Causes of death in people living with HIV in the post 95 -95 -95 era: Lessons from five AIDS Healthcare Foundation clinics in Eswatini (preprint)

Background Eswatini has a high HIV prevalence in adults (24.8%), and despite achieving HIV epidemic control, AIDS-related deaths are still high at 200 per 100,000 population. This study, therefore, describes the causes of death among people living with HIV (PLHIV) receiving care at five clinics in Eswatini. Methods Data of clients receiving antiretroviral therapy (ART) from five AIDS Healthcare Foundation (AHF) Clinics in Eswatini who died was analysed to describe the causes of death. Clients' records were included if they received treatment from any of the five clinics from January 1, 2021, to June 30, 2022. Clients' sociodemographic, clinical, and specific cause of death data were extracted from their clinical records into an Excel spreadsheet for mortality reporting and audits. The different causes of death were categorised and descriptive, and comparative analysis was done using Stata 15 and R. Odds ratio significant at p<0.05 (with 95% confidence interval) to estimate the different associations between the client's characteristics and the four leading causes of death. Results Of 257 clients, 52.5% (n=135) were males, and the median age was 47 years (IQR: 38, 59). The leading causes of death were non-communicable diseases (NCDs) (n=59, 23.0%), malignancies (n=37, 14.4%), Covid-19 (n=36, 14.0%) and advanced HIV disease (AHD) (n=24, 9.3%). Patients aged ≥60 years (OR 0.08; 95% CI: 0.004, 0.44) had lower odds of death from AHD than ≥40 years, and those who had been on ART for 12 – 60 months (OR 0.01; 95% CI: 0.0006, 0.06) and >60 months (OR 0.006; 95% CI: 0.0003, 0.029) had lower odds of death from AHD compared to those on ART for <12 months. Patients aged ≥40 years had higher odds of dying from COVID-19, while females (OR 2.64; 95% CI: 1.29, 5.70) had higher odds of death from malignancy. Conclusion Most patients who died were aged 40 years and above and died from an NCD, malignancy, COVID-19 and AHD-related cause. This indicates a need to expandprevention, screening, and integration of treatment for NCDs and cancers into HIV services. Specific interventions targeting younger PLHIV will limit their risks for AHD.

Combinatorial biomedicine: A novel discipline (preprint)

Based on the author’s previous work, this article proposed a novel discipline– combinatorial biomedicine. Currently, there are several classical examples. One is a magic “polypill” covering the “Health Essential (HE) 5”, that is, “environment-sleep-emotion-exercise-diet” intervention [E(e)SEEDi] lifestyle; Another is an innovative “traditional Chinese medicine (TCM) Hot Pot”. In addition, the iRT-ABCDEFG program is indeed suitable for better management of human diseases. In fact, combinatorial biomedicine is pivotal in the development of life science, biology and medicine, in particular the pandemic and post-COVID-19 era, and has obvious advantages in screening, diagnosis, treatments, prevention and rehabilitation of both major non-communicable diseases (such as cardiovascular disease, diabetes, cancer, stroke, and neurodegenerative diseases) and major infectious diseases (such as AIDS, Helicobacter pylori infection, and COVID-19). As a novel discipline, combinatorial biomedicine plays a crucial role in combating human diseases and improving population health. It is about time to propose and establish this novel discipline.

Neurosyphilis with Concomitant Cryptococcal Meningitis in a Patient with AIDS after COVID-19: a case report (preprint)

Background The common infections agents causing meningitis in patients with human immunodeficiency virus (HIV) include Cryptococcus neoformans and Treponema pallidum. Furthermore, there is an elevated risk of meningitis in patients with HIV concomitantly infected with SARS-CoV-2.Case presentation: A 38-year-old male presented with headache and dizziness. After hospitalization, polymerase chain reaction test for SARS-CoV-2 in nasopharyngeal swab was positive, and lumbar puncture revealed neurosyphilis with concomitant cryptococcal meningitis. He underwent Paxlovid, penicillin, antifungal and antiretroviral treatment. The patient had no other neurological symptoms and was stable during the 6-month follow-up period.Conclusions During the COVID-19 pandemic, patients with HIV, particularly those not underwent antiretroviral therapy, are at higher risk for severe infections, including central nervous system complications, due to their compromised immune systems.

