and many member states banned entry from countries with high rates of COVID infection, such as India.15 The United States banned entry for non-essential travelers from the European Union and the United Kingdom.16 The most devastating consequences of border closures, though, have been for asylum seekers and refugees. At the height of the pandemic, at least 168 nations had closed or restricted their borders and around 90 countries had closed their borders to those seeking asylum.17 Simultaneously, COVID-19 served as a "threat multiplier," compounding the effects of poverty, lack of healthcare, and violence affecting refugees and displaced people.18 There were 82.4 million forcibly displaced people in the world at the end of 2020, the highest number ever recorded,19 but fewer refugees were resettled in 2020 than any year in the previous two decades.20 The United Nations High Commissioner for Refugees ("UNHCR") estimated that about 1.5 million refugees and asylum seekers were unable to seek international protection because they were stranded by these border closures in 2020.21 Border closures are particularly harmful to asylum seekers, who rely on the ability to cross borders to seek safety and refuge.22 Asylum seekers, by definition, have been displaced from their homes, and they rely on access to territory outside of their country of origin to seek protection from persecution.

SARS-CoV-2 Seroprevalence at an Urban Hospital in Haiti.

BACKGROUND: Much to the surprise of the global community, Haiti has had far fewer COVID-19 cases and deaths than initially expected. In this study, we sought to estimate the seroprevalence of COVID-19 in a convenience cohort based in Port-au-Prince, Haiti, to elucidate potential reasons for the apparently low burden of COVID-19 in Haiti. METHODS: We performed a cross-sectional analysis of SARS-CoV-2 antibody prevalence in patients aged one to 89 years old who were seen at the Haiti Adventist Hospital (HAH) laboratory between December 17, 2020, and July 3, 2021, with an order requiring a blood draw. We excluded patients outside of the age range and those who did not verbally consent to the study. We tested residual patient serum samples using the Biosys PlusTM COVID-19 IgM/IgG Rapid Test. FINDINGS: Of 9,740 patients seen by the HAH laboratory from December 2020 to July 2021, 538 consented to have antibody testing and answer survey questions. 529 were included in the final analysis. We excluded nine participants who were aged greater than 89 (n=3), aged less than one (n=2), or had results that were not properly recorded (n=4). Three of the tested patients were repeat testers, with one who had been tested three times. These repeat results were included for a final seroprevalence analysis of 533 samples. In the final participant pool, 142 (26.6%) of 533 samples tested positive for either IgM, IgG, or both antibodies to the SARS-CoV-2 virus. Adjustment for test sensitivity resulted in an estimated seroprevalence of 28.7% (95% CI 24.9-32.9). We observed significant differences in seroprevalences among age groups, with seroprevalence increasing with age. INTERPRETATION: The SARS-CoV-2 antibody seroprevalence in Haiti appears to be greater than the publicly reported statistics by several orders of magnitude. Furthermore, a reduced fatality rate relative to high-income countries points to uncertain factors that may confer immunologic resistance in the Haitian population.