What does the COVID-19 pandemic mean for HIV, tuberculosis, and malaria control?

Trends in HIV incidence and mortality across Bharat (India) after the emergence of COVID-19

BACKGROUND

Human immunodeficiency virus (HIV) is a sexually transmitted infection impacting populations worldwide. While there have been major improvements in controlling HIV over recent years, the COVID-19 pandemic may have potentially resulted in major interruptions to this control of HIV. Bharat (India) is a country that has been greatly impacted by the COVID-19 pandemic, and we aimed to analyse the trends in HIV control since the start of the pandemic.

METHODS

In this study we evaluated changes in rates of HIV incidence and mortality across Bharat for the years both before, and after, the start of the COVID-19 pandemic. Percent and absolute changes were determined, and thereafter, both bivariate and multi linear regression was conducted to evaluate the relationship between COVID-19 burden and changes in HIV epidemiology across the nation.

RESULTS

It was shown that, despite the COVID-19 pandemic, annual incidence and deaths of HIV/AIDS have both decreased across Bharat. From 2019-2021, in Bharat, the total number of new HIV cases annually decreased by 9.03%, and the total number of HIV/AIDS deaths annually decreased by 28.82%. A similar trend was shown across most states/union territories; however, there were notable exceptions (such as Karnataka, Bihar, and Assam) where the rates have instead increased.

CONCLUSIONS

Our analysis has demonstrated that government efforts to control the HIV/AIDS epidemic have not been greatly impacted across the majority of Bharat since the emergence of COVID-19. The reduction in annual HIV/AIDS deaths in the country has been better than the world average, and the improvements from the period of 2019 to 2021 were greater than those from 2017 to 2019. Regardless, there are regions in the nation where the epidemic has instead worsened during this period.

[After the pandemic is before the pandemic: And how interdisciplinary research can help here]

Aviation is among the social sectors most impacted by the COVID-19 pandemic, and at the same time has contributed to the rapid global spread of the SARS-CoV-2 virus. SARS-CoV-2 is one of the coronaviruses that have led to outbreaks such as MERS-CoV in the past. This group of pathogens, as well as others that may be unknown at this time, will continue to challenge our society in the future. In order to be able to react better, a research training group was established at DLR in cooperation with 6 institutes, which will develop interdisciplinary approaches to researching and combating current and future pandemics. Engineers, physicists, software developers, biologists and physicians are working closely together on new concepts and the development of interdisciplinary knowledge in order to better control and contain future pandemics and to be able to react in a more targeted manner. One focus is the reduction of germ contamination in airplanes but also in other means of public transport such as buses and trains. In this review, we provide an overview of the baseline situation and possible approaches to address future pandemic challenges.

Effects of the COVID-19 Pandemic on ART Initiation and Access to HIV Viral Load Monitoring in Adults Living With HIV in West Africa: A Regression Discontinuity Analysis

OBJECTIVES

Efforts to control the COVID-19 pandemic have potentially compromised the availability and/or quality of HIV services. We aimed to assess the pandemic's impact on antiretroviral therapy (ART) initiation and HIV viral load (VL) monitoring in 3 West African countries.

METHODS

We used routinely collected data from 5 clinics contributing to the International epidemiologic Database to Evaluate AIDS collaboration in Burkina Faso, Côte d'Ivoire, and Nigeria. We included ART-naïve adults living with HIV initiating ART from January 1, 2018. We conducted regression discontinuity analysis to estimate changes in the number of ART initiations and VL measures per week, before and during the pandemic period in each country.

RESULTS

In clinics in Burkina Faso and Côte d'Ivoire, ART initiations per week remained constant throughout the studied periods (-0.24 points (p) of ART initiations/week 95% CI: -5.5 to 5.9, -0.9 p, 95% CI: -8.5 to 8.6, respectively), whereas in Nigeria's clinic, they decreased significantly (-6.3 p, 95% CI: -10.8 to -1.7) after the beginning of the pandemic. The volume of VL tests performed decreased significantly in all 3 countries (-17.0 p, 95% CI: -25.3 to -8.6 in Burkina Faso, -118.4 p, 95% CI: -171.1 to -65.8 in Côte d'Ivoire and -169.1 p, 95% CI: -282.6 to -55.6 in Nigeria).