The impact of the COVID-19 pandemic on Voluntary Medical Male Circumcision in Gauteng Province, South Africa (preprint)

Objective: Voluntary Medical Male Circumcision (VMMC) has a 60% effectiveness and is cost-effective in preventing HIV/AIDS transmission in Sub-Saharan Africa. However, there is a lack of evidence of the COVID-19 pandemic's potential impact on VMMC in Gauteng province, South Africa. This study aimed to assess the impact of the COVID-19 pandemic on VMMC in Gauteng Province. Method: This was a longitudinal study design. VMMC data was obtained from all public and private hospitals in Gauteng province from the District Health Information System and all medical schemes respectively. The datasets were merged with the years 2019 and 2020 as the before and during COVID-19 periods respectively. Percentage change in VMMC was calculated to demonstrate the effect of the pandemic on VMMC. Results: Provincially, VMMC declined in 2020 by an overall of 33.8% for ≥10 years, 32.4% for 10-14 years, and 35.8% for ≥15 years. All five districts in Gauteng province were affected differently. Exceptionally, the Tshwane Metropolitan district recorded an increase of 21.8% in ≥10 years and 36.0% in 10-14 years. While the other four districts saw a percentage decline in the three age groups, the worst performance was experienced in the West Rand district. Conclusion:  The COVID-19 pandemic had an adverse indirect impact on VMMC in the Gauteng province of South Africa, except in one district. Considering the biomedical evidence and cost-effectiveness of VMMC in reducing HIV/AIDS transmission, there is an urgency to return VMMC post-COVID-19 to its pre-pandemic levels.

Time Series Forecasting of HIV/AIDS in the Philippines Using Deep Learning: Does COVID-19 Epidemic Matter? (preprint)

With a 676% growth rate in HIV incidence between 2010 and 2021, the HIV/AIDS epidemic in the Philippines is the one that is spreading the quickest in the western Pacific. Although the full effects of COVID-19 on HIV services and development are still unknown, it is predicted that such disruptions could lead to a significant increase in HIV casualties. Therefore, the nation needs some modeling and forecasting techniques to foresee the spread pattern and enhance the governments prevention, treatment, testing, and care program. In this study, the researcher uses Multilayer Perceptron Neural Network to forecast time series during the period when the COVID-19 pandemic strikes the nation, using statistics taken from the HIV/AIDS and ART Registry of the Philippines. After training, validation, and testing of data, the study finds that the predicted cumulative cases in the nation by 2030 will reach 145,273. Additionally, there is very little difference between observed and anticipated HIV epidemic levels, as evidenced by reduced RMSE, MAE, and MAPE values as well as a greater coefficient of determination. Further research revealed that the Philippines seems far from achieving Sustainable Development Goal 3 of Project 2030 due to an increase in the nations rate of new HIV infections. Despite the detrimental effects of COVID-19 spread on HIV/AIDS efforts nationwide, the Philippine government, under the Marcos administration, must continue to adhere to the United Nations 90-90-90 targets by enhancing its ART program and ensuring that all vital health services are readily accessible and available.

A Review of Mental Health Burden and Social Determinants of Mental Health Among Adolescent Girls and Young Women in Sub-Saharan Africa (preprint)

