Leadership,communication,and science:three pillars essential to public health emergency response and closing the gap in the HIV response among key populations

Globally,there have been multiple public health emergencies in recent decades.High rates of morbidity,occasionally mortality,and economic instability are usually associated with pandemics.One of the epidemics that has significantly increased morbidity and mortality worldwide is the human immunodeficiency virus(HIV)and acquired immune deficiency syndrome(AIDS)pandemic.HIV has a disproportionately negative impact on key populations.Strong leadership,effective communication,and sound science are necessary for public health emergency(PHE)responses to be successful.These three PHE response pllars are also essential for bridging the HIV response gap among key populations in the setting of restrictive laws.In this review,we explored the importance of these three pillars of successful PHEs responses,and how they are essential to closing the gap in the HIV response among key populations.Leaders must make decisions and instil a sense of authority in the populace during PHEs to foster trust and confidence.Leaders should base their choices on scientific evidence.Effective communication during PHEs should be proactive,polite,imaginative,innovative,and constructive.To address gaps in the HIV response among key populations,leaders must create a supportive environment for effective communication and scientific research,communication should be used to raise awareness of HIV and to dispel stigma and discrimination,while science should provide evidence of efficacy and effectiveness of interventions amongkey populations.

Modelling Key Population Attrition in the HIV and AIDS Programme in Kenya Using Random Survival Forests with Synthetic Minority Oversampling Technique-Nominal Continuous

HIV and AIDS has continued to be a major public health concern, and hence one of the epidemics that the world resolved to end by 2030 as highlighted in sustainable development goals (SDGs). A colossal amount of effort has been taken to reduce new HIV infections, but there are still a significant number of new infections reported. HIV prevalence is more skewed towards the key population who include female sex workers (FSW), men who have sex with men (MSM), and people who inject drugs (PWID). The study design was retrospective and focused on key population enrolled in a comprehensive HIV and AIDS programme by the Kenya Red Cross Society from July 2019 to June 2021. Individuals who were either lost to follow up, defaulted (dropped out, transferred out, or relocated) or died were classified as attrition;while those who were active and alive by the end of the study were classified as retention. The study used density analysis to determine the spatial differences of key population attrition in the 19 targeted counties, and used Kilifi county as an example to map attrition cases in smaller administrative areas (sub-county level). The study used synthetic minority oversampling technique-nominal continuous (SMOTE-NC) to balance the datasets since the cases of attrition were much less than retention. The random survival forests model was then fitted to the balanced dataset. The model correctly identified attrition cases using the predicted ensemble mortality and their survival time using the estimated Kaplan-Meier survival function. The predictive performance of the model was strong and way better than random chance with concordance indices greater than 0.75.

Dried blood spot sampling as an alternative for the improvement of hepatitis B and C diagnosis in key populations

BACKGROUND To achieve the elimination of hepatitis B and C,there is an urgent need to develop alternative strategies to increase the access of diagnosis,particularly among key populations such as people living with human immunodeficiency virus(HIV),individuals with coagulopathies and chronic kidney disease(CKD)patients.AIM To evaluate the use of dried blood spot(DBS)in the detection of hepatitis B virus(HBV)and hepatitis C virus(HCV)markers.METHODS A total of 430 individuals comprised of people living with HIV,coagulopathies and CKD provided paired serum and DBS samples.HBsAg,anti-HBc and anti-HCV were tested in those samples using a commercial electrochemiluminescence.Demographic and selected behavioral variables were evaluated to assess possible association with HBV and HCV positivity.RESULTS Using DBS,HBsAg prevalence varied from 3.9%to 22.1%,anti-HBc rates varied from 25.5%to 45.6%and anti-HCV positivity ranged from 15.9%to 41.2%in key populations.Specificities of HBV and HCV tests using DBS varied from 88.9%to 100%.The HBsAg assay demonstrated the best performance in CKD and coagulopathy individuals and the anti-HCV test had a sensitivity and specificity of 100%in people living with HIV.Accuracy of HBV and HCV detection in DBS varied from 90.2%to 100%.In the CKD group,HBsAg positivity was associated with infrequent use of condoms,and anti-HBc positivity was associated with sharing nail cutters/razors/toothbrushes.Anti-HCV reactivity was positively associated with a history of transplantation and length of time using hemodialysis in both specimens.In people living with HIV,only the male gender was associated with anti-HBc positivity in serum and DBS.CONCLUSION DBS with electrochemiluminescence are useful tools for the diagnosis and prevalence studies of hepatitis B and C among key populations and may increase the opportunity to foster prevention and treatment.