CONCLUSIONS

HIV clinics in two out of three countries in West Africa demonstrated resilience as they successfully maintained access to ART for ALWH despite the challenges imposed by the pandemic. However, VL monitoring was severely disrupted and did not return to prepandemic levels approximately 1 year after the beginning of the pandemic. Continued monitoring of the HIV care continuum in the postpandemic period is essential to mitigate potential enduring effects on ALWH's virological and clinical outcomes.

The effect of COVID-19 on malaria cases in Zambia: a mixed effect multilevel analysis

BACKGROUND

The burden of Malaria in Zambia remains a challenge, with the entire population at risk of contracting this infectious disease. Despite concerted efforts by African countries, including Zambia, to implement malaria policies and strategies aimed at reducing case incidence, the region faces significant hurdles, especially with emerging pandemics such as COVID-19. The efforts to control malaria were impacted by the constraints imposed to curb its transmission during the COVID-19 pandemic. The aim of the study was to assess the effect of the COVID-19 pandemic on malaria cases in Zambia and the factors associated by comparing the COVID-19 period and the pre-COVID-19 era.

METHODS

This was a cross-sectional panel study in which routinely collected programmatic data on malaria was used. The data were extracted from the Health Management Information System (HMIS) for the period January 2018 to January 2022. The period 2018 to 2022 was selected purely due to the availability of data and to avoid the problem of extrapolating too far away from the period of interest of the study. A summary of descriptive statistics was performed in which the number of cases were stratified by province, age group, and malaria cases. The association of these variables with the COVID-19 era was checked using the Wilcoxon rank-sum test and Kruskal‒Wallis test as applicable. In establishing the factors associated with the number of malaria cases, a mixed-effect multilevel model using the Poisson random intercept and random slope of the COVID-19 panel. The model was employed to deal with the possible correlation of the number of cases in the non-COVID-19 panel and the expected correlation of the number of cases in the COVID-19 panel.

RESULTS

A total of 18,216 records were extracted from HMIS from January 2018 to January 2022. Stratifying this by the COVID-19 period/era, it was established that 8,852 malaria cases were recorded in the non-COVID-19 period, whereas 9,364 cases were recorded in the COVID-19 era. Most of the people with malaria were above the age of 15 years. Furthermore, the study found a significant increase in the relative incidence of the COVID-19 panel period compared to the non-COVID-19 panel period of 1.32, 95% CI (1.18, 1.48, p < 0.0001). The observed numbers, as well as the incident rate ratio, align with the hypothesis of this study, indicating an elevated incidence rate ratio of malaria during the COVID-19 period.

CONCLUSION

This study found that there was an increase in confirmed malaria cases during the COVID-19 period compared to the non-COVID-19 period. The study also found Age, Province, and COVID-19 period to be significantly associated with malaria cases.

Regional regulatory harmonisation initiatives: Their potential contribution to the newly established African Medicines Agency

BACKGROUND

Key regulatory entities can serve as building blocks for the African Medicines Agency (AMA). The aim of this study is to demonstrate how the regional medicines regulatory harmonisation programmes could contribute to AMA's effectiveness and efficiency.

METHODS

A literature search was conducted using key words to identify publications about the AMA, African Medicines Regulatory Harmonisation (AMRH) and East African Community Medicines Regulatory Harmonisation programmes (EAC-MRH) from 2009 to 2023. The EAC-MRH programme experience was used to highlight the benefits and challenges of African regulatory harmonisation.

RESULTS

As the foundation for the AMA, the AMRH has established structures and workstreams to support its operationalisation, including 10 Technical Committees (TCs) and 5 Regional Economic Committees (RECs). Lessons learned from the EAC-MRH 10-year experience are being used to scale up regulatory harmonisation and could be of value to AMA harmonisation experience.

CONCLUSIONS

As of June 2023, 35 of 55 countries have either signed and/or ratified the AMA Treaty, whilst 20 have neither signed nor ratified it. An effective AMA will need strong National Medicines Regulatory Authorities as well as Regional programmes and it is imperative for more well-resourced countries to ratify the treaty to ensure access to essential medical products and technologies for the African people.