Background: Adolescent girls and young women (AGYW) are an important sub-population in sub-Saharan Africa (SSA), where youth account for more than two-thirds of the region’s population. In comparison to their male counterparts, AGYW are at a higher risk of mental health burden. This review aims to review the peer-reviewed evidence on the mental health burden and social determinants of mental health amongst AGYW aged 10- 24 years in the sub-Saharan African context. Methods: Electronic databases including CINAHL, PubMed, Science Direct and Google Scholar were searched to identify peer-reviewed studies focusing on mental health in adolescent girls and young women in the identified context that have been published between 2015 and 2023 in English. Results and Discussion: A total of 39 studies were reviewed. The findings from the review show that the literature on mental health in AGYW identifies several biological, demographic, social, economic, neighbourhood and environmental factors affecting the burden of the issue. Within the context of environmental factors such as the HIV/AIDS epidemic and the more recent COVID-19 pandemic, social determinants of mental health that are unique to or disproportionately affect AGYW such as pregnancy, HIV/AIDS and violence present concerning associations to negative mental health outcomes in different rural and urban settings. Conclusions: The findings of the review shed light on the multifaceted nature of mental health issues and stresses the importance of a targeted approach in addressing mental health in adolescent girls and young women in the region. Recommendations include increased attention towards scaling up mental health research capacity and policy implementation and a focus on community-based interventions addressing factors unique to the target population in resource-poor settings.

SARS-CoV-2 shedding and evolution in immunocompromised hosts during the Omicron period: a multicenter prospective analysis (preprint)

Background: Prolonged SARS-CoV-2 infections in immunocompromised hosts may predict or source the emergence of highly mutated variants. The types of immunosuppression placing patients at highest risk for prolonged infection and associated intrahost viral evolution remain unclear. Methods: Adults aged >18 years were enrolled at 5 hospitals and followed from 4/11/2022-2/1/2023. Eligible patients were SARS-CoV-2 positive in the previous 14 days and had a moderate or severely immunocompromising condition or treatment. Nasal specimens were tested by rRT-PCR every 2-4 weeks until negative in consecutive specimens. Positive specimens underwent viral culture and whole genome sequencing. A Cox proportional hazards model was used to assess factors associated with duration of infection. Results: We enrolled 150 patients with: B cell malignancy or anti-B cell therapy (n=18), solid organ or hematopoietic stem cell transplant (SOT/HSCT) (n=59), AIDS (n=5), non-B cell malignancy (n=23), and autoimmune/autoinflammatory conditions (n=45). Thirty-eight (25%) were rRT-PCR positive and 12 (8%) were culture-positive [≥]21 days after initial SARS-CoV-2 detection or illness onset. Patients with B cell dysfunction had longer duration of rRT-PCR positivity compared to those with autoimmune/autoinflammatory conditions (aHR 0.32, 95% CI 0.15-0.64). Consensus (>50% frequency) spike mutations were identified in 5 individuals who were rRT-PCR positive >56 days; 61% were in the receptor-binding domain (RBD). Mutations shared by multiple individuals were rare (<5%) in global circulation.

Clinical and laboratory features of COVID-19 illness and outcomes in immunocompromised individuals during the first pandemic wave in Sydney, Australia (preprint)

People with immunocompromising conditions are at increased risk of SARS-CoV-2 infection and mortality, however early in the pandemic it was challenging to collate data on this heterogenous population. We conducted a registry study of immunocompromised individuals with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection from March - October 2020 in Sydney, Australia to understand clinical and laboratory outcomes in this population prior to the emergence of the Delta variant. 27 participants were enrolled into the study including people with a haematologic oncologic conditions (n=12), secondary immunosuppression (N=8) and those with primary or acquired immunodeficiency (i.e. HIV; N=7). All participants had symptomatic COVID-19 with the most common features being cough (64%), fever (52%) and headache (40%). Five patients demonstrated delayed SARS-CoV-2 clearance lasting three weeks to three months. The mortality rate in this study was 7% compared to 1.3% in the state of New South Wales Australia during the same period. This study provides data from the first eight months of the pandemic on COVID-19 outcomes in at-risk patient groups.

