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1.
Pharmaceutics ; 14(8):1690, 2022.
Article in English | ProQuest Central | ID: covidwho-2023992

ABSTRACT

Poly(lactic-co-glycolic acid) (PLGA) nanoparticle-based drug delivery systems are known to offer a plethora of potential therapeutic benefits. However, challenges related to large-scale manufacturing, such as the difficulty of reproducing complex formulations and high manufacturing costs, hinder their clinical and commercial development. In this context, a reliable manufacturing technique suitable for the scale-up production of nanoformulations without altering efficacy and safety profiles is highly needed. In this paper, we develop an inline sonication process and adapt it to the industrial scale production of immunomodulating PLGA nanovaccines developed using a batch sonication method at the laboratory scale. The investigated formulations contain three distinct synthetic peptides derived from the carcinogenic antigen New York Esophageal Squamous Cell Carcinoma-1 (NY-ESO-1) together with an invariant natural killer T-cell (iNKT) activator, threitolceramide-6 (IMM60). Process parameters were optimized to obtain polymeric nanovaccine formulations with a mean diameter of 150 ± 50 nm and a polydispersity index <0.2. Formulation characteristics, including encapsulation efficiencies, release profiles and in vitro functional and toxicological profiles, are assessed and statistically compared for each formulation. Overall, scale-up formulations obtained by inline sonication method could replicate the colloidal and functional properties of the nanovaccines developed using batch sonication at the laboratory scale. Both types of formulations induced specific T-cell and iNKT cell responses in vitro without any toxicity, highlighting the suitability of the inline sonication method for the continuous scale-up of nanomedicine formulations in terms of efficacy and safety.

2.
African Health Sciences ; 22(2):85-92, 2022.
Article in English | EMBASE | ID: covidwho-2010438

ABSTRACT

Introduction: Keeping HIV-infected adults away from the health care system during the COVID-19 travel restrictions, presents a challenge to HIV treatment adherence. Methods: This study focused on the initial two phases where Phase 1 designed a Makerere College of Health Sciences (MakCHS) Unstructured Supplementary Service Data (USSD)-based application;and Phase 2 piloted patient enrolment onto the application and determined the feasibility of remote follow-up of patients receiving long-term antiretroviral therapy (ART). Results: A off/online user application, MakCHS Health app, was developed. Overall, 112 patients [(66(59%) female] receiving ART at Mulago ISS clinic, Kampala, were enrolled onto the MakCHS Health app. Up to 89 (80%) utilized the app to access medical help. Patients’ medical queries included needs for drug refills, missed taking HIV medication, medical illnesses, access to COVID-19 vaccination and other personal needs that required clinicians’ attention. Conclusion: Piloting a MakCHS Health application for patient follow-up was feasible and well-received by HIV treatment pro-viders and patients receiving ART. We recommend scale up of the application to enroll all patients receiving long-term treatment for HIV/AIDS, and subsequently expand to. other HIV treatment programs in similar settings.

3.
Harm reduction journal ; 19(1):100, 2022.
Article in English | MEDLINE | ID: covidwho-2009413

ABSTRACT

BACKGROUND: Vaccine-hesitant persons who inject drugs are at increased risk for several vaccine-preventable diseases. However, vaccination rates among this population remain low. While syringe services programs (SSPs) are places where persons who inject drugs feel comfortable accessing services, few offer vaccination services. This study describes facilitators and barriers to vaccination at SSPs. METHODS: We used convenience sampling to conduct semi-structured, qualitative in-depth interviews with 21 SSPs in the USA from June to August 2021. Interview questions asked SSPs about their perceptions, priorities, barriers, facilitators, and the effects of partnerships and policies on vaccine administration. We used deductive thematic analysis to identify the main themes. RESULTS: Eight (n = 8) SSPs offered vaccinations, and thirteen (n = 13) did not offer vaccinations. Most SSPs believed offering vaccination services was important, although addressing SSP participants' immediate needs often took precedence. Staffing, physical space, and logistical issues were the most common barriers to vaccine administration reported by SSPs, followed by SSP participant-related barriers. Facilitators of vaccine administration included access to a tracking system, partnering with agencies or other organizations providing vaccines, and having a licensed vaccination provider on-site. Partnerships provided SSPs opportunities to expand capacity but could also restrict how SSPs operate. Recommended policy changes to facilitate vaccine administration included subsidizing the cost of vaccinations and addressing restrictions around who could administer vaccinations. CONCLUSIONS: Increasing the availability of vaccination services at SSPs requires addressing the varying capacity needs of SSPs, such as tracking systems, licensed vaccinators, and free or low-cost vaccination supplies. While these needs can be met through partnerships and supportive policies, both must consider and reflect cultural competence around the lived experiences of persons who inject drugs.