Prevalence of covid-19 among patients with chronic obstructive pulmonary disease and tuberculosis

BACKGROUND

The exhaustive information about non-communicable diseases associated with COVID-19 and severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) are getting easier to find in the literature. However, there is a lack of knowledge regarding tuberculosis (TB) and chronic obstructed pulmonary disease (COPD), with numerous infections in COVID-19 patients.

OBJECTIVES

Priority is placed on determining the patient's prognosis based on the presence or absence of TB and COPD. Additionally, a comparison is made between the risk of death and the likelihood of recovery in terms of time in COVID-19 patients who have either COPD or TB.

METHODOLOGY

At the DHQ Hospital in Muzaffargarh, Punjab, Pakistan, 498 COVID-19 patients with TB and COPD were studied retrospectively. The duration of study started in February 2022 and concluded in August 2022. The Kaplan-Meier curves described time-to-death and time-to-recovery stratified by TB and COPD status. The Wilcoxon test compared the survival rates of people with TB and COPD in two matched paired groups and their status differences with their standard of living.

RESULTS

The risk of death in COVID-19 patients with TB was 1.476 times higher than in those without (95% CI: 0.949-2.295). The recovery risk in COVID-19 patients with TB was 0.677 times lower than in those without (95% CI: 0.436-1.054). Similarly, patients with TB had a significantly shorter time to death (p=.001) and longer time to recovery (p=.001).

CONCLUSIONS

According to the findings, the most significant contributor to an increased risk of morbidity and mortality in TB and COPD patients was the COVID-19.KEY MESSAGESSARS-Cov-19 is a new challenge for the universe in terms of prevention and treatment for people with tuberculosis and chronic obstructive pulmonary disease, among other diseases.Propensity score matching to control for potential biases.Compared to hospitalized patients with and without (TB and COPD) had an equivalently higher mortality rate.

Place Visitation Data Reveals the Geographic and Racial Disparities of COVID-19 Impact on HIV Service Utilization in the Deep South

BACKGROUND

The COVID-19 pandemic has posed unprecedented pressure to health care systems, and interrupted health care delivery and access including HIV care in the United States' Deep South, which endures a double epidemic of HIV and COVID-19. Ryan White programs cover HIV care services for over half of PLWH in the Deep South. Given the important role of Ryan White programs, examining the visitation changes to Ryan White facilities during the pandemic offers insights into the impact of the pandemic on HIV healthcare utilization.

OBJECTIVES

Analyze the geographic distribution of HIV facility visitors at the county level before and during the pandemic in the nine US states of Deep South (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas) to reveal the geographic and racial disparity in visitation disruption caused by the pandemic.

METHODS

We first extracted mobile device-based visitation data for Ryan White HIV facilities in the Deep South during 2019 and 2020. To quantify the disruption in visitations during 2020, we calculated the visitation reduction rate (VRR) for each county, using 2019 data as the baseline. Next, we conducted a spatial analysis of the VRR values to uncover geographical disparities in visitation interruptions. To investigate racial disparities, we performed spatial regression analyses with VRR as the dependent variable, and the percentages of Black, Hispanic, and Asian populations as the independent variables. In this analysis, we controlled for potential confounders.

RESULTS

Geographic disparities in visitation reduction were observed, with all nine Deep South states experiencing significant drops. Georgia experienced the highest visitation loss (VRR = -0.58), followed by Texas (-0.47), Alabama (0.47), and Tennessee (-0.46), while South Carolina had the smallest reductions (-0.11). All the regression models consistently revealed racial disparities in visitation interruption. That is, counties with a higher proportion of Black population tended to have higher RW facility visitation reductions.

CONCLUSIONS

Our analysis revealed distinct geographic disparities in visitation interruptions at Ryan White HIV facilities in the Deep South during the COVID-19 pandemic in 2020. Furthermore, we found that the Black/African American population experienced a greater disruption at the county level in the Deep South during this period.