Exploring Perceptions of Pregnant Women on Antenatal Care visit during their First Trimester at Area 25 Health Center in Lilongwe, Malawi – A Qualitative Study (preprint)

Background Initiation of antenatal care during the first trimester is crucial for reducing maternal and neonatal morbidity and mortality. Unfortunately, only 24% of pregnant women in Malawi initiate antenatal care during this time with even lower rates of 15% at Area 25 Health Centre in Lilongwe. Despite such cases, there is scarce literature on obstacles that prevent women from accessing first-trimester antenatal care in Malawi.Aim To explore perceptions of pregnant women and how they influence attendance during the first-trimester at Area 25 Health Centre in Lilongwe, Malawi.Methods We employed a qualitative exploratory study on 55 purposely identified pregnant women, aged between 18 and 42 years with gestational period of up to 36 weeks who were attending antenatal care at Area 25 Health Centre in Lilongwe urban, Malawi. Data was collected through a total of 15 In-depth Interviews (IDIs) and four Focus Group Discussions (FGDs) and were manually analyzed using thematic analysis, which included categorization and deductive theme identification with reference to the study objectives and the Health Belief Model (HBM).Results Pregnant women perceived that the first-trimester antenatal care visits are only for those experiencing ill health conditions like backache, headache, and HIV/AIDS during pregnancy. First trimester pregnancy was perceived as too small not worthy of seeking antenatal care, the women placed a low value on it. Majority of those who initiated antenatal care in the first trimester had previously experienced disorders and complications such as previous caesarean section and abortions. In addition to limited knowledge about the required total number of ANC visit, challenges such as long-distance, preoccupation with business, multiple antenatal visits, scheduling of antenatal care visits, negative attitude of health workers, adherence to COVID-19 containment measures, and inadequate partner support were identified as barriers to seeking early antenatal care.Conclusion Negative perceptions among pregnant women, coupled with various economic and infrastructure barriers, attribute to low attendance rates for first trimester antenatal care in Malawi. Addressing knowledge gaps and overcoming barriers related to economic, infrastructure and health care delivery can improve women’s early antenatal care visits. Future research should consider including pregnant women from diverse socioeconomic backgrounds to gain a better understanding of these perceptions and barriers.

Sexuality and prevention among men who have sex with men in the contexts of the AIDS and COVID-19 pandemics. / Sexualidade e prevenção entre homens que fazem sexo com homens nos contextos das pandemias de AIDS e da Covid-19.

This essay reflects on sexual practices and prevention in the contexts of the AIDS and COVID-19 pandemics. It analyses data collected between July and October 2020 through participant observation, as part of an ethnographic research project on HIV vulnerability and prevention among men who have sex with men in the Metropolitan Region of Recife, state of Pernambuco (PE), Brazil. The results point to the relevance of physical appearance and the affective bond between partners in engendering emotions that mediate coping with the risk of infection during both pandemics. It indicates the need to incorporate those communicational dimensions into informational materials to make them more effective.

Este ensaio reflete sobre práticas sexuais e prevenção nos contextos das pandemias de AIDS e da COVID-19. Analisa dados coletados entre julho e outubro de 2020, por meio de observação participante, no âmbito de uma pesquisa etnográfica sobre vulnerabilidade e prevenção ao HIV entre homens que fazem sexo com homens da Região Metropolitana do Recife. Os resultados apontam para a relevância da aparência corporal e da vinculação afetiva entre os parceiros no engendramento de emoções que medeiam a lida com risco de infecção em ambas as pandemias. Sinaliza para a necessidade de incorporar essas dimensões comunicacionais em materiais informativos, de modo a torná-los mais eficazes.

Efficacy and Durability of Dolutegravir- or Darunavir-Based Regimens in ART-Naïve AIDS- or Late-Presenting HIV-Infected Patients.