4.
Journal of Public Health in Africa ; 13:15, 2022.
Article in English | EMBASE | ID: covidwho-2006923

ABSTRACT

Introduction/ Background: There have been low reported cases per population of SARS-CoV-2 in sub-Saharan Africa. Populationbased studies are needed to estimate the true cumulative incidence of SARS-CoV-2 to inform public health interventions. This study estimated SARS-CoV- 2 seroprevalence in four states in Nigeria in October 2020, and two states in June 2021. Methods: We conducted a two-stage cluster sample household survey in Enugu, Gombe, Lagos, and Nasarawa September-October 2020 and Kano and Federal Capital Territory (FCT) in June 2021. Thirty-four enumeration areas (EAs) were randomly sampled per state (30 in Lagos), and 20 households randomly selected per EA. All household members were eligible. Oral and nasopharyngeal swabs were taken for molecular testing and blood collected for antibody testing. Samples were tested on the multi-antigen target Luminex xMAP assay. Results: A total of 3,546 households (>83% of households) and 14,835 individuals (>94% of individuals) participated. In October 2020, SARS-CoV-2 seroprevalence was 25.2% (95% CI:21.8-28.6) in Enugu, 9.3% (95% CI:7.0- 11.5) in Gombe, 23.3% (95% CI:20.5, 26.4) in Lagos, and 18.0% (95% CI:14.4-21.6) in Nasarawa. In June 2021, seroprevalence was 42.6% (95% CI:39.4-45.8) in Kano and 40.3% (95% CI:34.7-45.9) in FCT. By July 2021, <3% of the populations of Kano and FCT had received at least one vaccine dose. Among the 38.9% and 53.1% respectively who indicated they would not take the vaccine, safety concern was the main reason (84.9%, 83.7% respectively). Impact: Population based surveys are important tools to estimate the true seroprevalence of novel pathogens more accurately with predominantly asymptomatic presentation. These surveys provide seroprevalence provide estimates that are not subject to bias from unequal distribution or uptake of testing services during outbreaks for development of accurate public health mitigation measures. Conclusion: Sixteen months in, approximately 60% of the populations of FCT and Kano had no antibodies to SARS-CoV-2, indicating a significant proportion of the population remained vulnerable to infection. Rapid scale-up of vaccine distribution and efforts to encourage vaccine uptake are needed to prevent the emergence of SARS-CoV-2 variants of concern.

5.
Journal of Public Health in Africa ; 13:74-75, 2022.
Article in English | EMBASE | ID: covidwho-2006874

ABSTRACT

Introduction/ Background: May 2021, Kisumu County was affected by a COVID- 19 Delta variant outbreak. For non-resilient health systems with data channels based on paper, such outbreaks are a major challenge. A public-private partnership was initiated in Kisumu, Kenya. This partnership emphasizes digital mobile solutions that have a high potential for scalability. Methods: The partnership was between Kisumu County, KEMRI, PharmAccess, and healthcare facilities to roll out the implementation research. All those accessing tests as per the case definition of the MoH case definition were eligible for inclusion. We digitalized the Ministry of Health COVID-19 Case Identification Form, gathered data in healthcare facilities on digital tools, and shared aggregated results via a co-created (semi-) live dashboard to all relevant stakeholders. We performed descriptive analyses on the data. Additionally, semi-structured interviews with key stakeholders on the experiences of the project will provide qualitative insights. Results: As of November 2021, 32 healthcare facilities are connected to the dashboard, over 23,000 COVID-19 tests have been done with more than 2,800 positive cases: 52% Delta variant, 45% Alpha variant, and 4% Beta variant. All key staff are connected to the digital tools and actively use them for decision-making. Geomapping of cases has shown to be useful for disease surveillance, especially case-tracking. Proper training and technical support for the digital tools and dashboard, co-creation with all users, and having a strong roll-out plan are key for success. Impact: Public-private partnerships offer the possibility of scaling up diagnostic capacity and using technology to track the epidemic in real-time guiding efficient allocation of limited resources in an evidence-based manner, a good step towards epidemic preparedness. Better decision making and targeted action can be taken because of this digitalized systems approach. Conclusion: Digital platforms have a key role to play in epidemics tracking and preparedness. From these outcomes, the digital platform we developed during this study is being scaled up to 14 more counties of Kenya to be used to track the epidemic in a population of over 15 million people.

