First Case Mild Symptoms COVID-19 in Rural Central Java Area: Case Report of an Indonesian Patient

BACKGROUND: SARS-CoV-2 virus infection is a pandemic that began to emerge in December 2019 in various countries with high death rates of 4-9% until now. In March 2020, Indonesia found its first case where the condition of the infection kept spreading to various regions in Indonesia. Different regional conditions in Indonesia make it difficult to manage this virus infection. The capability of the regional hospitals to detect this virus infection with their facilities and infrastructure is required. CASE PRESENTATION: A 17-year-old man came to the Ajibarang Regional Hospital with complaints of coughs and colds felt for 4 days and fever for 2 days. Physical examination found a good general condition, moderate pain, the temperature of 38.8degreeC, pharyngeal hyperemia, and minimal lung crackles sound. Laboratory tests showed normal leukocytes, platelet, and hemoglobin levels. Chest radiograph was suggestive of bronchitis. The patient was hospitalized for approximately 4 days until the fever resolved and was discharged. Five days after the patient was discharged from the hospital, the results of the viral load examination using real-time polymerase chain reaction confirmed positive for Coronavirus Disease 2019 (COVID-19). CONCLUSION(S): This case showed unusual conditions of a mild clinical COVID-19 infection, laboratory results that did not support viral infections, as well as radiology examination of only bronchitis. The viral load test was found to be positive. Therefore, the diagnosis of the COVID-19 infection requires a comprehensive interpretation of complete history taking, clinical examination, laboratory, and radiology examinations for clinicians working with limited hospital facilities and infrastructures.Copyright © 2023 Edward Kurnia Setiawan Limijadi, Inge Cahya Ramadhani, Dian Tunjungsari Hartutiningtyas, Gara Samara Brajadenta.

Surfaces as a Source for SARS-CoV-2 Transmission

The role of contaminated surfaces as a potential source for SARS-CoV-2 transmission has not been clear at the beginning of the pandemic. Numerous laboratory studies show that SARS-CoV-2 can remain infectious at room temperature on different types of surfaces for a few days and substantially longer in the dark. A higher temperature such as 30 °C or 40 °C and a higher relative humidity result in a shorter persistence. On surfaces in the surrounding of confirmed COVID-19 patients the detection rates of SARS-CoV-2 RNA were mostly less than 30% with Ct-values mostly >30 suggesting a low viral load and the absence of infectious SARS-CoV-2. The RNA detection rates on public surfaces were low with 0-22.1%, the corresponding Ct values were mostly >30. Infectious SARS-CoV-2 was only detected in 2 of 11 studies in the immediate surrounding of COVID-19 patients with 0.7% or 10.5% of the samples being positive. A major limitation of the results, however, is that in one study 7 of 8 positive samples were obtained in the surrounding of only one patient with persistent cough and frequent sputum spitting during sampling. Overall, the probability of surfaces to be the source of SARS-CoV-2 transmission is low, especially for public surfaces. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Evaluation of Association Between Ct Value of SARS-COV-2 PCR with Disease Progression and Mortality

Objective: Multiple factors have been studied in association with disease severity in COVID-19. The cycle threshold (Ct) value of polymerase chain reaction (PCR) can reflect viral load in the specimens. In this study, we aimed to evaluate the effect of the Ct value on clinical course and mortality in COVID-19 patients. Methods: Adult patients who tested positive for SARS-CoV-2 with PCR test and who were hospitalized with COVID-19-related symptoms between August 1, 2020, and November 30, 2020, were included in the study. In addition, Ct value, demographic and clinical data (length of hospital stay, need for admission to intensive care unit (ICU), need for mechanical ventilation (MV), and mortality) were reviewed retrospectively. Results: 117 patients were included in the study. The mean Ct value was 22.37 +/- 4.72 (11.07-34.06). There was no significant difference in the mean Ct values between the patients who needed ICU admission and those who did not. When the patients were evaluated by dividing them into three groups according to their Ct values, as < 20, between 20-24 and >24;there was no significant difference between these three groups in terms of severity of pneumonia, laboratory parameters (D-dimer, Neutrophil/Lymphocyte ratio, C-reactive protein, lymphocyte count), length of hospital stay, need for ICU admission, need for MV and mortality. When the patients were divided into two groups with Ct values as <23.3 and >= 23.3, no significant difference was found between the groups regarding ICU need, MV need, and 28-day mortality rates. Conclusion: Most of the studies in the literature about Ct value and its effect on clinical course indicate that lower Ct values are potentially associated with worse outcomes in COVID-19. However, there are also studies reporting that the Ct value does not reflect the severity of the disease. We did not find a correlation between Ct value and laboratory markers, length of hospital stay, the severity of pneumonia, need for ICU admission or MV, and mortality in COVID19 patients in this presented study.

