Enhancing HIV positivity yield in southern Mozambique: The effect of a Ministry of Health training module in targeted provider-initiated testing and counselling

In Mozambique, targeted provider-initiated HIV testing and counselling (PITC) is recommended where universal PITC is not feasible, but its effectiveness depends on healthcare providers' training. This study aimed to evaluate the effect of a Ministry of Health training module in targeted PITC on the HIV positivity yield, and identify factors associated with a positive HIV test. We conducted a single-group pre-post study between November 2018 and November 2019 in the triage and emergency departments of four healthcare facilities in Manhiça District, a resource-constrained semi-rural area. It consisted of two two-month phases split by a one-week targeted PITC training module ("observation phases"). The HIV positivity yield of targeted PITC was estimated as the proportion of HIV-positive individuals among those recommended for HIV testing by the provider. Additionally, we extracted aggregated health information system data over the four months preceding and following the observation phases to compare yield in real-world conditions ("routine phases"). Logistic regression analysis from observation phase data was conducted to identify factors associated with a positive HIV test. Among the 7,102 participants in the pre- and post-training observation phases (58.5% and 41.5% respectively), 68% were women, and 96% were recruited at triage. In the routine phases with 33,261 individuals (45.8% pre, 54.2% post), 64% were women, and 84% were seen at triage. While HIV positivity yield between pre- and post-training observation phases was similar (10.9% (269/2470) and 11.1% (207/1865), respectively), we observed an increase in yield in the post-training routine phase for women in triage, rising from 4.8% (74/1553) to 7.3% (61/831) (Yield ratio = 1.54; 95%CI: 1.11-2.14). Age (25-49 years) (OR = 2.43; 95%CI: 1.37-4.33), working in industry/mining (OR = 4.94; 95%CI: 2.17-11.23), unawareness of partner's HIV status (OR = 2.50; 95%CI: 1.91-3.27), and visiting a healer (OR = 1.74; 95%CI: 1.03-2.93) were factors associated with a positive HIV test. Including these factors in the targeted PITC algorithm could have increased new HIV diagnoses by 2.6%. In conclusion, providing refresher training and adapting the current targeted PITC algorithm through further research can help reach undiagnosed PLHIV, treat all, and ultimately eliminate HIV, especially in resource-limited rural areas.

High proportion of unknown HIV exposure status among children aged less than 2 years: An analytical study using the 2015 National AIDS Indicator Survey in Mozambique

Background: Determination of the human immunodeficiency virus (HIV) exposure status in infants and young children is required to guarantee timely diagnosis and access to appropriate care. HIV prevalence among Mozambican women aged 15-49 years is 15%, and vertical transmission rate is still high. The study investigated HIV exposure in children aged less than 2 years in Mozambique and the factors associated with unknown HIV exposure and with HIV exposure status in this population. Methods: This was a cross-sectional analytical study using data from the 2015 Survey of Indicators on Immunization, Malaria and HIV/AIDS in Mozambique. A total of 2141 mothers (15-49 years) with children aged less than 2 years were interviewed. The dependent variables were "known HIV exposure status in a child" and "HIV-exposed child," and the explanatory variables were mother's social, demographic, economic, and reproductive health characteristics. We used binary and logistic regression, adjusted for complex sampling, to determine the association between variables. Results: HIV exposure status was unknown in 27% of children (95% CI, 25.1-28.9). Mothers residing in the North (AOR, 4.41; 95% CI, 2.18-8.91), in rural area (AOR, 2.44; 95% CI, 1.33-4.35), with no education (AOR, 2.72; 95% CI, 1.38-5.36), and not having utilized any health services in the last pregnancy (AOR, 1.9; 95% CI, 1.42-2.55) were more likely to have a child with unknown HIV exposure status. Six percent of children were HIV-exposed (95% CI, 5-7). Children were less likely to be HIV-exposed if the head of the household was a male (AOR, 0.26; 95% CI, 0.08-0.86), if the mother was residing in the North (AOR, 0.41; 95% CI, 0.26-0.66) and did not utilize any health services in her last pregnancy (AOR, 0.52; 95% CI, 0.32-0.83). Conclusion: The high proportion of children with unknown HIV exposure status and the associated socioeconomic factors suggests that HIV retesting of eligible women throughout breastfeeding should be intensified and identifies the urgent need to reach women without prior access to health care using a multisectoral approach.

Color stability of repairs on bis-acryl resin submitted to thermal aging and immersion in beverages.