6.
Journal of Public Health in Africa ; 13:74, 2022.
Article in English | EMBASE | ID: covidwho-2006823

ABSTRACT

Introduction/ Background: The COVID-19 pandemic has impacted public health laboratories with shortages and an increase in the cost of RNA extraction kits. The aim of this project was to develop and validate an RNA extraction kit for use in the diagnosis of SARS-CoV-2 infection to improve COVID-19 testing and surveillance in Nigeria. Methods: The developed kit is based on the spin-column method and named the NIMR Biotech Total RNA Extraction Kit. The kit is intended for RNA extraction from different specimens, including blood, animal tissues, cell lines, bacteria, viruses, and swabs. Analytical validation of the kit for COVID-19 diagnosis was done at six different COVID-19 testing sites on 20 different nasopharyngeal and oropharyngeal specimens, with the results compared using NIMR Biotech. Kit and another commercial RNA extraction kit (spin-column and magnetic-bead based). Results: Validation results showed an average correlation of 93% when compared to other spin-column based kits. When compared with the Qiagen RNA extraction kit, the performance indices of the kit were sensitivity of 94%, specificity of 100%, positive predictive value of 100%, negative predictive values of 94.7%, and accuracy of 95%. The NIMR Biotech total RNA kit showed a good correlation with the DaanGene and the Geneaid extraction kits. In both instances, there was only one disparity between the NIMR Biotech kit and these two kits. Impact: The developed RNA extraction kit from this study provides a suitable and cheaper alternative to high-end, commercially available RNA extraction kits. The adoption of this kit in all COVID-19 testing laboratories in Nigeria, and Africa, will help scale-up COVID-19 testing in Africa. Conclusion: NIMR Biotech's Total RNA extraction kit is sufficiently robust for the extraction of viral and human RNA from oropharyngeal and nasopharyngeal samples. The kit correlates better with the spin-columnbased RNA extraction method when compared to the magnetic-bead-based method and will be useful for monitoring SARS-CoV-2 infection and other RNA viruses.

7.
Molecular Genetics and Metabolism ; 135(4):303-304, 2022.
Article in English | EMBASE | ID: covidwho-2004625

ABSTRACT

Introduction: The impact of the COVID19 pandemic on pediatric neurodevelopmental disorders like mitochondrial disease (MtD) has not been well characterized. Viral infection is a major cause of morbidity in children with MtD. Historically, pediatric patients with MtD experience neurologic decline and metabolic decompensation if exposed to viral infection and families practice strict risk mitigation behavior to avoid infection. As many caregivers of children with MtD are essential workers, the household serves as a transmission risk factor. To better understand SARS-CoV-2 infection in children with MtD, we conducted a serologic study of MtD households. Methods: Families with a child with MtD were shipped a Neoteryx Blood Collection kit. Patient samples came from fifteen states across the United States as well as two European countries. All household individuals provided a dried blood sample which was shipped back for analysis of SARS-CoV-2 antibodies against both the nucleocapsid and the spike protein. Online questionnaires were also distributed to each family to assess exposure risks, MtD severity, and viral symptomatology. These data will allow us to define the status of proximate contacts of children with MtD, as well as symptomatology and asymptomatic infection. Results: Twenty families enrolled with N = 83 samples collected. All 20 families had at least one member with a positive nucleocapsid antibody test. Of the 21 patients with mitochondrial disease, 18 were positive for antibodies against the nucleocapsid antibody. However, of the 14 MtD patients who reported community testing prior to sampling, only one patient with MtD had known a positive test in the community. Of those with positive nucleocapsid antibodies, 29% had a known exposure to someone with COVID-19 infection. Symptomatology analysis concluded that between March of 2020 and the sampling date, 6 patients experienced fever or chills, 2 experienced a new or worsening cough, 1 experienced shortness of breath, 2 experienced pneumonia and 1 presented with muscle or body aches. Conclusion: There is serologic evidence that the majority of families affected by mitochondrial disease have been exposed to COVID19 despite strict risk mitigation behaviors. Of the patients exposed to COVID19, almost all had another family member also exposed, indicating the household as a possible transmission factor. None of these patients experienced hospitalization, neurologic decline, or metabolic decompensation. This implies that patients with mitochondrial disease may be capable of having asymptomatic COVID19 infections and may be able to tolerate this disease without acute decompensation. This may have implications about mitochondrial function in the immune response to COVID19. Future directions for this study include a network scale up model which will aid in making broader generalizations about this disease community through exposure levels.