Exploring the Perspectives of Healthcare Providers on Providing HIV Prevention and Treatment Services for Key Populations in Rwanda: A Qualitative Study

Background: The overall HIV prevalence and incidence in Rwanda have decreased significantly in the past decade. However, opposite trends are seen among key populations (KP). The HIV prevalence among sex workers is as high as 51% and continues to rise. While the HIV prevalence among KP remains high, their adherence to treatment is low. Healthcare providers play a vital role in KP’s access and adherence to HIV treatment. This study aimed to explore the perspectives of healthcare providers on providing HIV services to key populations in Rwanda. Methods: An exploratory qualitative study was conducted with nurses, doctors, social workers, and psychologists who provide HIV services to KP in public health facilities in Rwanda. In-depth interviews were conducted using a semi-structured interview guide. All data were analyzed thematically using Dedoose. Results: Interviews were conducted with 18 healthcare providers. Three overarching themes emerged from the interviews: healthcare providers’ intrinsic feelings affect the ways they provide HIV services to key populations, key populations face a multitude of challenges related to accessing treatment and preventing the spread of HIV, and a more comprehensive and sensitive approach should be used to improve HIV services for key populations. Conclusion: Healthcare providers expressed difficulties in providing services to key populations and identified a lack of adherence to treatment and prevention guidelines, structural barriers, KP’s lack of trust in the healthcare system, and the discrimination and abuse KP face as challenges to effective HIV prevention and treatment. More comprehensive services including clinical, financial, and psychosocial support from trusted sources are needed. Some important policy changes are essential to facilitate access to HIV services for KP.

A potential transition from a concentrated to a generalized HIV epidemic:the case of Madagascar

Background HIV expansion is controlled by a range of interrelated factors,including the natural history of HIV infection and socio-economical and structural factors.However,how they dynamically interact in particular contexts to drive a transition from concentrated HIV epidemics in vulnerable groups to generalized epidemics is poorly understood.We aim to explore these mechanisms,using Madagascar as a case-study.Methods We developed a compartmental dynamic model using available data from Madagascar,a country with a contrasting concentrated epidemic,to explore the interaction between these factors with special consideration of commercial and transactional sex as HIV-infection drivers.Results The model predicts sigmoidal-like prevalence curves with turning points within years 2020-2022,and prevalence reaching stabilization by 2033 within 9 to 24%in the studied(10 out of 11)cities,similar to high-prevalence regions in Southern Africa.The late/slow introduction of HIV and circumcision,a widespread traditional practice in Madagascar,could have slowed down HIV propagation,but,given the key interplay between risky behaviors associated to young women and acute infections prevalence,mediated by transactional sex,the protective efect of circumcision is currently insufcient to contain the expansion of the disease in Madagascar.Conclusions These results suggest that Madagascar may be experiencing a silent transition from a concentrated to a generalized HIV epidemic.This case-study model could help to understand how this HIV epidemic transition occurs.

Limited Spatial Transferability of the Relationships Between Kriging Variance and Soil Sampling Spacing in Some Grasslands of Ireland:Implications for Sampling Design

Sampling plays an important role in acquiring precise soil information required in modern agricultural production worldwide, which determines both the cost and quality of final soil mapping products. For sampling design, it has been proposed possibile to transfer the relationships between kriging variance and sampling grid spacing from an area with existing information to other areas with similar soil-forming environments. However, this approach is challenged in practice because of two problems: i) different population vaxiograms among similar areas and ii) sampling errors in estimated variograms. This study evaluated the effects of these two problems on the transferability of the relationships between kriging variance and sampling grid spacing, by using spatial data simulated with three variograms and soil samples collected from four grasslands in Ireland with similar soil-forming environments. Results showed that the variograms suggested by different samples collected with the same grid spacing in the same or similar areas were different, leading to a range of mean kriging variance (MKV) for each grid spacing. With increasing grid spacing, the variation of MKV for a specific grid spacing increased and deviated more from the MKV generated using the population variograms. As a result, the spatial transferability of the relationships between kriging variance and grid spacing for sampling design was limited.