Wastewater early warning system for SARS-CoV-2 outbreaks and variants in a Coruña, Spain.

Wastewater-based epidemiology has been widely used as a cost-effective method for tracking the COVID-19 pandemic at the community level. Here we describe COVIDBENS, a wastewater surveillance program running from June 2020 to March 2022 in the wastewater treatment plant of Bens in A Coruña (Spain). The main goal of this work was to provide an effective early warning tool based in wastewater epidemiology to help in decision-making at both the social and public health levels. RT-qPCR procedures and Illumina sequencing were used to weekly monitor the viral load and to detect SARS-CoV-2 mutations in wastewater, respectively. In addition, own statistical models were applied to estimate the real number of infected people and the frequency of each emerging variant circulating in the community, which considerable improved the surveillance strategy. Our analysis detected 6 viral load waves in A Coruña with concentrations between 103 and 106 SARS-CoV-2 RNA copies/L. Our system was able to anticipate community outbreaks during the pandemic with 8-36 days in advance with respect to clinical reports and, to detect the emergence of new SARS-CoV-2 variants in A Coruña such as Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron (B.1.1.529 and BA.2) in wastewater with 42, 30, and 27 days, respectively, before the health system did. Data generated here helped local authorities and health managers to give a faster and more efficient response to the pandemic situation, and also allowed important industrial companies to adapt their production to each situation. The wastewater-based epidemiology program developed in our metropolitan area of A Coruña (Spain) during the SARS-CoV-2 pandemic served as a powerful early warning system combining statistical models with mutations and viral load monitoring in wastewater over time.

Effects of oral of administration of monoglycide laurate on virus load and inflammation in PEDV infected porcine.

To investigate the effect of monoglyceryl laurate (GML) against PEDV in vivo, the clinical signs, pathological changes, tissue viral load and cytokine levels of piglets were compared in different GML treatment groups and PEDV infected group. The diets of experimental groups were supplemented with different doses of GML (5g for A1, 10g for A2, 20g for A3) on day 1, 2, and 3 after PEDV challenge, and the virus challenge group (group C) and blank group (group B) were set as control. The results showed that compared with group C, groups As could reduce the mortality rate of piglets, among which the protection rates of groups A2 and A3 could reach 100%. The trend of weight loss of piglets was effectively slowed down and growth performance recovered in GML treated groups. GML reduced the pathological damage of intestinal tract and the viral load in intestine and mesenteric lymph nodes. The levels of IL-8 and TNF-α in the blood of group As were inhibited by GML in a dose-dependent manner when compared with group C. Our study suggests that GML has potential anti-PEDV effects in vivo.

Performances of Dried Blood Spots and Point-of-Care Devices to Identify Virological Failure in HIV-Infected Patients: A Systematic Review and Meta-Analysis.

To broaden access to HIV viral load monitoring (VLM), the use of blood samples from dried blood spots (DBS) or point-of-care (POC) devices, could be of great help in settings where plasma is not easily accessible. The variety of assays available makes the choice complex. This systematic review and meta-analysis aims to estimate the sensitivity and specificity of DBS and POC devices to identify patients in virological failure using World Health Organization (WHO) recommendations (viral load ≥1000 copies/mL), compared with plasma, for the assays currently available. Four databases were searched for articles, and two reviewers independently identified articles reporting sensitivity and specificity of DBS and/or POC to identify patients in virological failure. We excluded articles that used other thresholds as well as articles with a total number of participants below 50 to avoid reporting bias. Heterogeneity and factors associated with assays' performances were assessed by I2 statistics and metaregression. The protocol of this review follows the PRISMA guidelines. Out of 941 articles, 47 were included: 32 DBS evaluations and 16 POC evaluations. Overall, when using DBS, the Abbott RT HIV-1, Roche CAP-CTM, NucliSENS BioMerieux and Aptima assays presented sensitivity and specificity exceeding 85%, but reported results were highly heterogeneous. Factors associated with better performances were high volume of blood and the use of the same assay for DBS and plasma VLM. Regarding the POC devices, SAMBA I, SAMBA II, and GeneXpert devices presented high sensitivity and specificity exceeding 90%, with less heterogeneity. DBS is suitable VLM, but performances can vary greatly depending on the protocols, and should be performed in trained centers. POC is suitable for VLM with less risk of heterogeneity but is more intensive in costs and logistics.