BACKGROUND: Since limited data are available, we aimed to compare the efficacy and durability of dolutegravir and darunavir in advanced naïve patients. METHODS: Retrospective multicenter study including AIDS- or late-presenting (def. CD4 ≤ 200/µL) HIV-infected patients starting dolutegravir or ritonavir/cobicistat-boosted darunavir+2NRTIs. Patients were followed from the date of first-line therapy initiation (baseline, BL) to the discontinuation of darunavir or dolutegravir, or for a maximum of 36 months of follow-up. RESULTS: Overall 308 patients (79.2% males, median age 43 years, 40.3% AIDS-presenters, median CD4 66 cells/µL) were enrolled; 181 (58.8%) and 127 (41.2%) were treated with dolutegravir and darunavir, respectively. Incidence of treatment discontinuation (TD), virological failure (VF, defined as a single HIV-RNA > 1000 cp/mL or two consecutive HIV-RNA > 50 cp/mL after 6 months of therapy or after virological suppression had been achieved), treatment failure (the first of TD or VF), and optimal immunological recovery (defined as CD4 ≥ 500/µL + CD4 ≥ 30% + CD4/CD8 ≥ 1) were 21.9, 5.2, 25.6 and 1.4 per 100 person-years of follow-up, respectively, without significant differences between dolutegravir and darunavir (p > 0.05 for all outcomes). However, a higher estimated probability of TD for central nervous system (CNS) toxicity (at 36 months: 11.7% vs. 0%, p = 0.002) was observed for dolutegravir, whereas darunavir showed a higher probability of TD for simplification (at 36 months: 21.3% vs. 5.7%, p = 0.046). CONCLUSIONS: Dolutegravir and darunavir showed similar efficacy in AIDS- and late-presenting patients. A higher risk of TD due to CNS toxicity was observed with dolutegravir, and a higher probability of treatment simplification with darunavir.

Tuberculosis in Poland in 2020.

AIM OF THE STUDY: To evaluate the main features of epidemiology of tuberculosis (TB) in 2020 in Poland and to compare with the situation in the European Union and European Economic Area (EU/EEA) countries. MATERIAL AND METHODS: Analysis of case-based data on TB patients from National TB Register, data on anti-TB drug susceptibility in cases notified in 2020, data from Statistics Poland on deaths from tuberculosis in 2019, data from National Institute of Public Health NIH - National Research Institute (NIPH NIH - NRI) on HIV-positive subjects for whom TB was an AIDS-defining disease, data from the report "European Centre for Disease Prevention and Control, WHO Regional Office for Europe. Tuberculosis surveillance and monitoring in Europe 2022 - 2020 data. Copenhagen: WHO Regional Office for Europe and Stockholm: European Centre for Disease Prevention and Control; 2022." RESULTS: In 2020, 3,388 TB cases were reported in Poland. The incidence rate was 8.8 cases per 100,000 with large variability between voivodeships from 5.5 to 13.3 per 100,000. A decrease in the incidence was found in 15 voivodeships, the most significant in Slaskie voivodship (63.9%). The number of all pulmonary tuberculosis cases was 3,237 i.e. 8.4 per 100,000. Pulmonary cases represented 95.5% of all TB cases. In 2020, 151 extrapulmonary TB cases were notified (4.5% of all TB cases). Pulmonary tuberculosis was bacteriologically confirmed in 2,573 cases (79.5% of all pulmonary TB cases, the incidence rate 6.7 per 100,000). The number of smear-positive pulmonary TB cases was 1,771 i.e. 4.6 per 100,000 (54.7% of all pulmonary TB cases). In 2020, there were 38 cases (15 of foreign origin) with multidrug resistant TB (MDR-TB) representing 1.6% of cases with known drug sensitivity. The incidence rates of tuberculosis were growing along with increasing age from 0.7 per 100,000 among children (0-14 years) to 15.0 per 100,000 among subjects in the age group 45-64 years, the incidence rate in the age group ≥65 years was 12.1 per 100,000. There were 39 cases in children up to 14 years of age (1.2% of the total) and 49 cases in adolescents between 15 and 19 years of age - rates 0.7 and 2.7 per 100,000 respectively. In 2020, there were 2,506 cases of tuberculosis in men and 882 in women. The TB incidence in men - 13.5 per 100,000 was 3.0 times higher than among women - 4.5. The biggest difference in the TB incidence between the two sex groups occurred in persons aged 50-54 years - 26.8 vs. 4.1 and in age group 55 to 59 years - 28.7 vs. 4.8. In 2020, there were 116 patients of foreign origin among all cases of tuberculosis in Poland (3.4%). In 2019, TB was the cause of death for 456 people (mortality rate - 1.2 per 100,000). CONCLUSIONS: TB incidence in Poland in 2020 was 36.7% lower than in 2019. Such significant declines in the incidence have not been observed in the last two decades. As in previous years, there were differences in incidence rates between voivodeships with an unexpectedly sharp decrease in incidence in Silesia (Slaskie voivodeship). The percentage of tuberculosis cases with bacteriological confirmation exceeded 78%, more than in EU/EEA countries (67.3%). The percentage of MDR-TB cases was still lower than the average in EU/EEA countries (1.6% vs. 3.8%). The highest incidence rates were found in Poland in the older age groups (EU/EEAaged 25 to 44). The percentage of children up to 14 years of age among the total number of TB patients was 1.2%, less than the average in EU/EEA countries (3.8%). The incidence of tuberculosis in men was three times higher than in women in Poland, and six times higher in patients aged 50 to 59. The impact of migration on the TB pattern in Poland has not yet become significant in 2020. The percentage of foreigners among TB patients was 3.4% (33% in EU/EEA countries).