8.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003371

ABSTRACT

Background: Pediatric admissions in Canada have demonstrated increasing complexity, acuity and subspeciality usage. However, subspecialists are concentrated in urban tertiary centres, forcing rural pediatric patients to travel long distances. Moreover, tertiary centres are in overcapacity while regional sites underutilize pediatric beds. Therefore, our team developed an innovative Telehealth-facilitated Rounding and Consultation Model for Kids (TRaC-K). TRaC-K is currently being piloted between a tertiary pediatric hospital (Alberta Children's Hospital), and a single regional hospital (Medicine Hat Regional Hospital) in the Canadian province of Alberta. To sustain, improve and scale-up the TRaC-K model, it is essential to understand the experiences of those using the model. Hence, the purpose of this study was to understand tertiary and regional site clinician experiences with providing inpatient clinical care using the TRaC-K model. Methods: This qualitative study was conducted after 3 months of piloting the TRaC-K model. Clinicians with the experience of using TRaC-K at tertiary and regional hospitals were recruited to participate in focus groups. These focus groups were conducted virtually to elicit their perspectives, experiences, and suggestions regarding the model. NVivo 12 was used to conduct inductive thematic analysis. The Donabedian model, a conceptual model commonly used for examining health services and evaluating quality of health care based on structure, process and outcomes was used as the framework to thematically analyze the qualitative data. Preliminary findings of this study are reported here. Results: In total, 15 clinicians participated in 6 focus groups across the two sites. Participants included physicians, nurses and allied health professionals. In terms of structure, clinicians identified that various members were involved in TRaC-K. The model aided in connecting multidisciplinary care teams from both hospitals as well as families, promoting inclusive participation. The telehealth monitor was easy to maneuver with good audio and visual quality. However, technology improvements included integrating TRaC-K with other platforms such as Zoom and providing captions. Regarding process, the onset of the COVID-19 pandemic and shift towards virtual health increased the applicability and uptake of the program. The clinicians suggested operational improvements such as off- hours availability, role clarifications, and more clearly defined goals. Despite suggested improvements, the program was easy to use and had beneficial outcomes such as collaborative decision making between the sites which increased confidence in inter-hospital transfer. Clinicians expressed that the program had the potential to be expanded into other patient populations and sites. Conclusion: These findings indicate that the users of the TRaC-K model felt that it was feasible and reported positive perceptions and experiences using TRaC-K. The findings from this study would help develop similar models to provide pediatric inpatient clinical care to rural children in other parts of the world.

9.
BioPharm Int. ; 35:10-15, 2022.
Article in English | EMBASE | ID: covidwho-1995149
10.
Journal of Hepatology ; 77:S225, 2022.
Article in English | EMBASE | ID: covidwho-1967499

ABSTRACT

Background and aims: The natural history of Hepatitis C Virus (HCV) demonstrates an asymptomatic disease that often leads to liver degeneration in approximately three decades. In HIV/HCV coinfection, liver degeneration is accelerated with decompensated cirrhosis occurring in less than two decades resulting in higher mortality rates. The asymptomatic nature of HCV, increased rate of disease progression in HIV, low awareness, and poor care seeking behaviour emphasizes the need to improve HCV case finding in People Living with HIV (PLHIV). In Nigeria, the Nasarawa State Government has committed to HCV elimination, with an initial focus on PLHIV, necessitating integration of services to screen ART patients for HCV. However, due to the COVID pandemic and the resultant scale-up of Differentiated Service Delivery (DSD) models within the HIV program, screening yield from facility-based case finding reduced significantly. To ensure last mile linkage to HCV screening, the Patient Navigator pilot was conducted from March-October 2021. This analysis aims to assess screening coverage before and during this pilot period. Method: One healthcare worker across three secondary facilities i.e., General Hospitals Keana, Awe, and Uke, labelled patient navigator (PN) was charged with the responsibility of identifying unscreened PLHIV using facility screening records and enrolment data. These PNs were HIV program defaulter trackers, consequently integrating this service within the HIV program. The PN employed strategic patient tracking approaches like phone calls, community engagements and peer group meetings. Using laboratory screening registers, screening progress was compared pre-intervention (July 2020 to February 2021) versus during the intervention (March to October 2021). Results: A total of 125, 560, and 923 were active on ART care as of January 2020 in General Hospitals Keana, Awe, and Uke respectively. Across sites, the first 4 months of the pre-intervention phase sawhigh screening numbers as all available patients presenting to facilities were screened. Subsequently, a decline in screening numbers across all facilities. However, the intervention phase demonstrated extended coverage, reaching the last mile patients leading to an increase in case finding by 18% in GH Keana, and 23% in GH Awe and GH Uke respectively. (Figure Presented) Conclusion: The use of patient navigators demonstrates the feasibility and cost-effectiveness of increasing case-finding through HCV/HIV program integration.