COVID-19 in immunocompromised children: comparison of SARS-CoV-2 viral load dynamics between the first and third waves.

SARS-CoV-2 dynamics across different COVID-19 waves has been unclear in immunocompromised children. We aimed to compare the dynamics of SARS-CoV-2 RNA viral load (VL) during the first and third waves of COVID-19 in immunocompromised children. A retrospective and longitudinal cohort study was conducted in a pediatric referral hospital of Argentina. The study included 28 admitted immunocompromised children with laboratory confirmed SARS-CoV-2 infection. Thirteen acquired the infection during COVID-19 first wave (May to August 2020, group 1 (G1)) and fifteen in the third wave (January to March 2022, group 2 (G2)). RNA viral load measure and its dynamic reconstruction were performed in nasopharyngeal swabs by validated quantitative, real time RT-PCR, and linear mixed-effects model, respectively. Of the 28 children included, 54% were girls, most of them had hemato-oncological pathology (57%), and the median age was 8 years (interquartile range (IQR): 3-13). The dynamic of VL was similar in both groups (P = 0.148), starting from a level of 5.34 log10 copies/mL (95% confidence interval (CI): 4.47-6.21) in G1 and 5.79 log10 copies/mL (95% CI: 4.93-6.65) in G2. Then, VL decayed with a rate of 0.059 (95% CI: 0.038-0.080) and 0.088 (95% CI: 0.058-0.118) log10 copies/mL per day since diagnosis and fell below the limit of quantification at days 51 and 39 after diagnosis in G1 and G2, respectively. Our results evidenced a longer viral RNA persistence in immunocompromised pediatric patients and no difference in VL dynamic between COVID-19 first wave-attributed to ancestral infections-and third wave-attributed to Omicron infections.

Corrigendum: Differential association of viral dynamics with disease severity depending on patients' age group in COVID-19.

[This corrects the article DOI: 10.3389/fmicb.2021.712260.].

Viral loads of parainfluenza virus type 3 and severity of respiratory diseases in children.

BACKGROUND: Parainfluenza virus type 3 (PIV-3) is one of the common pathogens for respiratory infections in children. Whether viral load of PIV-3 is associated with severity of respiratory diseases in children is not yet known. Our aim was to determine significance of PIV-3 viral load among infected children. METHODS: We conducted a single-center, retrospective study at Tokyo Metropolitan. Children's Medical Center, Japan, from June to August 2021. Hospitalized children were screened with a posterior nasal swab for multiplex PCR, and viral load was subsequently measured from remained samples by real-time PCR. Demographic data were collected from digital charts. PIV-3 positive patients were categorized into mild group with no oxygen demand, moderate group with low-flow oxygen demand and severe group with high-flow nasal cannula oxygen or non-invasive positive pressure ventilation or mechanical ventilation. Viral loads were compared among mild, moderate and severe groups. RESULTS: 151 patients were positive for PIV-3. We found no statistically significant association among PIV-3 viral load and severity of respiratory diseases (p = 0.35), and no statistically significant association between severity of illness and co-detection of other viruses. In each severity group, relatively high viral load per posterior nasal swab was observed at the time of testing. CONCLUSION: Among PIV-3 patients, we could not find statistically significant between viral load and their severity, therefore we could not conclude that viral load is a good surrogate marker for clinical severity of PIV-3.

Temporal study of wastewater surveillance from September 2020 to March 2021: an estimation of COVID-19 patients in Lahore, Pakistan.