What We Lost in the Fire: Endemic Tropical Heart Diseases in the Time of COVID-19.

The COVID-19 pandemic has profoundly influenced the effort to achieve global health equity. This has been particularly the case for HIV/AIDS, tuberculosis, and malaria control initiatives in low- and middle-income countries, with significant outcome setbacks seen for the first time in decades. Lost in the calls for compensatory funding increases for such programs, however, is the plight of endemic tropical heart diseases, a group of disorders that includes rheumatic heart disease, Chagas disease, and endomyocardial fibrosis. Such endemic illnesses affect millions of people around the globe and remain a source of substantial mortality, morbidity, and health disparity. Unfortunately, these conditions were already neglected before the pandemic, and thus those living with them have disproportionately suffered during the time of COVID-19. In this perspective, we briefly define endemic tropical heart diseases, summarizing their prepandemic epidemiology, funding, and control statuses. We then describe the ways in which people living with these disorders, along with the healthcare providers and researchers working to improve their outcomes, have been harmed by the ongoing COVID-19 pandemic. We conclude by proposing the path forward, including approaches we may use to leverage lessons learned from the pandemic to strengthen care systems for these neglected diseases.

Quantitatively assessing early detection strategies for mitigating COVID-19 and future pandemics (preprint)

Researchers and policymakers have proposed systems to detect novel pathogens early by monitoring samples from hospital patients, wastewater, and air travel, in order to mitigate future pandemics. How much benefit would such systems offer? We developed, empirically validated, and mathematically characterized a quantitative model that simulates disease spread and detection time for any given disease and detection system. We find that hospital monitoring could have detected COVID-19 in Wuhan 0.4 weeks earlier than it was actually discovered, at 2,300 cases compared to 3,400. Wastewater monitoring would not have accelerated COVID-19 detection in Wuhan, but provides benefit in smaller catchments and for asymptomatic or long-incubation diseases like polio or HIV/AIDS. Monitoring of air travel provides little benefit in most scenarios we evaluated. In sum, early detection systems can substantially mitigate some future pandemics, but would not have changed the course of COVID-19.

Impact of COVID-19 on Adolescent HIV Prevention and Treatment Services in the AHISA Network.

We investigated perceived impacts of COVID-19 on the delivery of adolescent HIV treatment and prevention services in sub-Saharan Africa (SSA) by administering a survey to members of the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) from February to April 2021. We organized COVID-19 impacts, as perceived by AHISA teams, under three themes: service interruptions, service adjustments, and perceived individual-level health impacts. AHISA teams commonly reported interruptions to prevention programs, diagnostic testing, and access to antiretroviral therapy (ART). Common service adjustments included decentralization of ART refills, expanded multi-month ART distribution, and digital technology use. Perceived individual-level impacts included social isolation, loss to follow-up, food insecurity, poverty, and increases in adolescent pregnancies and sexually transmitted infections. The need for collaboration among stakeholders were commonly cited as lessons learned by AHISA teams. Survey findings highlight the need for implementation science research to evaluate the effects of pandemic-related HIV service adaptations in SSA.