OBJECTIVE: Defects/bubbles can occur during the manufacture of bis-acryl resin provisional restorations, requiring repair or new prosthesis. This study evaluated the color stability of bis-acryl resin specimens repaired, aging, and immersioned in beverages. MATERIAL AND METHODS: Eighty disks were made of bis-acryl resin. Twenty disks were not repaired (BCR), 20 disks were repaired with the same bis-acryl resin (BCR-BCR), 20 disks were repaired with flowable resin (BCR-FR), and 20 disks received an adhesive layer prior to flowable resin repair (BCR-AFR). Coordinates L*a*b* were obtained. Ten disks from each group were thermocycled (5000 cycles) and the others were immersed in coffee with sugar (n = 5) and cola-based soft drinks (n = 5) for 7 days. Color, lightness, chroma, and hue differences were calculated by the CIEDE2000 formula, analyzed by two-way analysis of variance. Multiple comparisons were made with the Tukey's HSD test (α = .05). RESULTS: BCR-FR group presented the highest color differences (5.6) between groups repaired (P < .001). BCR-BCR group showed the smallest color differences (0.9) after aging (P = .003), but the greatest variation between T0 and T1 (about 1 ΔE). BCR-ARF immersed in coffee showed the greatest color differences (20.6) (P < .001). CONCLUSIONS: Aging and immersion altered the colorimetric behavior of repairs, especially after the use of coffee. CLINICAL IMPLICATIONS: Repairs are indicated when defects and bubbles are present in the surface of the bis-acryl resin provisional restorations after its manufacture. However, they may present noticeable color changes, especially when the use of coffee is frequent.

Esthetic and functional rehabilitation of bilateral congenital absence of maxillary lateral incisors: Minimally invasive surgical and prosthetic approach.

OBJECTIVE: Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an esthetic and functional restorative treatment. Noninvasive treatments, that are in accordance with the patients' expectations, should be the first therapeutic alternative. If the deciduous tooth is present, minimally invasive dental extraction followed by immediate dental implant placement and provisional restoration is indicated. In this restorative treatment, an adequate emergency profile can be achieved by peri-implant soft-tissue-conditioning techniques. Moreover, the association of restorative materials, such as composite resins and dental ceramics, provides more predictable esthetic results. CLINICAL CONSIDERATIONS: The present case report presents a rehabilitation of bilateral congenital absence of maxillary lateral incisors through a multidisciplinary approach. Dental implants, long-term provisional restoration, tooth bleaching, minimally veneered high-translucent monolithic zirconia crowns, feldspathic veneers, and composite restorations were used by the dental team to achieve the expected functional and esthetic outcomes. CONCLUSIONS: Different treatment modalities are available for the rehabilitation of congenital absence of teeth. However, it is important that a dental team consider performing minimally invasive treatments, as many of these treatments are done on young patients. CLINICAL SIGNIFICANCE: Patient-centered treatments involving minimally invasive approaches in a multidisciplinary environment would be appropriate in order to achieve predictable results.

Performance characteristics of finger-stick dried blood spots (DBS) on the determination of human immunodeficiency virus (HIV) treatment failure in a pediatric population in Mozambique

Quantitative plasma viral load (VL) at 1000 copies /mL was recommended as the threshold to confirm antiretroviral therapy (ART) failure by the World Health Organization (WHO). Because of ongoing challenges of using plasma for VL testing in resource-limited settings (RLS), especially for children, this study collected 717 DBS and paired plasma samples from children receiving ART ≥1 year in Mozambique and compared the performance of DBS using Abbott's VL test with a paired plasma sample using Roche's VL test. At a cut-off of 1000 copies/mL, sensitivity of DBS using Abbott DBS VL test was 79.9%, better than 71.0% and 63.9% at 3000 and 5000 copies/mL, respectively. Specificities were 97.6%, 98.8%, 99.3% at 1000, 3000, and 5000 copies/mL, respectively. The Kappa value at 1000 copies/mL, 0.80 (95% CI: 0.73, 0.87), was higher than 0.73 (95% CI: 0.66, 0.80) and 0.66 (95% CI: 0.59, 0.73) at 3000, 5000 copies/mL, respectively, also indicating better agreement. The mean difference between the DBS and plasma VL tests with 95% limits of agreement by Bland-Altman was 0.311 (-0.908, 1.530). Among 73 children with plasma VL between 1000 to 5000 copies/mL, the DBS results were undetectable in 53 at the 1000 copies/mL threshold. While one DBS sample in the Abbott DBS VL test may be an alternative method to confirm ART failure at 1000 copies/mL threshold when a plasma sample is not an option for treatment monitoring, because of sensitivity concerns between 1,000 and 5,000 copies/ml, two DBS samples may be preferred accompanied by careful patient monitoring and repeat testing.