The first aim of study was to quantify the viral load in the wastewater samples by RT-qPCR testing in Lahore population to estimate the number of patients affected and predict the next resurgence of COVID-19 wave in the city. The second aim of the study was to determine the hotspot areas of Lahore which remained positive more often for virus with high viral load. In this study, n = 420 sewage samples were collected on an average of two weeks intervals from 30 different sewage water disposal stations (14 sampling events) from Sept 2020 to March 2021. RNA was extracted and quantified by RT-qPCR without concentrating the virus in samples. Number of positive disposal sites (7-93%), viral load from sewage samples (100.296 to 103.034), and estimated patients (660-17,030) ranged from low to high according to the surge and restrain of 2nd and 3rd COVID-19 waves in the country. The viral load and estimated patients were reported high in January 2021 and March 2021 which were similar to the peak of 2nd and 3rd waves in Pakistan. Site 18 (Niaz Baig village DS) showed the highest viral load among all sites. Findings of the present study helped to estimate the number of patients and track the resurgence in COVID-19 waves in Lahore particularly, and in Punjab generally. Furthermore, it emphasizes the role of wastewater-based epidemiology to help policymakers strengthen the quarantine measures along with immunization to overcome enteric viral diseases. Local and national stake holders should work in collaboration to improve the environmental hygiene to control the disease.

Staging of COVID-19 disease, using selected laboratory profiles for prediction, prevention and management of severe SARS-CoV-2 infection in Africa-review

There are many uncertainties on the future management of the coronavirus disease 19 (COVID-19) in Africa. By July 2021, Africa had lagged behind the rest of the world in Covid-19 vaccines uptake, accounting for just 1.6% of doses administered globally. During that time COVID 19 was causing an average death rate of 2.6% in Africa, surpassing the then global average of 2.2%. There were no clear therapeutic guidelines, yet inappropriate and unnecessary treatments may have led to unwanted adverse events such as worsening of hyperglycemia and precipitating of ketoacidosis in administration of steroid therapy. in order to provide evidence-based policy guidelines, we examined peer-reviewed published articles in PubMed on COVID 19, or up-to date data, we focused our search on publications from 1st May 2020 to 15th July, 2021. For each of the studies, we extracted data on pathophysiology, selected clinical chemistry and immunological tests, clinical staging and treatment. Our review reports a gross unmet need for vaccination, inadequate laboratory capacity for immunological tests and the assess-ment of individual immune status, clinical staging and prediction of disease severity.We recommend selected laboratory tools in the assessment of individual immune status, prediction of disease severity and de-termination of the exact timing for suitable therapy, especially in individuals with co-morbidities.

Impact of admission viral load on respiratory outcomes in hospitalized SARS-CoV-2 infected patients with cancer and without cancer: A 2-, 4- and 6-months follow-up prospective study.

BACKGROUND: This prospective follow-up study aimed to determine the temporal changes in respiratory outcomes over 6 months period in patients with and without cancer hospitalized for severe COVID-19 and to determine the associated risk factors based on admission viral load. METHODS: All adult patients hospitalized with a confirmed diagnosis of severe SARS-CoV-2 infection were investigated using rRT-PCR on nasopharyngeal swab specimens. Patients were divided into three arbitrary groups according to their cycle threshold (CT) values obtained at admission as high (CT<25.0), medium (CT between 25.0 and 30.0), and low (CT>30.0) viral load. Patients had pulmonary function tests, chest high-resolution computed tomography (HRCT), and a 6-minute walking time distance measured at each follow-up visit. RESULTS: This follow-up study had a total of 112 participants, of which 75 were cancer-free and 37 had active cancer. Overall, 29.5% had a low viral load, compared to 48.2% who had a high viral load, and 22.3% had a medium viral load. For patients who did not have cancer, the mean age was 57.3 (SD 15.4) and for those who had cancer, it was 62.3 (SD 18.4). Most patients had overall better temporal changes in pulmonary function and tolerance, as well as exercise capacity, even though severe and chronic respiratory abnormalities persisted in a fraction of the patients. In patients without cancer who had a high viral load, we have seen a substantial reduction in diffusion capacity of the lungs for carbon monoxide (DLCO) predicted value with a median of 65 (IQR 63-70) while in patients with cancer, it was 60 (IQR 56-67) at 2 months. At 4 and 6 months, the predicted DLCO values for patients without cancer were 65 (IQR 61-70), whereas the predicted DLCO values for patients with active cancer were 62 (IQR 60-67) and 67 (59-73). Importantly, radiological abnormalities persisted in 22 (29%) non-cancer patients and 16 (43%) cancer patients. Multivariate regression analysis showed an increased odds ratio of impaired HRCT associated with a high viral load of 3.04 (95% CI:1.68-6.14; p < 0.001) for patients without cancer and 5.07 (95% CI: 4.04-10.8; p < 0.0001) for patients with cancer. The CT pneumonia score at hospitalization was 2.25 (95% CI:1.76-3.08; p = 0.041) and 2.85 (95% CI:1.89-5.14; p = 0.031) for non-cancer and cancer patients respectively. CONCLUSIONS: The evidence of persistent pulmonary abnormalities and radiographic changes was found in both patient groups who had high viral load at hospital admission and suggesting that SARS-CoV-2 viral load might serve as a useful indicator to predict the development of respiratory complications in patients with COVID-19.