11.
Pharmaceutical Technology ; 45(11):34-40, 2021.
Article in English | EMBASE | ID: covidwho-1935337
12.
European Journal of Obstetrics and Gynecology and Reproductive Biology ; 273:e9-e10, 2022.
Article in English | EMBASE | ID: covidwho-1926418

ABSTRACT

I am truly honored to be invited to present during the lecture named after Prof. Lazlo von Dobszay, who was a remarkable Hungarian PAG Pioneer. This lecture will highlight the HPV vaccination path, where it comes from (from Good), where it stands today (to Great) and what it can expect in the years to come (to Excellent) HPV is a virus we can all beat, if we want to and if we put in the necessary effort. Yes, we can, … but unfortunately on our way we have encountered a game changer: the COVID pandemic. As a result of this roadblock, there is a worldwide HPV Coverage Gap. This worldwide crisis will affect health care for many years. Now we have to be fast and effective to get the HPV coverage back on track. Only then can we achieve the goal to fully vaccinate 80% of the adolescents, in order to obtain a herd immunity. Infections with human papillomavirus (HPV) constitute an important source of morbidity and mortality worldwide in people of all ages and genders. The HPV induced cancers show a remarkable trend with e.g. a greater incidence of head and neck cancers as compared to cervical cancers Gender neutral protection against HPV-related diseases is our moral duty. The success of that protection heavily depends on the timing of vaccination, especially before and even after unplanned exposure. Child sexual abuse requires even faster HPV action, the sooner the better. Unfortunately, HPV vaccine supplies are currently insufficient to meet the demand and some countries have already postponed its administration. Running out of vaccines is a reality, increases in supplies are imperative Recent research focuses on the non-inferiority of one versus two doses of the vaccine. If one-dose HPV vaccination became viable, some of the significant barriers to scaling-up and sustaining Low Income Countries/Low- and Middle Income Countries may be overcome. The limitations of preventive vaccines justify continuous innovation and adaptation of vaccination strategies.

13.
Australian and New Zealand Journal of Psychiatry ; 56(SUPPL 1):40-41, 2022.
Article in English | EMBASE | ID: covidwho-1916647

ABSTRACT

Background: Healthcare workers experience burnout, psychological distress and suicide at higher rates than the general population. The stressors inherent to these professions have been magnified during the COVID-19 pandemic. In response, in early 2020, a group of doctors, nurses and allied health practitioners developed Handn- Hand Peer Support Inc. (Helping Australian and New Zealand Nurses and Doctors). Objectives: This programme provides group or one-toone peer support to colleagues in a pre-clinical setting and aims to reduce the rates of distress and improve the wellbeing of its participants. In addition, Hand-n-Hand aims to provide effective peer support training to facilitators to ensure healthcare workers are appropriately supported. Methods: Data have been collected using quantitative and qualitative means since Hand-n-Hand's inception to monitor the uptake of peer support over time and impact on healthcare worker well-being. Social media and website traffic statistics have been monitored and compared to national lockdowns, COVID-19 outbreaks and referrals to Hand-n-Hand. Baseline confidential data has also been collected from each participant and facilitator who signs up for peer support. Finally, a mixed-methods survey has been provided to all participants for quality assessment purposes in addition to targeted interviews with volunteer group facilitators. Findings: There has been consistent uptake of Hand-n- Hand's peer support programme across various platforms. Hand-n-Hand has a strong social media presence and the Facebook peer support group continues to grow. More than 200 healthcare workers have referred themselves for small group or one-to-one peer support since March 2020. More than 90 healthcare workers have taken part in peer support training delivered by the team at Handn- Hand. Participants and group facilitators alike have found involvement with Hand-n-Hand beneficial for their well-being and personally rewarding. Based on the initial feedback, Hand-n-Hand will be expanding to incorporate medical schools in the peer support process from 2022, beginning with James Cook University and aim to reach colleagues in more isolated areas of practice such as rural and remote Australia. Conclusion: Hand-n-Hand began as a simple idea but has evolved into a bi-national early intervention pre-clinical support service for healthcare workers. Requests for peer support continue to increase and long-term funding solutions are imperative to ensure Hand-n-Hand can scale up its operations to meet the demand of the population.

