Sputum transportation from county-level to prefecture-level is an ideal strategy to cover the shortage of the laboratory capability in the resource-poor setting. Here, we firstly evaluated the feasibility of sputum tr...Sputum transportation from county-level to prefecture-level is an ideal strategy to cover the shortage of the laboratory capability in the resource-poor setting. Here, we firstly evaluated the feasibility of sputum transportation system in China by analyzing the culture and molecular diagnosis results from 1982 smear-positive patients with different delay in processing for culture.展开更多
Advances in antiretroviral therapy for both Human Immunodeficiency Virus (HIV) treatment and prevention have increased interest in adherence to HIV treatment. This is because the individual patient and public health b...Advances in antiretroviral therapy for both Human Immunodeficiency Virus (HIV) treatment and prevention have increased interest in adherence to HIV treatment. This is because the individual patient and public health benefits of antiretroviral treatment?(ART) greatly depend on the extent to which people living with HIV (PLHIV) adhere to the prescribed daily dosing regimens. Studies have shown that nonadherence to ART increases drug resistance, morbidity and person-to-person HIV transmission. Public health experts are trying different innovations to enhance ART adherence, including promoting support groups of PLHIV. The purpose of this study was to determine the value of support group participation in enhancing ART adherence. The study used a cross-sectional design to compare ART adherence among PLHIV who participate in support group activities and those who do not. Respondents were adults who were initiated on ART between January 1, 2010 and December 31, 2012. Multistage probability sampling was used to select study sites and respondents. Data was collected using a self-administered questionnaire from 1676 respondents between February and May 2014. Data was analyzed using STATA. Univariate analysis was carried out to generate descriptive statistics, while Chi-square tests were used to examine if there was an association between participation in support group activities and antiretroviral treatment adherence. ART adherence was self-reported by 745/788 (95%) and 814/888 (92%) respondents who had ever and had never participated in support group activities respectively. Among respondents who reported nonadherence to ART, 74/117 (8%) had never participated in support group activities compared to just 43/117 (5%) who participated in support group activities. These findings suggest that PLHIV who participate in support group activities are more likely to adhere to ART than those who do not participate. This implies that there is value in participating in support groups by PLHIV in terms of ART adherence.展开更多
Background:Adverse effects of antileishmanial drugs can affect patients’quality of life and adherence to therapy for visceral leishmaniasis(VL)and post-kala-azar dermal leishmaniasis(PKDL).In Bangladesh,there are 26 ...Background:Adverse effects of antileishmanial drugs can affect patients’quality of life and adherence to therapy for visceral leishmaniasis(VL)and post-kala-azar dermal leishmaniasis(PKDL).In Bangladesh,there are 26 treatment centers that manage leishmaniasis cases coming from 100 endemic upazilas(subdistricts)of 26 districts(these include VL,PKDL,treatment failure,and relapse VL and cutaneous leishmaniasis cases).This study aimed to investigate the feasibility of using focused pharmacovigilance for VL(VLPV)in Bangladesh’s National Kala-azar Elimination Programme for the early detection and prevention of expected and unexpected adverse drug reactions(ADRs).Methods:This activity has been going on since December 2014.Activity area includes secondary public hospital or Upazila health complex(UHC)in hundred sub districts and Surya Kanta Kala-azar Research Center(SKKRC)in Mymensingh District,a specialized center for management of complicated VL and PKDL cases.Communicable Disease Control(CDC)of the Directorate General of Health Services(DGHS)assigned twenty five of hundred UHCs and SKKRC(total 26)as treatment centers depending on their suitable geographical location.This was implemented for better management of VL cases with Liposomal Amphotericin B(AmBisome®)to ensure patient convenience and proper utilization of this expensive donated drug.A VLPV expert committee and a UHC VLPV team were established,an operational manual and pharmacovigilance report forms were developed,training and refresher training of health personnel took place at UHCs and at the central level,collected information such as patient data including demographics,treatment history and response,adverse events were analyzed.This report includes information for the period from December 2014 to December 2016.Results:From December 2014 to December 2016,1327 leishmaniasis patients were treated and 1066(80%)were available for VLPV.Out of these,57,33,9,and 1%were new VL,PKDL,VL relapse,and other cases,respectively.Liposomal amphotericin B was mostly used(82%)for case management,followed by miltefosine(20%)and paromomycin(3%).Out of the 1066 patients,26%experienced ADRs.The most frequent ADR was fever(17%,176/1066),followed by vomiting(5%,51/1066).Thirteen serious adverse events(SAEs)(eight deaths and five unexpected SAEs)were observed.The expert committee assessed that three of the deaths and all unexpected SAEs were possibly related to treatment.Out of the five unexpected SAEs,four were miltefosine-induced ophthalmic complications and the other was an AmBisome^(■)-induced avascular necrosis of the nasal alae.The Directorate General of the Drug Administration entered the ADRs into the World Health Organization Uppsala Monitoring Centre(WHO-UMC)VigiFlow database.Conclusions:This study found that VLPV through NKEP is feasible and should be continued as a routine activity into the public health system of Bangladesh to ensure patient safety against anti-leishmanial drugs.展开更多