Evaluation of Association Between Ct Value of SARS-COV-2 PCR with Disease Progression and Mortality

Objective: Multiple factors have been studied in association with disease severity in COVID-19. The cycle threshold (Ct) value of polymerase chain reaction (PCR) can reflect viral load in the specimens. In this study, we aimed to evaluate the effect of the Ct value on clinical course and mortality in COVID-19 patients. Methods: Adult patients who tested positive for SARS-CoV-2 with PCR test and who were hospitalized with COVID-19-related symptoms between August 1, 2020, and November 30, 2020, were included in the study. In addition, Ct value, demographic and clinical data (length of hospital stay, need for admission to intensive care unit (ICU), need for mechanical ventilation (MV), and mortality) were reviewed retrospectively. Results: 117 patients were included in the study. The mean Ct value was 22.37 +/- 4.72 (11.07-34.06). There was no significant difference in the mean Ct values between the patients who needed ICU admission and those who did not. When the patients were evaluated by dividing them into three groups according to their Ct values, as < 20, between 20-24 and >24;there was no significant difference between these three groups in terms of severity of pneumonia, laboratory parameters (D-dimer, Neutrophil/Lymphocyte ratio, C-reactive protein, lymphocyte count), length of hospital stay, need for ICU admission, need for MV and mortality. When the patients were divided into two groups with Ct values as <23.3 and >= 23.3, no significant difference was found between the groups regarding ICU need, MV need, and 28-day mortality rates. Conclusion: Most of the studies in the literature about Ct value and its effect on clinical course indicate that lower Ct values are potentially associated with worse outcomes in COVID-19. However, there are also studies reporting that the Ct value does not reflect the severity of the disease. We did not find a correlation between Ct value and laboratory markers, length of hospital stay, the severity of pneumonia, need for ICU admission or MV, and mortality in COVID-19 patients in this presented study.

A Comparison of Retrieved Respiratory Viral load emitted by infected SARS-CoV-2 patients

Viral RNA in fine (< 5 µm) aerosols from 13 patients infected by the SARS-CoV-2 virus were obtained using the Gesundheit-II (G-II) equipment which collects respiratory emissions. The collection was performed in isolation wards of the National Centre for Infectious Diseases of Singapore under an approved protocol. The patients breathed normally for 30 minutes, talk, and sing for 15 minutes each (with 30 minutes rest in between activity) into a specially designed aerosol collector in two size fractions. The coarse fraction (> 5 µm) and the fine aerosols (< 5 µm) are subsequently collected and subjected to PCR analysis for their viral load quantification. Viral RNA detected from 59% of the patients showed that patients earlier in illness were more likely to emit detectable RNA, and loads differed significantly between breathing, talking, and singing. © 2022 17th International Conference on Indoor Air Quality and Climate, INDOOR AIR 2022. All rights reserved.

SARS-CoV-2 VIRAL LOAD IN NEWBORNS WITH COVID-19

The article presents the results of investigation of SARS-CoV-2 viral load in newborns with RT-PCR confirmed COVID-19 of different severity. It has been revealed that total amount of SARS-CoV-2 RNA on nasopharyngeal mucosa of newborns is significantly higher as compared to elder children and is not associated with disease severity and lung injury.

Probiotic improves symptomatic and viral clearance in Covid19 outpatients: a randomized, quadruple-blinded, placebo-controlled trial.