14.
Vox Sanguinis ; 117(SUPPL 1):20-21, 2022.
Article in English | EMBASE | ID: covidwho-1916335

ABSTRACT

In response to the recommendations of WHA63.12 (2010) resolution on availability, safety and quality of blood products, the World Health Organization has steadily implemented numerous initiatives over the years to assist countries in building and strengthening their national blood systems, although with uneven success. In February 2020, WHO has developed the WHO Action Framework to Advance Universal Access to Safe, Effective and Quality-Assured Blood Products 2020-2023, which proposes a renewed effort to scale up programme implementation and improve access to blood products. The Framework aims to provide strategic direction to global efforts to address barriers to safety and availability of blood products and focuses on six strategic objectives: (1) an appropriately structured, well-coordinated and sustainably resourced national blood system;(2) an appropriate national framework of regulatory controls;(3) functioning and efficiently managed blood services;(4) effective implementation of patient blood management to optimize clinical practice of transfusion;(5) effective surveillance, haemovigilance and pharmacovigilance;and (6) partnerships, collaboration and information exchange to achieve key priorities and jointly address challenges and emerging threats at global, regional and national levels. During 2020-2021, to achieve these strategic objectives, some activities have been conducted, in the form of development written guidance as well as country assistance. Guidance on Centralization of blood donation testing and processing, and guidance on Increasing supply of plasma-derived medicinal products (PDMPs) in LMICs through fractionation of domestic plasma;Education Module on Update clinical use of blood and Policy Brief on the urgent need to implement Patient Blood Management have been published and disseminated through webinars. To assist country in implementation of WHO guidance, webinars on strengthening blood system through effective blood regulation, online training on haemovigilance system and on self-assessment using the Global Benchmarking Tools plus Blood have already been conducted. Assistance has also been given to Egypt in developing a plan for plasma fractionation. Some challenges to implement the action framework at country level still exist, for example, weak government support and commitment to the blood program, limited resources, and the Covid-19 pandemic, which hinders holding face to face meetings which are still effective for some activities. Currently some guidance is under development, and the Achilles Project, which is a WHO project to assist country in improving quality of their plasma for fractionation, will be run in Senegal, in collaboration with the International Coalition led by ISBT. As soon as the Covid-19 pandemic situation allows for face-to-face meetings, country assistance in the form of training, country visit for assessment and twinning program will be increased, to accelerate implementation of the action framework at country level.

15.
Journal of Paediatrics and Child Health ; 58(SUPPL 2):124, 2022.
Article in English | EMBASE | ID: covidwho-1916241

ABSTRACT

Background: COVID-19 and associated public health measures in low- and middle-income countries (LMIC) in the Asia Pacific Region have resulted in significant health service disruptions including disruption to MPDSR systems. Reports indicate maternal and perinatal mortality is rising due to both direct and indirect pandemic responses. Methods: We undertook a rapid stocktake process to understand the impact of COVID-19 on service provision and MPDSR. Data were collected by survey of 22 countries utilising a Likert scale measuring respondents' agreement with statements regarding MPDSR practices and health service disruptions. UNFPA representatives in identified countries were responsible for completing the survey. Results: Seventeen of the 22 country surveys were returned. Most frequently reported disruptions to MPDSR systems were lack of completion or delay of death reviews at both facility and country level and decreases in number of community death notifications. Redeployment of both maternity staff and those responsible for MPDSR activities was identified as a key issue. More than half of countries reported that MPDSR key contacts were redeployed to other COVID-19 duties. Countries where MPDSR had been in use for greater than 5 years reported less disruptions. Other COVID-19 related service disruptions included shortages of life-saving drugs, reduced operating theatre availability, and difficulty accessing emergency transport. Conclusions: Countries with embedded MPDSR systems and early prioritisation of maternal and newborn health reported less service disruptions. Urgent investment is needed to strengthen and scale up MPDSR processes to ensure that gains made prepandemic reducing global maternal and newborn deaths will not be lost.

16.
Textbook of Zoonoses ; n/a(n/a):192-197, 2022.
Article in English | Wiley | ID: covidwho-1913744

ABSTRACT

Summary Coronaviruses (CoVs) are important pathogens for humans and vertebrate animals. These viruses can infect the respiratory, gastrointestinal, hepatic and central nervous system of humans, livestock, birds, bats and other wild animals. The CoVs have frequently crossed species barriers and some have emerged as important human pathogens. Bats are well adapted anatomically and physiologically to CoVs. During the twenty-first century, the world has witnessed two pandemics of coronaviruses (SARSCoV and SARS-CoV-2) and fatal sporadic outbreaks due to the emerging Middle East respiratory syndrome-CoV. Most of the coronaviruses are transmitted through respiratory droplets during coughing or sneezing. Transmission through the ocular surface is also possible. Animal CoVs have been known since the late 1930s. Various diagnostic tests are available for the detection of coronaviruses infection which is mainly based on antigen detection or specific antibody detection. During the development of a SARS-CoV-2 vaccine candidate, at the height of the COVID-19 pandemic, raw materials shortages, including chromatography resins, necessitated the determination of a cleaning in place (CIP) strategy for a multimodal core-shell resin both rapidly and efficiently. Here, we describe the deployment of high throughput (HT) techniques to screen CIP conditions for cleaning Capto? Core 700 resin exposed to clarified cell culture harvest of a SARS-CoV-2 vaccine candidate produced in Vero adherent cell culture. The best performing conditions, comprised of 30% n-propanol and ≥0.75 N NaOH, were deployed in cycling experiments, completed with miniature chromatography columns, to demonstrate their effectiveness. The success of the CIP strategy was ultimately verified at the laboratory scale. Here, its impact was assessed across the entire purification process which also included an ultrafiltration/diafiltration step. It is shown that the implementation of the CIP strategy enabled the re-use of the Capto Core 700 resin for up to ten cycles without any negative impact on the purified product. Hence, the strategic combination of HT and laboratory-scale experiments can lead rapidly to robust CIP procedures, even for a challenging to clean resin, and thus help to overcome supply shortages. This article is protected by copyright. All rights reserved