Intersecting epidemics: COVID-19 and HIV in sub-Saharan Africa. A systematic review (2020-2022)

There has been significant progress with regards to winning the fight against HIV globally, particularly due to the introduction of antiretroviral therapy (ART). COVID-19 threatened to derail gains in the fight against HIV. As we have started to see with studies on COVID-19 and HIV, there is a need to 'provide an in-depth view' in understanding the dynamics between the two epidemics, especially in sub-Saharan Africa. We, therefore, undertook a systemic review of existing literature to synthesize the effects of COVID-19 on the utilization of HIV services in sub-Saharan Africa, the literature on the risks associated with HIV during the COVID-19 pandemic, and lastly, the innovations and strategies adopted to continue receiving treatment in sub-Saharan Africa. We conducted a systematic review of studies published between 2020 and April 2022. We searched for relevant sub-Saharan studies in the following databases: PubMed, Google Scholar, J-STOR, and Science Direct. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search identified 647 papers, and after screening, 41 were in line with the inclusion criteria and were included in the review. There was evidence of the negative effects of COVID-19 on reducing HIV testing, ART treatment, and HIV prevention services. There is evidence pointing to the need for people living with HIV to be prioritized for COVID-19 vaccinations. Innovations and strategies implemented to mitigate the effects of COVID-19 on HIV services include community-based ART distribution, multi-month ART dispensing, the use of digital technologies, and the use of the already existing HIV infrastructure to fight COVID-19. It is still imperative that future studies explore the predictors of utilization of HIV services in the advent of COVID-19.

Risk factors identification of COVID-19 patients with chronic obstructive pulmonary disease: A retrospective study in Punjab-Pakistan

BACKGROUND

Accessibility to the immense collection of studies on noncommunicable diseases related to coronavirus disease of 2019 (COVID-19) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an immediate focus of researchers. However, there is a scarcity of information about chronic obstructed pulmonary disease (COPD), which is associated with a high rate of infection in COVID-19 patients. Moreover, by combining the effects of the SARS-CoV-2 on COPD patients, we may be able to overcome formidable obstacles factors, and diagnosis influencers.

MATERIALS AND METHODS

A retrospective study of 280 patients was conducted at DHQ Hospital Muzaffargarh in Punjab, Pakistan. Negative binomial regression describes the risk of fixed successive variables. The association is described by the Cox proportional hazard model and the model coefficient is determined through log-likelihood observation. Patients with COPD had their survival and mortality plotted on Kaplan-Meier curves.

RESULTS

The increased risk of death in COPD patients was due to the effects of variables such as cough, lower respiratory tract infection (LRTI), tuberculosis (TB), and body-aches being 1.369, 0.693, 0.170, and 0.217 times higher at (95% confidence interval [CI]: 0.747-1.992), (95% CI: 0.231-1.156), (95% CI: 0.008-0.332), and (95% CI: -0.07 to 0.440) while it decreased 0.396 in normal condition.

CONCLUSION

We found that the symptoms of COPD (cough, LRTI, TB, and bodyaches) are statistically significant in patients who were most infected by SARS-CoV-2.

The Impacts of HIV-Related Service Interruptions During the COVID-19 Pandemic: Protocol of a Mixed Methodology Longitudinal Study

The global COVID-19 pandemic has imposed unprecedented pressure on health systems and has interrupted public health efforts for other major health conditions, including HIV. It is critical to comprehensively understand how the pandemic has affected the delivery and utilization of HIV-related services and what are the effective strategies that may mitigate the negative impacts of COVID-19 and resultant interruptions. The current study thus aims to comprehensively investigate HIV service interruptions during the pandemic following a socioecological model, to assess their impacts on various outcomes of the HIV prevention and treatment cascade and to identify resilience resources for buffering impacts of interruptions on HIV treatment cascade outcomes. We will assess HIV service interruptions in South Carolina (SC) since 2020 using operational report data from Ryan White HIV clinics and HIV service utilization data (including telehealth use) based on statewide electronic health records (EHR) and cellphone-based place visitation data. We will further explore how HIV service interruptions affect HIV prevention and treatment cascade outcomes at appropriate geospatial units based on the integration of multi-type, multi-source datasets (e.g., EHR, geospatial data). Finally, we will identify institutional-, community-, and structural-level factors (e.g., resilience resources) that may mitigate the adverse impacts of HIV service interruptions based on the triangulation of quantitative (i.e., EHR data, geospatial data, online survey data) and qualitative (i.e., in-depth interviews with clinic leaders, healthcare providers, people living with HIV, and HIV clinic operational reports) data regarding health system infrastructure, social capital, and organizational preparedness. Our proposed research can lead to a better understanding of complicated HIV service interruptions in SC and resilience factors that can mitigate the negative effects of such interruptions on various HIV treatment cascade outcomes. The multilevel resilience resources identified through data triangulation will assist SC health departments and communities in developing strategic plans in response to this evolving pandemic and other future public health emergencies (e.g., monkeypox, disasters caused by climate change). The research findings can also inform public health policymaking and the practices of other Deep South states with similar sociocultural contexts in developing resilient healthcare systems and communities and advancing epidemic preparedness.