Background The Xpert MTB/RIF showed high sensitivity and specificity in previous studies carried out in different epidemiological and geographical settings and patient populations in high-burden tuberculosis （TB） co...Background The Xpert MTB/RIF showed high sensitivity and specificity in previous studies carried out in different epidemiological and geographical settings and patient populations in high-burden tuberculosis （TB） countries.However,there were little data obtained by validation or demonstration study of the assay in China.In this study,the performance of Xpert MTB/RIF was investigated in two county-level laboratories in Hunan Province,China.Methods Consecutive patients with suspected pulmonary tuberculosis （PTB） and suspicion for multidrug-resistant tuberculosis （MDR-TB） were enrolled.For each patient suspected to have PTB,three sputum specimens （one spot sputum,one night sputum,and one morning sputum） were collected and each sputum was tested with smear microscopy,L（o）wenstein-Jensen （LJ） culture,and Xpert MTB/RIF test.For comparison across subgroups and testing methods,95％ confidence intervals were calculated.All analyses were done with SPSS 16.0,and P ＜0.05 was regarded as significant.Results For case detection,the sensitivity of Xpert MTB/RIF was 100％ for smear-and culture-positive TB and 88.6％ for smear-negative and culture-positive TB; the overall sensitivity was 94.5％ for all culture-positive patients.The specificity was 99.8％.The sensitivity of Xpert MTB/RIF assay was 22.0％ in clinical TB patients and the specificity reached 100.0％ in the group of patients who are infected with nontuberculous mycobacteria.For the detection of rifampin resistance,the sensitivity of MTB/RIF RIF-resistance detection was 92.9％,and the specificity was 98.7％.Of the 26 Xpert MTB/RIF-positive and RIF-resistant patients confirmed by LJ proportion tests,20 （76.9％） patients were infected by MDR-TB.Conclusions The Xpert MTB/RIF assay is a highly sensitive and specific method for diagnosis of TB and RIF resistance,which will enable it to have the potential to be used in county-level laboratories and lead to the reduction of the infectious pool and improvements in TB control in China.Further evaluations in county-level laboratories for implementing the assay are still required.展开更多
We report on the use of a novel non-instrumented platform to enable a Loop Mediated isothermal Amplification(LAMP) based assay for Salmonella enterica.Heat energy is provided by addition of a small amount(<150 g) o...We report on the use of a novel non-instrumented platform to enable a Loop Mediated isothermal Amplification(LAMP) based assay for Salmonella enterica.Heat energy is provided by addition of a small amount(<150 g) of boiling water,and the reaction temperature is regulated by storing latent energy at the melting temperature of a lipid-based engineered phase change material.Endpoint classification of the reaction is achieved without opening the reaction tube by observing the fluorescence of sequence-specific FRET-based assimilating probes with a simple handheld fluorometer.At or above 22℃ ambient temperature the non-instrumented devices could maintain reactions above a threshold temperature of 61℃ for over 90 min-significantly longer than the 60 min reaction time.Using the simple format,detection limits were less than 20 genome copies for reactions run at ambient temperatures ranging from 8 to 36℃.When used with a pre-enrichment step and non-instrumented DNA extraction device,trace contaminations of Salmonella in milk close to 1 CFU/mL could be reliably detected.These findings illustrate that the non-instrumented amplification approach is a simple,viable,low-cost alternative for field-based food and agricultural diagnostics or clinical applications in developing countries.展开更多
Background As female sex workers （FSWs） were becoming the driving force behind the HIV epidemic in Central China, a project to promote condom use by FSWs was implemented from 2004 to 2009. In this study, we discusse...Background As female sex workers （FSWs） were becoming the driving force behind the HIV epidemic in Central China, a project to promote condom use by FSWs was implemented from 2004 to 2009. In this study, we discussed the evaluation of the project, the factors associated with condom use among FSWs within the Chinese context, and proposed suggestions for future interventions for FSWs in China. Methods Two surveys using structured questionnaires were conducted in 2004 and 2009. Data collected from the surveys were analyzed and guided by a behavior change framework. We reviewed relevant articles to supplement the information that was not able to be obtained from the surveys. Results In general, the HIV prevalence among FSWs remained low （less than 1%） in the 5 years. With a high coverage of interventions for all FSWs in Central China, the project yielded better outcomes than the national average over the same time period. The awareness about HIV and condom use grew dramatically during the project period. The four factors/ determinants that influence the behavior of FSWs using condoms are population characteristics, opportunity, ability, and motivation. Statistical model shows that the significant variables for using a condom are age, availability of services, HIV- related knowledge, and intention. Conclusions With a high coverage of interventions for FSWs, the project achieved its goals. The differences among workplaces of FSWs may serve as a symbol of their socioeconomic status, patterns of condom use, and therefore risks of acauirina HIV.展开更多
基金supported by Bill and Melinda Gabes Foundation Project(51914)
文摘Sputum transportation from county-level to prefecture-level is an ideal strategy to cover the shortage of the laboratory capability in the resource-poor setting. Here, we firstly evaluated the feasibility of sputum transportation system in China by analyzing the culture and molecular diagnosis results from 1982 smear-positive patients with different delay in processing for culture.
