Impact of the DREAMS Program on New HIV Diagnoses in Adolescent Girls and Young Women Attending Antenatal Care - Lesotho, 2015-2020.

Lesotho is a small, landlocked country in southern Africa with a population of approximately 2 million persons, approximately two thirds of whom live in rural areas (1). Lesotho has the second highest prevalence of HIV infection in the world (2). In 2017, 25.6% of persons aged 15-59 years living in Lesotho were HIV-positive (3). Strategies implemented in recent years to control HIV include efforts to reduce mother-to-child transmission and improve coverage with antiretroviral therapy, as well as increasing testing for HIV. Among persons aged 15-24 years, the HIV prevalence among females in 2017 (11.1%) was approximately three times that among males (3.4%) (3). The Determined, Resilient, Empowered, AIDS-Free, Mentored, and Safe (DREAMS)* program in Lesotho was started during October 2016 in two districts. DREAMS comprises a package of biomedical, behavioral, and structural interventions to address factors that make adolescent girls and young women vulnerable to HIV acquisition (4). The goal of the DREAMS program was to decrease HIV incidence among adolescent girls and young women by 25% after 1 year and by 40% after 2 years (4). After 3.5 years of program implementation in Lesotho, new HIV diagnoses among adolescent girls and young women attending antenatal care (ANC) decreased 71.4% in the two districts that implemented DREAMS compared with a reduction of 48.4% in three comparison districts without the program (p = 0.002). During 2016-2020, reductions in new HIV diagnoses among adolescent girls and young women attending ANC in Lesotho have been substantial, both in districts that have and have not implemented the DREAMS program (DREAMS and non-DREAMS districts). Apart from the DREAMS program, the decrease in new HIV diagnoses might be a result of the reduction in viral load in the population because more persons living with HIV infection became virally suppressed while on antiviral therapy, as well as other interventions such as preexposure prophylaxis, voluntary medical male circumcision, behavior change, and increased HIV diagnostic coverage.

Human Papillomavirus Vaccination Coverage Among School Girls in a Demonstration Project - Botswana, 2013.

What is already known on this topic? Human papillomavirus (HPV) infection is common and aggressive in persons infected with human immunodeficiency virus (HIV). With an HIV prevalence of 28% among females aged 15­49, cervical cancer is the leading cause of cancer death among women in Botswana. Before 2013, HPV vaccine had not been used in the public sector in Botswana.What is added by this report? Efforts to expand services for cervical cancer through the Pink Ribbon Red Ribbon initiative focused on HPV-related disease in Botswana. A demonstration project for HPV vaccination was developed by the Ministry of Health for school girls aged ≥9 years in primary schools in one community. A total of 1,967 (79%) of 2,488 eligible girls received 3 doses of vaccine in the immunization effort that was centered in schools.What are the implications for public health practice? Preventing HPV infection in girls is an important component of a national comprehensive cervical cancer control program. HPV vaccination programming is challenging, and demonstration projects can prepare countries for national introduction. The success of the initial HPV vaccination effort in Botswana led to an expanded project in 2014, with implementation of nationwide rollout of the HPV vaccine in 2015. It might be beneficial for future HPV vaccination campaigns to include strategies to reach out-of-school girls.

Injury Prevention Practices as Depicted in G- and PG-Rated Movies, 2008-2012.

Unintentional injuries are the leading cause of death among children in the United States. The use of recommended safety practices can reduce injuries. Children often learn behaviors from media exposure. Children's movies released in 1995-2007 infrequently depicted appropriate injury prevention practices. The aim of this study was to determine if injury prevention practices in children's movies have improved. The top grossing 25 G- and PG-rated movies in the United States per year for 2008-2012 were eligible for inclusion in the study. Movies or scenes were excluded if they were animated, not set in the present day, fantasy, documentary, or not in English. Injury prevention practices involving riding in a motor vehicle, walking, boating, bicycling, and four other activities were recorded for characters with speaking roles. Fifty-six (45%) of the 125 movies met the inclusion criteria. A total of 603 person-scenes were examined involving 175 (29%) children and 428 (71%) adults. Thirty-eight person-scenes involved crashes or falls, resulting in four injuries and no deaths. Overall, 59% (353/603) of person-scenes showed appropriate injury prevention practices. This included 313 (70%) of 445 motor-vehicle passengers who were belted; 15 (30%) of 50 pedestrians who used a crosswalk, 2 (7%) of 30 boaters who wore personal flotation devices, and 8 (29%) of 28 bicyclists who wore helmets. In comparison with previous studies, there were significant increases in usage of seat belts, crosswalks, personal flotation devices, and bicycle helmets. However, 41% of person-scenes still showed unsafe practices and the consequences of those behaviors were infrequently depicted.