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 on People Living with HIV-1 and HIV-1-Associated Neurological Complications

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the causative pathogen of the coronavirus disease 2019 (COVID-19) pandemic, a fatal respiratory illness. The associated risk factors for COVID-19 are old age and medical comorbidities. In the current combined antiretroviral therapy (cART) era, a significant portion of people living with HIV-1 (PLWH) with controlled viremia is older and with comorbidities, making these people vulnerable to SARS-CoV-2 infection and COVID-19-associated severe outcomes. Additionally, SARS-CoV-2 is neurotropic and causes neurological complications, resulting in a health burden and an adverse impact on PLWH and exacerbating HIV-1-associated neurocognitive disorder (HAND). The impact of SARS-CoV-2 infection and COVID-19 severity on neuroinflammation, the development of HAND and preexisting HAND is poorly explored. In the present review, we compiled the current knowledge of differences and similarities between SARS-CoV-2 and HIV-1, the conditions of the SARS-CoV-2/COVID-19 and HIV-1/AIDS syndemic and their impact on the central nervous system (CNS). Risk factors of COVID-19 on PLWH and neurological manifestations, inflammatory mechanisms leading to the neurological syndrome, the development of HAND, and its influence on preexisting HAND are also discussed. Finally, we have reviewed the challenges of the present syndemic on the world population, with a particular emphasis on PLWH.

A systematic review on telenursing as a solution in improving the treatment compliance of tuberculosis patients in the COVID-19 pandemic

Introduction: The COVID-19 pandemic had made patients scared of coming to clinics or hospitals, and this could affect the treatment of TB. Therefore, one type of service that can be used by nurses to improve compliance to TB treatment is Telenursing. This article aims to ascertain whether telenursing could be a solution in improving the compliance of TB patients to treatments in the COVID-19 pandemic. Design and Method: This research was conducted using the Randomised Controlled Trial design as well as PRISMA. Furthermore, useful research articles were sourced from the database using the keywords, “Message Reminder and Tuberculosis OR Medication Adherence”. The databases used are Scopus, Science Direct, PubMed, and SAGE, all in English text and from 2015 to 2021, with inclusion criteria. 277 articles were obtained, and then filtered to select 3 articles by reading the main focus of the write-up, with regard to the topic of study. Result: Telenursing can be a solution to reduce the spread of COVID-19, and a substitute for remotely motivating individuals, as social support. Furthermore, it could be used as a reminder to patients to be obedient in carrying out treatments, and as a means of educating and improving good relationships with providers. Conclusions: Telenursing is a fairly effective solution in helping TB patients improve treatment compliance, reduce drug dropout rates and missed doses, as well as, raise awareness about the importance of health in the COVID-19 pandemic.  

Mean Temperature and Drought Projections in Central Africa: A Population-Based Study of Food Insecurity, Childhood Malnutrition and Mortality, and Infectious Disease

The Central African Region is an agricultural and fishing-based economy, with 40% of the population living in rural communities. The negative impacts of climate change have caused economic/health-related adverse impacts and food insecurity. This original article aims to research four key themes: (i) acute food insecurity (AFI); (ii) childhood malnutrition and mortality; (iii) infectious disease burden; and (iv) drought and mean temperature projections throughout the twenty-first century. Food insecurity was mapped in Central Africa based on the Integrated Food Security Phase Classification (IPC) for AFI. The global hunger index (GHI) was presented along with the proportion of children with undernourishment, stunting, wasting, and mortality. Data for infectious disease burden was computed by assessing the adjusted rate of change (AROC) of mortality due to diarrhea among children and the burden of death rates due to pneumonia across all age groups. Finally, the mean drought index was computed through the year 2100. This population-based study identifies high levels of hunger across a majority of the countries, with the mean drought index suggesting extreme ends of wet and dry days and an overall rise of 1-3 °C. This study is a source of evidence for stakeholders, policymakers, and the population residing in Central Africa.