17.
Biotechnol J ; : e2200191, 2022 Jun 30.
Article in English | MEDLINE | ID: covidwho-1905797

ABSTRACT

During the development of a SARS-CoV-2 vaccine candidate, at the height of the COVID-19 pandemic, raw materials shortages, including chromatography resins, necessitated the determination of a cleaning in place (CIP) strategy for a multimodal core-shell resin both rapidly and efficiently. Here, the deployment of high throughput (HT) techniques to screen CIP conditions for cleaning Capto Core 700 resin exposed to clarified cell culture harvest (CCCH) of a SARS-CoV-2 vaccine candidate produced in Vero adherent cell culture are described. The best performing conditions, comprised of 30% n-propanol and ≥0.75 N NaOH, were deployed in cycling experiments, completed with miniature chromatography columns, to demonstrate their effectiveness. The success of the CIP strategy was ultimately verified at the laboratory scale. Here, its impact was assessed across the entire purification process which also included an ultrafiltration/diafiltration step. It is shown that the implementation of the CIP strategy enabled the re-use of the Capto Core 700 resin for up to 10 cycles without any negative impact on the purified product. Hence, the strategic combination of HT and laboratory-scale experiments can lead rapidly to robust CIP procedures, even for a challenging to clean resin, and thus help to overcome supply shortages.

18.
Topics in Antiviral Medicine ; 30(1 SUPPL):373, 2022.
Article in English | EMBASE | ID: covidwho-1880996

ABSTRACT

Background: HIV prevalence in 15-64-year-olds in Migori County remains high at 13%, nearly 2.7 times higher than the national prevalence (4.9%) and 28% of all new HIV infections were among adolescent 10-19 years, while 52% were young people age 15-24 years. LVCT Health STEPS project implemented the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) program in 12 wards in Migori County with a goal of reducing new HIV infections among adolescent girls and young women (AGYW) aged 10-24 years. A combination of evidence-based behavioral, structural, and biomedical interventions were delivered through the safe space (SS) model. Methods: The DREAMS program mobilized, screened for HIV vulnerability, enrolled and offered services to eligible AGYW between June 2017 and June 2021. Mentors, facilitators, and health service providers were trained and engaged to provide mandatory primary and need-based secondary interventions in community spaces considered to be safe from harassment, where AGYW could have fun, relax, display talents, and express themselves. AGYW were segmented based on age categories, geographic location, marital, and schooling status. Due to COVID-19 pandemic, AGYW participation was reduced from 30 to 15 and SS held in open spaces while observing ministry of health protocols. Service completion data was uploaded in DREAMS database, exported, and analysed in Excel. Results: By June 2021, 1,206 SS were established. A total of 52,477 AGYW were screened for vulnerability and 93% (47,587) enrolled in DREAMS. Majority, 83% (39,603) were active at SS and received primary age-based interventions including: 96% (38,064) gender-based violence (GBV) screening, 98% (38,960) financial literacy training, 97% (38,283) school/community-based HIV and violence prevention intervention. Of the 30,759 AGYW eligible for HIV testing services (HTS), 95% received HTS, 98% (30,067) PrEP education, 99% (30,356) contraceptive method mix education, 99% (30,318) condom education and 79% (9,388) received entrepreneurship training. AGYW were prioritized for secondary interventions. Of 2,339 eligible for PrEP, 89% were initiated, among 5,097 sexually active, 99% received contraceptives. Additionally, 92% (17,778) were supported on education subsidy and 60% (7,718) on economic strengthening, and of those disclosing GBV, 100% (16,560) received post violence care. Conclusion: Safe spaces are platforms for scaling up comprehensive HIV prevention interventions among AGYW.