Follow-up of infants diagnosed with HIV - Early Infant Diagnosis Program, Francistown, Botswana, 2005-2012.

The 2011 prevalence of human immunodeficiency virus (HIV) among pregnant women in Botswana was 30.4%. High coverage rates of HIV testing and antiretroviral prophylaxis have reduced the rate of mother-to-child transmission of HIV in Botswana from as high as 40% with no prophylaxis to <4% in 2011. In June 2005, the national Early Infant Diagnosis (EID) Program began testing HIV-exposed infants (i.e., those born to HIV-infected mothers) for HIV using polymerase chain reaction (PCR) at 6 weeks postpartum. During 2005-2012, follow-up of all HIV-infected infants diagnosed in all 13 postnatal care facilities in Francistown, Botswana, was conducted to ascertain patient outcomes. A total of 202 infants were diagnosed with HIV. As of September 2013, 82 (41%) children were alive and on antiretroviral therapy (ART), 79 (39%) had died, and 41 (20%) were either lost to follow-up, had transferred, or their mothers declined ART. Despite success in preventing mother-to-child transmission in Botswana, results of the EID program highlight the need for early diagnosis of HIV-infected infants, prompt initiation of ART, and retention in care.

Fatalities in swimming pools with lifeguards: USA, 2000-2008.

BACKGROUND: Pools with lifeguards are often perceived to represent a safe environment for swimming. OBJECTIVES: To examine how often fatalities occurred in pools with lifeguards and what factors were common in these incidents. DESIGN: Case series. SETTING: USA. SUBJECTS: A case was defined as a death in a swimming pool with at least one lifeguard that occurred in the USA from 2000 to 2008. Potential cases were identified from media accounts using Lexis-Nexis and ProQuest databases. Supplemental information was obtained through internet based searches and review of death certificates. RESULTS: A total of 140 deaths from 37 states were identified. Of decedents, 109 (78%) were children and 93 (66%) were males. African Americans accounted for 44% of deaths among those of known race. 104 (74%) fatalities occurred during May through August; 85 (61%) deaths occurred in outdoor pools. Sites for fatal incidents included 53 (38%) municipal pools, 21 (15%) community organisations, and 20 (14%) schools. The median swimmer to lifeguard ratio was 13:1. Decedents were initially identified in the pool twice as often by non-lifeguards (eg, other swimmers or bystanders) as by lifeguards. CONCLUSIONS: Deaths in pools with lifeguards are uncommon, but do occur. Groups most affected include children, males, and African Americans. While lifeguards provide an important layer of protection at swimming pools, they alone cannot prevent all drownings. Additional safety measures are needed.

An outbreak of hepatitis A among primary and secondary contacts of an international adoptee.

The Advisory Committee on Immunization Practices recommends that susceptible people traveling to developing countries receive hepatitis A vaccine or immune globulin prior to departure. Until 2009, the recommendations did not address non-traveling family members or other close contacts of international adoptees. We report an outbreak of hepatitis A in 2008 that occurred in Maine. Eight members of an extended family developed hepatitis A following the arrival of an asymptomatic infant from Ethiopia who was brought to the United States by an adoption agency. Two children in the family attended an elementary school where five additional cases of hepatitis A were subsequently identified. Only three (1%) of 208 students at the school had previously been immunized against hepatitis A. This outbreak highlights the need to immunize household members and other close contacts of families adopting children from countries where hepatitis A is endemic, as well as all children at one year of age.

Injury-prevention practices as depicted in G- and PG-rated movies, 2003-2007.