Intestinal bacteria may influence lung homeostasis via the gut-lung axis. We conducted a single-center, quadruple-blinded, randomized trial in adult symptomatic Coronavirus Disease 2019 (Covid19) outpatients. Subjects were allocated 1:1 to probiotic formula (strains Lactiplantibacillus plantarum KABP022, KABP023, and KAPB033, plus strain Pediococcus acidilactici KABP021, totaling 2 × 109 colony-forming units (CFU)) or placebo, for 30 days. Co-primary endpoints included: i) proportion of patients in complete symptomatic and viral remission; ii) proportion progressing to moderate or severe disease with hospitalization, or death; and iii) days on Intensive Care Unit (ICU). Three hundred subjects were randomized (median age 37.0 years [range 18 to 60], 161 [53.7%] women, 126 [42.0%] having known metabolic risk factors), and 293 completed the study (97.7%). Complete remission was achieved by 78 of 147 (53.1%) in probiotic group compared to 41 of 146 (28.1%) in placebo (RR: 1.89 [95 CI 1.40-2.55]; P < .001), significant after multiplicity correction. No hospitalizations or deaths occurred during the study, precluding the assessment of remaining co-primary outcomes. Probiotic supplementation was well-tolerated and reduced nasopharyngeal viral load, lung infiltrates and duration of both digestive and non-digestive symptoms, compared to placebo. No significant compositional changes were detected in fecal microbiota between probiotic and placebo, but probiotic supplementation significantly increased specific IgM and IgG against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) compared to placebo. It is thus hypothesized this probiotic primarily acts by interacting with the host's immune system rather than changing colonic microbiota composition. Future studies should replicate these findings and elucidate its mechanism of action (Registration: NCT04517422).Abbreviations: AE: Adverse Event; BMI: Body Mass Index; CONSORT: CONsolidated Standards of Reporting Trials; CFU: Colony-Forming Units; eDRF: Electronic Daily Report Form; GLA: Gut-Lung Axis; GSRS: Gastrointestinal Symptoms Rating Scale; hsCRP: High-sensitivity C-Reactive Protein; HR: Hazard Ratio; ICU: Intensive Care Unit; OR: Odds Ratio; PCoA: Principal Coordinate Analysis; RR: Relative Risk; RT-qPCR: Real-Time Quantitative Polymerase Chain Reaction; SARS-CoV2: Severe acute respiratory syndrome coronavirus 2; SpO2: Peripheral Oxygen Saturation; WHO: World Health Organization.

Hiv Viral Load Suppression and Racial Disparities during the Covid-19 Pandemic in Nyc

Background: Antiretroviral therapy is highly effective in achieving HIV viral load suppression (VLS) but requires sustained engagement in care. The COVID-19 pandemic disrupted medical care, and its impact on engagement in HIV care and VLS remains unclear. Health information exchanges (HIEs) enable examination of patient care across multiple health systems. We sought to leverage HIE data to examine the effect of pandemic-related disruptions in HIV care on VLS and to explore racial/ethnic disparities in VLS. Method(s): We performed a retrospective observational study of people living with HIV (PLWH) using de-identified data from Healthix, an HIE encompassing >20 million patients and 8,000 healthcare facilities in the greater New York City (NYC) region, between 1/1/2018 and 7/14/2022. We identified PLWH based on HIV viral load (VL) tests and HIV diagnosis codes (ICD and SNOMED). We established two cohorts: PLWH engaged in care in 2020 with >=1 VL test in 2019, 2020, and 2021(Group A) and PLWH not engaged in care in 2020 with >=1 VL test in 2019 and 2021 but 0 VL tests in 2020 (Group B). HIV VLS outcomes were categorized as suppressed (< 200 copies/mL) or not suppressed ( >200 copies/mL) using the last VL in 2019, first VL in 2021, and last recorded VL. We compared proportions using X2-tests and fit a group-stratified logistic regression to examine the effect of race/ethnicity on VLS. Result(s): We identified 711,358 VL tests representing 81,122 patients at 249 facilities. Of these patients, 36,199 met our definition of PLWH. Of those, 12,448 met the inclusion criteria for Group A, and 3,377 met the inclusion criteria for Group B. In 2019, Group B had a lower VLS proportion than Group A (85.9% vs 88.1%, X2 = 12.3, p< 0.0001). In 2021, this gap increased;the proportion of VLS was 80.7% in Group B and 88.0% in Group A (X2 = 121.8, p< 0.00001). Most recently, VLS in Group B had increased to 85.6%, but the inter-group gap in VLS had grown from 2.2% to 4.4%. Within both groups, Black and Hispanic patients had lower odds of VLS than white patients. This disparity was greatest in Group B when they reengaged in care in 2021, with 72.0% of Black patients (OR 0.30, 95% CI 0.22-0.42), and 79.1% of Hispanic patients (OR 0.45, 95% CI 0.31-0.63), compared to 89.5% of white patients achieving VLS. Conclusion(s): VLS remained high among PLWH who stayed engaged in care in 2020, dropped among PLWH who disengaged in care, and was lower in minoritized groups even after controlling for engagement in care.