19.
Topics in Antiviral Medicine ; 30(1 SUPPL):357-358, 2022.
Article in English | EMBASE | ID: covidwho-1880895

ABSTRACT

Background: After COVID-19 shelter-in-place (SIP) orders on 3/16/2020, viral suppression (VS) rates initially decreased within a safety-net HIV clinic in San Francisco, with greater decreases among homeless people living with HIV (PLWH). We sought to understand if (1) proactive outreach to provide social services, (2) scaling up of in-person visits for most patients and drop-in visits at the clinic, and (3) expansion of housing programs could reverse this decline. Methods: We assessed VS 24 months before and 13 months after SIP using mixed-effects logistic regression and propensity score methods, followed by interrupted time series (ITS) analysis to examine changes in the rate of viral suppression per month. Loss to follow-up was assessed via active clinic outreach and tracing using Kaplan-Meier methods. Results: The cohort contained 1816 patients with a median age of 51;12% female, 14% unstably housed, and 15% with CD4+-cell counts <200 cells/mm3. The adjusted odds of VS increased 1.34-fold following the intervention (95% CI: 1.21-1.46), with similar results using inverse probability weighting (adjusted odds ratio (AOR) 1.31;95% CI: 1.17-1.46). Results from the ITS analysis show that the odds of VS continuously increased by 1.05-fold per month over the post-intervention period (95% CI: 1.01-1.08, Figure). Proactive phone outreach successfully reached 90.0% of the clinic to offer services. The one-year cumulative loss to follow-up rate was 3.2% (95% CI: 2.5-3.9%). The proportion of total attended visits that were telephone visits decreased from a maximum of 64.9% to a minimum of 10.1% at the end of the analysis period. The rate of viral load monitoring decreased by 15% after the institution of SIP (95% CI: 0.83-0.88). Among homeless PLWH, the AOR for VS was 1.70 (95% CI: 1.24-2.34) and there was a 5.9% increase in VS per month using ITS methods (95% CI: 1.0-12.3%). Conclusion: After an initial destabilization in VS in a large safety-net clinic following SIP orders, the VS rate increased following scale-up of in-person visits, clinic outreach to patients, intensification of social services during this time, and access to COVID-related housing programs. The loss to follow-up rate was similar or lower compared to prior years. Maintaining in-person care for underserved patients, with flexible telemedicine options, along with provision of social services and permanent expansion of housing assistance programs, will be needed to support VS among underserved populations during the COVID-19 pandemic.

20.
Topics in Antiviral Medicine ; 30(1 SUPPL):300-301, 2022.
Article in English | EMBASE | ID: covidwho-1880872

ABSTRACT

Background: South Africa is one of the African countries most affected by the COVID-19 pandemic. SARS-CoV-2 seroprevalence surveys provide valuable epidemiological information given the existence of asymptomatic cases. We report the findings of the first nationwide household-based population estimates of SARS-CoV-2 seroprevalence among people aged 12 years and older in South Africa. Methods: The survey used a cross-sectional multi-stage stratified cluster design undertaken over two separate time periods (November 2020-February 2021 and April-June 2021) which coincided with the second and third waves of the pandemic in South Africa. The Abbott® and Euroimmun® ani-SARS CoV-2 antibody assays were used to test for SARS-CoV-2 antibodies, the latter being the final result. The survey data was weighted with final individual weights benchmarked against 2020 mid-year population estimates by age, race, sex, and province. Frequencies were used to describe characteristics of the study population and SARS-CoV-2 seroprevalence. Bivariate and multivariate logistics regression analysis were used to identify factors associated with SARS-CoV-2 seropositivity. Results: 13640 participants gave a blood sample. The SARS-CoV-2 seroprevalence using the Euroimmun assay was 19.6% (95% CI 17.9-21.3) over the study period, translating to an estimated 8 675 265 (95% CI 7 508 393-9 842 137) estimated infections among people aged 12 years and older across South Africa by June 2021. Seroprevalence was higher in the Free State (26.8%), and Eastern Cape (26.0%) provinces (Figure). Increased odds of seropositivity were associated with prior PCR testing [aOR=1.29 (95% CI: 0.99-1.66)], being female [aOR=1.28 (95% CI 1.00-1.64), p=0.048] and hypertension, [aOR=1.28 (95% CI 1.00-1.640, p=0.048]. Conclusion: These findings highlight the burden of infection in South Africa by June 2021, and support testing strategies that focus on individuals with known exposure or symptoms since universal testing is not feasible. Females and younger people were more likely to be infected suggesting need for additional strategies targeting these populations. The estimated number of infections was 6.5 times higher than the number of SARS-CoV-2 cases reported nationally, suggesting that the country's testing strategy and capacity partly explain the dynamics of the pandemic. It is therefore essential to bolster testing capacity and to rapidly scale up vaccinations in order to contain the spread of the virus in the country.

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