The COVID-19, tuberculosis and HIV/AIDS: Ménage à Trois

In December 2019, a novel pneumonic condition, Coronavirus disease 2019 (COVID- 19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in China and spread globally. The presentation of COVID-19 is more severe in persons with underlying medical conditions such as Tuberculosis (TB), Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) and other pneumonic conditions. All three diseases are of global concern and can significantly affect the lungs with characteristic cytokine storm, immunosuppression, and respiratory failure. Co-infections of SARS-CoV-2 with HIV and Mycobacterium tuberculosis (Mtb) have been reported, which may influence their pathogenesis and disease progression. Pulmonary TB and HIV/AIDS patients could be more susceptible to SARS-CoV-2 infection leading to lethal synergy and disease severity. Therefore, the biological and epidemiological interactions of COVID-19, HIV/AIDS, and TB need to be understood holistically. While data is needed to predict the impact of the COVID-19 pandemic on these existing diseases, it is necessary to review the implications of the evolving COVID-19 management on HIV/AIDS and TB control, including therapy and funding. Also, the impact of long COVID on patients, who may have this co-infection. Thus, this review highlights the implications of COVID-19, HIV/AIDS, and TB co-infection compares disease mechanisms, addresses growing concerns, and suggests a direction for improved diagnosis and general management.

Covid-19 and female sex workers in India: a journey of brutal reality

The present paper is focused on the devastating effect of the Covid-19 pandemic on female sex workers (FSWs) in India and the globe. In Indian scenario, it emphasises on historical factors and theoretical frameworks that explicates the ceaseless exploitation of FSWs even before the pandemic. This inquiry analyses the efficacy of legislative and judicial endeavours taken with regard to FSWs. It highlights the role of non-governmental organisations and sex workers' community, actively working in providing support to the FSWs. Here, we attempt to document the scattered information from various reports regarding sex workers and prostitution. Literature search was done through search engines like Science Direct, Google Scholar and PubMed using keywords such as "COVID-19 pandemic" "sex workers", "prostitutes", "health", and "policies". Web hits from Google Scholar were collected using a Boolean search and retrieval method involving sex workers and the "AND" operator. During Covid-19 pandemic, due to stigmatisation of their profession FSWs are majorly excluded from government relief programs and health services. In India, the existing laws for FSWs are rigid in nature. They emphasize on prohibition of prostitution. There is an urgent need in India to move towards a substitute model which embody a flexible decriminalisation policy for sex workers. By studying relevant literature on the present topic the gap between policy formulation and implementation was identified. In case of India, it outlines recommendations, in particular providing immediate aid and relief, issuance of temporary documentation to sex workers.

Availability, price, and affordability of medicines used for the management of Covid-19 in health facilities of Dessie town WHO/HAI survey

BACKGROUND

The rapidly spreading nature of Covid-19 virus associated with its high mortality and mortality rate is triggering an unprecedented public health crisis. The study assessed the availability, price, and affordability of medicines used in the management of Covid-19 in health facilities of Dessie town.

METHODS

A retrospective cross-sectional study design was employed in the health facilities of Dessie town from September 1 to September 20, 2021. Data was collected using a standard checklist adopted from the Logistics Indicator Assessment Tool and WHO/HAI. WHO/HAI methodology was applied to select the surveyed health facilities (30) and medicines (44). The daily wage of the lowest-paid unskilled government worker is used to estimate affordability.

RESULTS

Fifteen and five medicines were not found at all public and private health facilities, respectively. The originator brand (OB) and lowest price generic (LPG) availability in private health facilities was 2.03% and 51.33%, respectively. In the public sector, the availability of OB and LPG was 0% and 34.44%, respectively. In public and private health facilities, the mean number of stock-outs was 2.25 and 2.91, and the mean number of stock-out days was 177.83 and 106.16 days, respectively. Eight and one LPG medicines were out of stock in public and private health facilities, respectively. Eight (33.33%) and 6 (28.57%) had higher prices than international prices in private and public health facilities, respectively. The median price ratio in public and private health facilities ranged from 0.02 and 3.05 and 0.04 to 2.70, respectively. Eighty percent of the products were unaffordable in both sectors.