文摘Advances in antiretroviral therapy for both Human Immunodeficiency Virus (HIV) treatment and prevention have increased interest in adherence to HIV treatment. This is because the individual patient and public health benefits of antiretroviral treatment?(ART) greatly depend on the extent to which people living with HIV (PLHIV) adhere to the prescribed daily dosing regimens. Studies have shown that nonadherence to ART increases drug resistance, morbidity and person-to-person HIV transmission. Public health experts are trying different innovations to enhance ART adherence, including promoting support groups of PLHIV. The purpose of this study was to determine the value of support group participation in enhancing ART adherence. The study used a cross-sectional design to compare ART adherence among PLHIV who participate in support group activities and those who do not. Respondents were adults who were initiated on ART between January 1, 2010 and December 31, 2012. Multistage probability sampling was used to select study sites and respondents. Data was collected using a self-administered questionnaire from 1676 respondents between February and May 2014. Data was analyzed using STATA. Univariate analysis was carried out to generate descriptive statistics, while Chi-square tests were used to examine if there was an association between participation in support group activities and antiretroviral treatment adherence. ART adherence was self-reported by 745/788 (95%) and 814/888 (92%) respondents who had ever and had never participated in support group activities respectively. Among respondents who reported nonadherence to ART, 74/117 (8%) had never participated in support group activities compared to just 43/117 (5%) who participated in support group activities. These findings suggest that PLHIV who participate in support group activities are more likely to adhere to ART than those who do not participate. This implies that there is value in participating in support groups by PLHIV in terms of ART adherence.
基金This activity was supported by funds from PATH,USA.The funders had no role in the study’s design,data collection and analysis,decision to publish,or preparation of the paper.
文摘Background:Adverse effects of antileishmanial drugs can affect patients’quality of life and adherence to therapy for visceral leishmaniasis(VL)and post-kala-azar dermal leishmaniasis(PKDL).In Bangladesh,there are 26 treatment centers that manage leishmaniasis cases coming from 100 endemic upazilas(subdistricts)of 26 districts(these include VL,PKDL,treatment failure,and relapse VL and cutaneous leishmaniasis cases).This study aimed to investigate the feasibility of using focused pharmacovigilance for VL(VLPV)in Bangladesh’s National Kala-azar Elimination Programme for the early detection and prevention of expected and unexpected adverse drug reactions(ADRs).Methods:This activity has been going on since December 2014.Activity area includes secondary public hospital or Upazila health complex(UHC)in hundred sub districts and Surya Kanta Kala-azar Research Center(SKKRC)in Mymensingh District,a specialized center for management of complicated VL and PKDL cases.Communicable Disease Control(CDC)of the Directorate General of Health Services(DGHS)assigned twenty five of hundred UHCs and SKKRC(total 26)as treatment centers depending on their suitable geographical location.This was implemented for better management of VL cases with Liposomal Amphotericin B(AmBisome®)to ensure patient convenience and proper utilization of this expensive donated drug.A VLPV expert committee and a UHC VLPV team were established,an operational manual and pharmacovigilance report forms were developed,training and refresher training of health personnel took place at UHCs and at the central level,collected information such as patient data including demographics,treatment history and response,adverse events were analyzed.This report includes information for the period from December 2014 to December 2016.Results:From December 2014 to December 2016,1327 leishmaniasis patients were treated and 1066(80%)were available for VLPV.Out of these,57,33,9,and 1%were new VL,PKDL,VL relapse,and other cases,respectively.Liposomal amphotericin B was mostly used(82%)for case management,followed by miltefosine(20%)and paromomycin(3%).Out of the 1066 patients,26%experienced ADRs.The most frequent ADR was fever(17%,176/1066),followed by vomiting(5%,51/1066).Thirteen serious adverse events(SAEs)(eight deaths and five unexpected SAEs)were observed.The expert committee assessed that three of the deaths and all unexpected SAEs were possibly related to treatment.Out of the five unexpected SAEs,four were miltefosine-induced ophthalmic complications and the other was an AmBisome^(■)-induced avascular necrosis of the nasal alae.The Directorate General of the Drug Administration entered the ADRs into the World Health Organization Uppsala Monitoring Centre(WHO-UMC)VigiFlow database.Conclusions:This study found that VLPV through NKEP is feasible and should be continued as a routine activity into the public health system of Bangladesh to ensure patient safety against anti-leishmanial drugs.