HIV and AIDS prevention: knowledge, attitudes, practices and health literacy of older persons in the Western Cape and KwaZulu-Natal Provinces, South Africa and in Lesotho.

BACKGROUND: Population ageing and access to anti-retroviral therapies in South Africa have resulted in ageing of the HIV/AIDS epidemic, which has implications for policy, planning and practice. Impactful interventions on HIV/AIDS for older persons require knowledge on effects of the pandemic on this population. A study was undertaken to assess knowledge, attitudes, and practices (KAP) of HIV/AIDS, as well as health literacy (HL) level of a population aged ≥ 50 years. METHODS: A cross-sectional survey was conducted at three sites in South Africa and two sites in Lesotho with an educational intervention at the South African sites. At baseline, data were collected for assessment of KAP of HIV/AIDS and HL levels. The pre- and post-intervention comprised participants at South African sites being familiarised with the contents of a specially constructed HIV/AIDS educational booklet. Participants' KAP was reassessed six weeks later. A composite score of ≥ 75% was considered adequate KAP and an adequate HL level. RESULTS: The baseline survey comprised 1163 participants. The median age was 63 years (range 50-98 years); 70% were female, and 69% had ≤ 8 years' education. HL was inadequate in 56% and the KAP score was inadequate in 64%. A high KAP score was associated with female gender (AOR = 1.6, 95% CI = 1.2-2.1), age < 65 years (AOR = 1.9, 95% CI = 1.5-2.5) and education level (Primary school: AOR = 2.2; 95% CI = 1.4-3.4); (High school: AOR = 4.4; 95% CI = 2.7-7.0); (University/college: AOR = 9.6; 95% CI = 4.7-19.7). HL was positively associated with education but no association with age or gender. The educational intervention comprised 614 (69%) participants. KAP scores increased post intervention: 65.2% of participants had adequate knowledge, versus 36% pre-intervention. Overall, younger age, being female and higher education level were associated with having adequate knowledge about HIV/AIDS, both pre- and post-intervention. CONCLUSIONS: The study population had low HL, and KAP scores regarding HIV/AIDS were poor but improved following an educational intervention. A tailored educational programme can place older people centrally in the fight against the epidemic, even in the presence of low HL. Policy and educational programmes are indicated to meet the information needs of older persons, which are commensurate with the low HL level of a large section of that population.

The Impact of COVID-19 Lockdown on Cases of and Deaths From AIDS, Gonorrhea, Syphilis, Hepatitis B, and Hepatitis C: Interrupted Time Series Analysis.