Staging of COVID-19 disease, using selected laboratory profiles for predictionprevention and management of severe SARS-CoV-2 infection in Africa-review

There are many uncertainties on the future management of the coronavirus disease 19 (COVID-19) in Africa. By July 2021, Africa had lagged behind the rest of the world in Covid-19 vaccines uptake, accounting for just 1.6% of doses administered globally. During that time COVID 19 was causing an average death rate of 2.6% in Africa, surpassing the then global average of 2.2%. There were no clear therapeutic guidelines, yet inappropriate and unnecessary treatments may have led to unwanted adverse events such as worsening of hyperglycemia and precipitating of ketoacidosis in administration of steroid therapy. in order to provide evidence-based policy guidelines, we examined peer-reviewed published articles in PubMed on COVID 19, or up-to date data, we focused our search on publications from 1st May 2020 to 15th July, 2021. For each of the studies, we extracted data on pathophysiology, selected clinical chemistry and immunological tests, clinical staging and treatment. Our review reports a gross unmet need for vaccination, inadequate laboratory capacity for immunological tests and the assessment of individual immune status, clinical staging and prediction of disease severity. We recommend selected laboratory tools in the assessment of individual immune status, prediction of disease severity and determination of the exact timing for suitable therapy, especially in individuals with co-morbidities.Copyright © 2023 Sendagire H et al.

Utility of Digital Solutions in Sustaining Access and Improving Efficiency of Hiv Vl

Background: Coronavirus Disease 2019 (COVID-19) pandemic disrupted routine program implementation worldwide with significant impact on quality and extent of technical oversight of implementation. Diverse digital reporting solutions and online meetings were some strategies designed to bridge program implementation supervision and reporting gaps worldwide. This paper evaluates usefulness and efficiency of digital solutions deployed by USAIDNigeria to ensure adequate oversight to sustain access and reporting of HIV viral load (VL) services Methods: To promote accountability and encourage peer-to-peer review and learning among USAID Implementing Partners, daily reporting via digital platforms and virtual weekly peer-review meetings were introduced. This enabled USAID team to monitor IPs' performance at health facilities and during community VL drives against set targets of 100% and 95% patient VL coverage and suppression (VLC/S) respectively. The platforms include National Laboratory Information Management System, remote sample login and Googlebased VL Status and Daily Lab Performance dashboards. This study assesses uptake of VL services and clinical outcomes in 16 states of Nigeria between October2019 through March2021 during various levels of COVID-19 lock down. Chi Square test was used to compare the pre-COVID (October2019-March2020), during lockdown (April2020-September2020) and post-COVID lockdown (October2020-March2021) performances at 95 confidence interval and < 0.05 level of significance. Result(s): Significant improvements in VL indicators were reported among eight USAID partners across 16 states. Pre-COVID, 591,906 clients on treatment were eligible for VL monitoring, 455,099 were tested and had documented VL results with a 76.9% and 89% VLC/S. During-COVID lockdown, 685,915 became eligible for VL monitoring, 531,371 had documented VL results, with 77.5% and 90% VLC/S. VLC/S increased to 93% each post-COVID lockdown, when 771,149 had documented VL out of 833,463 eligible. There was a significant increase number of clients on treatment who became eligible for VL test and had documented VL results and suppression from pre- during-COVID, and post-COVID lockdown (p=0.001) Conclusion(s): Digital solutions deployed by USAID were instrumental to sustaining service delivery with significant growth in access and efficiency to HIV VL services in 16 States in Nigeria despite impact of COVID-19. Program managers should continue to explore cost-efficient innovative approaches for program oversight.