OBJECTIVE: Our goal was to determine if the depiction of injury-prevention practices in children's movies is different from what was reported from 2 earlier studies, which showed infrequent depiction of characters practicing recommended safety behaviors. METHODS: The top-grossing 25 domestic G-rated (general audience) and PG-rated (parental guidance suggested) movies per year for 2003-2007 were included in this study. Movies or scenes were excluded if they were animated, not set in the present day, fantasy, documentary, or not in English. Injury-prevention practices involving motor vehicles, pedestrians, boaters, and bicyclists were recorded for characters with speaking roles. RESULTS: Sixty-seven (54%) of 125 movies met the inclusion criteria for this study. A total of 958 person-scenes were examined: 524 (55%) depicted children and 434 (45%) adults. Twenty-two person-scenes involved crashes or falls, resulting in 3 injuries and no deaths. Overall, 311 (56%) of 555 motor-vehicle passengers were belted; 73 (35%) of 211 pedestrians used crosswalks; 60 (75%) of 80 boaters wore personal flotation devices; and 8 (25%) of 32 bicyclists wore helmets. In comparison with previous studies, usage of safety belts, crosswalks, personal flotation devices, and bicycle helmets increased significantly. CONCLUSIONS: The entertainment industry has improved the depiction of selected safety practices in G- and PG-rated movies. However, approximately one half of scenes still depict unsafe practices, and the consequences of these behaviors are rarely shown. The industry should continue to improve how it depicts safety practices in children's movies. Parents should highlight the depiction of unsafe behaviors and educate children in following safe practices.

Preventing suicide by jumping: the effect of a bridge safety fence.

OBJECTIVE: To evaluate the effect of a bridge safety fence in preventing suicide. METHODS: We examined suicides from jumping off the Memorial Bridge in Augusta, Maine, from 1 April 1960 to 31 July 2005. The safety fence was installed during 1983, the mid-point of the study period. RESULTS: 14 suicides from the bridge were identified; all occurred before installation of the safety fence. The number of suicides by jumping from other structures remained unchanged after installation of the fence. CONCLUSION: The safety fence was effective in preventing suicides from the bridge. There was no evidence that suicidal individuals sought alternative sites for jumping.

Revisions to chronic disease surveillance indicators, United States, 2004.

To allow public health officials to uniformly define, collect, and report chronic disease data, Indicators for Chronic Disease Surveillance was released by the Council of State and Territorial Epidemiologists in 1999. This publication provided standard definitions for 73 indicators developed by epidemiologists and chronic disease program directors at the state and federal levels. The indicators were selected because of their importance to public health and the availability of state-level data. This report describes the latest revisions to the chronic disease indicators published in 2004. The revised set of 92 indicators includes 24 for cancer; 15 for cardiovascular disease; 11 for diabetes; 7 for alcohol; 5 each for nutrition and tobacco; 3 each for oral health, physical activity, and renal disease; and 2 each for asthma, osteoporosis, and immunizations. The remaining 10 indicators cover such overarching conditions as poverty, education, and life expectancy. Although multiple states have used the indicators, wider adoption depends on increased epidemiology capacity at the state level and improved access to surveillance data.

Maintenance of optimal fluoride levels in public water systems.

OBJECTIVE: This study examines the quality of water fluoridation in public water supplies. METHODS: An assessment of daily fluoride levels among all communities that fluoridate their public water supplies in New Hampshire was conducted from January 1, 2000, through June 30, 2002. Results were compared against recommendations from the Centers for Disease Control and Prevention. RESULTS: The fluoride concentration was less than the recommended minimum value on 42.0 percent of days, within the accepted control range on 49.8 percent of days, and above the recommended maximum value on 1.0 percent of days. On 7.1 percent of days, a fluoride concentration was not determined. Only 2 (18.2%) of 11 public water supplies maintained the fluoride concentration in the optimal range > or =80 percent of the days. CONCLUSIONS: For public water supplies in New Hampshire that fluoridate, suboptimal levels are the most common problem. Water systems need to better maintain recommended fluoride levels if communities are to realize the full benefits of fluoridation.

Survey of restaurants regarding smoking policies.

The New Hampshire Indoor Smoking Act was implemented in 1994 to protect the public's health by regulating smoking in enclosed places. A survey was conducted of New Hampshire restaurants to determine smoking policies, to determine restaurant characteristics associated with smoking policies, and to evaluate compliance with the Indoor Smoking Act. A list of New Hampshire restaurants was obtained from a marketing firm. Establishments were selected randomly until 400 had completed a 22-question telephone survey. Forty-four percent of restaurants permitted smoking. Characteristics positively associated with permitting smoking were being a non-fast-food restaurant, selling alcohol, selling tobacco, and having greater than the median number of seats. Of restaurants permitting smoking, 96.1% had a designated smoking area, 87.0% had a ventilation system to minimize secondhand smoke, 83.6% had a physical barrier between smoking and nonsmoking areas, and 53.1% exhibited signs marking the smoking area. Forty percent of restaurants permitting smoking met all four requirements of the Indoor Smoking Act. Smoking policies differ, by type of restaurant. Compliance with the Indoor Smoking Act is low.