文摘Background The Xpert MTB/RIF showed high sensitivity and specificity in previous studies carried out in different epidemiological and geographical settings and patient populations in high-burden tuberculosis （TB） countries.However,there were little data obtained by validation or demonstration study of the assay in China.In this study,the performance of Xpert MTB/RIF was investigated in two county-level laboratories in Hunan Province,China.Methods Consecutive patients with suspected pulmonary tuberculosis （PTB） and suspicion for multidrug-resistant tuberculosis （MDR-TB） were enrolled.For each patient suspected to have PTB,three sputum specimens （one spot sputum,one night sputum,and one morning sputum） were collected and each sputum was tested with smear microscopy,L（o）wenstein-Jensen （LJ） culture,and Xpert MTB/RIF test.For comparison across subgroups and testing methods,95％ confidence intervals were calculated.All analyses were done with SPSS 16.0,and P ＜0.05 was regarded as significant.Results For case detection,the sensitivity of Xpert MTB/RIF was 100％ for smear-and culture-positive TB and 88.6％ for smear-negative and culture-positive TB; the overall sensitivity was 94.5％ for all culture-positive patients.The specificity was 99.8％.The sensitivity of Xpert MTB/RIF assay was 22.0％ in clinical TB patients and the specificity reached 100.0％ in the group of patients who are infected with nontuberculous mycobacteria.For the detection of rifampin resistance,the sensitivity of MTB/RIF RIF-resistance detection was 92.9％,and the specificity was 98.7％.Of the 26 Xpert MTB/RIF-positive and RIF-resistant patients confirmed by LJ proportion tests,20 （76.9％） patients were infected by MDR-TB.Conclusions The Xpert MTB/RIF assay is a highly sensitive and specific method for diagnosis of TB and RIF resistance,which will enable it to have the potential to be used in county-level laboratories and lead to the reduction of the infectious pool and improvements in TB control in China.Further evaluations in county-level laboratories for implementing the assay are still required.
基金Financial support at UH was provided by USDA-Hatch project HA-517NINA concepts and prototypes developed at PATH were supported by grants under the Health Innovations Portfolio,which is supported by the United States Agency for International Development,private foundations,and individual donors
文摘We report on the use of a novel non-instrumented platform to enable a Loop Mediated isothermal Amplification(LAMP) based assay for Salmonella enterica.Heat energy is provided by addition of a small amount(<150 g) of boiling water,and the reaction temperature is regulated by storing latent energy at the melting temperature of a lipid-based engineered phase change material.Endpoint classification of the reaction is achieved without opening the reaction tube by observing the fluorescence of sequence-specific FRET-based assimilating probes with a simple handheld fluorometer.At or above 22℃ ambient temperature the non-instrumented devices could maintain reactions above a threshold temperature of 61℃ for over 90 min-significantly longer than the 60 min reaction time.Using the simple format,detection limits were less than 20 genome copies for reactions run at ambient temperatures ranging from 8 to 36℃.When used with a pre-enrichment step and non-instrumented DNA extraction device,trace contaminations of Salmonella in milk close to 1 CFU/mL could be reliably detected.These findings illustrate that the non-instrumented amplification approach is a simple,viable,low-cost alternative for field-based food and agricultural diagnostics or clinical applications in developing countries.
文摘Background As female sex workers （FSWs） were becoming the driving force behind the HIV epidemic in Central China, a project to promote condom use by FSWs was implemented from 2004 to 2009. In this study, we discussed the evaluation of the project, the factors associated with condom use among FSWs within the Chinese context, and proposed suggestions for future interventions for FSWs in China. Methods Two surveys using structured questionnaires were conducted in 2004 and 2009. Data collected from the surveys were analyzed and guided by a behavior change framework. We reviewed relevant articles to supplement the information that was not able to be obtained from the surveys. Results In general, the HIV prevalence among FSWs remained low （less than 1%） in the 5 years. With a high coverage of interventions for all FSWs in Central China, the project yielded better outcomes than the national average over the same time period. The awareness about HIV and condom use grew dramatically during the project period. The four factors/ determinants that influence the behavior of FSWs using condoms are population characteristics, opportunity, ability, and motivation. Statistical model shows that the significant variables for using a condom are age, availability of services, HIV- related knowledge, and intention. Conclusions With a high coverage of interventions for FSWs, the project achieved its goals. The differences among workplaces of FSWs may serve as a symbol of their socioeconomic status, patterns of condom use, and therefore risks of acauirina HIV.