BACKGROUND: China implemented a nationwide lockdown to contain COVID-19 from an early stage. Previous studies of the impact of COVID-19 on sexually transmitted diseases (STDs) and diseases caused by blood-borne viruses (BBVs) in China have yielded widely disparate results, and studies on deaths attributable to STDs and BBVs are scarce. OBJECTIVE: We aimed to elucidate the impact of COVID-19 lockdown on cases, deaths, and case-fatality ratios of STDs and BBVs. METHODS: We extracted monthly data on cases and deaths for AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C between January 2015 and December 2021 from the notifiable disease reporting database on the official website of the National Health Commission of China. We used descriptive statistics to summarize the number of cases and deaths and calculated incidence and case-fatality ratios before and after the implementation of a nationwide lockdown (in January 2020). We used negative binominal segmented regression models to estimate the immediate and long-term impacts of lockdown on cases, deaths, and case-fatality ratios in January 2020 and December 2021, respectively. RESULTS: A total of 14,800,330 cases of and 127,030 deaths from AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C were reported from January 2015 to December 2021, with an incidence of 149.11/100,000 before lockdown and 151.41/100,000 after lockdown and a case-fatality ratio of 8.21/1000 before lockdown and 9.50/1000 after lockdown. The negative binominal model showed significant decreases in January 2020 in AIDS cases (-23.4%; incidence rate ratio [IRR] 0.766, 95% CI 0.626-0.939) and deaths (-23.9%; IRR 0.761, 95% CI 0.647-0.896), gonorrhea cases (-34.3%; IRR 0.657, 95% CI 0.524-0.823), syphilis cases (-15.4%; IRR 0.846, 95% CI 0.763-0.937), hepatitis B cases (-17.5%; IRR 0.825, 95% CI 0.726-0.937), and hepatitis C cases (-19.6%; IRR 0.804, 95% CI 0.693-0.933). Gonorrhea, syphilis, and hepatitis C showed small increases in the number of deaths and case-fatality ratios in January 2020. By December 2021, the cases, deaths, and case-fatality ratios for each disease had either reached or remained below expected levels. CONCLUSIONS: COVID-19 lockdown may have contributed to fewer reported cases of AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C and more reported deaths and case-fatality ratios of gonorrhea, syphilis, and hepatitis C in China.

'Condoms are hard to get by': access to HIV prevention methods during lockdown of the COVID-19 epidemic in eastern Zimbabwe.

BACKGROUND: In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, health services were disrupted worldwide, including HIV prevention services. While some studies have begun to document the effects of COVID-19 on HIV prevention, little has been done to qualitatively examine how lockdown measures were experienced and perceived to affect access to HIV prevention methods in sub-Saharan Africa. OBJECTIVES: To explore how the COVID-19 pandemic was perceived to affect access to HIV prevention methods in eastern Zimbabwe. METHOD: This article draws on qualitative data from the first three data collection points (involving telephone interviews, group discussions, and photography) of a telephone and WhatsApp-enabled digital ethnography. Data were collected from 11 adolescent girls and young women and five men over a 5-month period (March-July 2021). The data were analysed thematically. RESULTS: Participants reported widespread interruption to their condom supply when beerhalls were shut down as part of a nationwide lockdown. Restrictions in movement meant that participants who could afford to buy condoms from larger supermarkets or pharmacies were unable to. Additionally, the police reportedly refused to issue letters granting permission to travel for the purpose of accessing HIV prevention services. The COVID-19 pandemic was also described to obstruct the demand (fear of COVID-19, movement restrictions) and supply (de-prioritised, stock-outs) for HIV prevention services. Nonetheless, under certain formal and informal circumstances, such as accessing other and more prioritised health services, or 'knowing the right people', some participants were able to access HIV prevention methods. CONCLUSION: People at risk of HIV experienced the COVID-19 epidemic in Zimbabwe as disruptive to access to HIV prevention methods. While the disruptions were temporary, they were long enough to catalyse local responses, and to highlight the need for future pandemic response capacities to circumvent a reversal of hard-won gains in HIV prevention.

mRNA vaccines: a new opportunity for malaria, tuberculosis and HIV.

The success of the first licensed mRNA-based vaccines against COVID-19 has created a widespread interest on mRNA technology for vaccinology. As expected, the number of mRNA vaccines in preclinical and clinical development increased exponentially since 2020, including numerous improvements in mRNA formulation design, delivery methods and manufacturing processes. However, the technology faces challenges such as the cost of raw materials, the lack of standardization, and delivery optimization. MRNA technology may provide a solution to some of the emerging infectious diseases as well as the deadliest hard-to-treat infectious diseases malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), for which an effective vaccine, easily deployable to endemic areas is urgently needed. In this review, we discuss the functional structure, design, manufacturing processes and delivery methods of mRNA vaccines. We provide an up-to-date overview of the preclinical and clinical development of mRNA vaccines against infectious diseases, and discuss the immunogenicity, efficacy and correlates of protection of mRNA vaccines, with particular focus on research and development of mRNA vaccines against malaria, tuberculosis and HIV.