CONCLUSIONS

The availability of medicines was low. One-third of the medicines had higher prices than international prices. Eighty percent of the products were unaffordable. The regular supply of these medicines is crucial for better management of the disease.

Experiences of mothers and significant others in accessing comprehensive healthcare in the first 1000 days of life post-conception during COVID-19 in rural Uganda

BACKGROUND

COVID-19 presented an unprecedented global public health challenge because of its rapid and relentless spread, and many countries instituted lockdowns to prevent the spread of infection. Although this strategy may have been appropriate to reduce infection, it presented unintended difficulties in rural Uganda, especially in maternal and born newborn care. For example, some services were suspended, meaning the nearest health facility was at a considerable distance. This study explored the experiences of mothers and their significant others of comprehensive care in the first 1000 days of life post-conception during the COVID-19 pandemic in Bunghokho-Mutoto sub-county, Mbale District, Uganda.

METHODS

A qualitative exploratory descriptive design was used with data collected in semi-structured interviews. Mothers (pregnant or with a child under 2 years) and their significant others were purposively recruited for this study. The sample size (N = 14) was determined by data saturation.

DATA

were analysed using thematic analysis.

RESULTS

One theme emerged "Increasing barriers to healthcare", which encompassed six sub-themes: accessing healthcare, distressing situations, living in fear, making forced choices, navigating the gatekeepers, and 'coping with increased poverty.

CONCLUSION

This study found that the COVID-19 pandemic increased barriers to accessing healthcare services in the region. Participants' narratives emphasised the lack of access to expert care and the shortage of skilled health workers, especially midwives.

Trend analysis of the loss and gain of patients on HIV treatment in the context of COVID-19 in South West Shewa Zone, Oromia, Ethiopia from 2016 to 2020: a short report

Coronavirus disease 2019 poses significant risk to countries. People living with HIV may be at greater risk for COVID-19 complications. Therefore, this short report analyses the trend of the loss and gain of patients receiving ART in the context of COVID-19 in South West Shewa Zone, Oromia, Ethiopia. Descriptive secondary data trend analysis was conducted during August, 2020 to September, 2020 in the study area. The number of patients receiving ART was increased from 1691 to 1865 during July, 2016 to June, 2020. However, decreased from 1884 during January, 2020 to March, 2020 down to 1865 during April, 2020 to June, 2020. The quarterly median proportion of loss was 0.61 (IQR: 0.26-0.86) compared with newly started ART. The proportion of patient loss was higher during April, 2020 to June, 2020. Disruptions to HIV services from the COVID-19 pandemic could lead to a higher loss of patients. Hence, maintaining HIV treatment service is a priority for reducing COVID-19 impact.

Emergence of infectious diseases and role of advanced nanomaterials in point-of-care diagnostics: a review

Infectious outbreaks are the foremost global public health concern, challenging the current healthcare system, which claims millions of lives annually. The most crucial way to control an infectious outbreak is by early detection through point-of-care (POC) diagnostics. POC diagnostics are highly advantageous owing to the prompt diagnosis, which is economical, simple and highly efficient with remote access capabilities. In particular, utilization of nanomaterials to architect POC devices has enabled highly integrated and portable (compact) devices with enhanced efficiency. As such, this review will detail the factors influencing the emergence of infectious diseases and methods for fast and accurate detection, thus elucidating the underlying factors of these infections. Furthermore, it comprehensively highlights the importance of different nanomaterials in POCs to detect nucleic acid, whole pathogens, proteins and antibody detection systems. Finally, we summarize findings reported on nanomaterials based on advanced POCs such as lab-on-chip, lab-on-disc-devices, point-of-action and hospital-on-chip. To this end, we discuss the challenges, potential solutions, prospects of integrating internet-of-things, artificial intelligence, 5G communications and data clouding to achieve intelligent POCs.

Linkage to care and treatment among men with reactive HIV self-tests after workplace-based testing in Uganda: A qualitative study

Introduction

HIV self-testing at workplaces has the potential to reach men at risk of HIV infection with lower access to HIV testing services. While several studies have reported high uptake of HIV self-testing, linkage to HIV care following a positive result remains a challenge. This study, therefore, explored the motivators for and barriers to linkage to HIV care and treatment among men who returned positive results following workplace-based HIV self-testing.

Methods

A qualitative descriptive study, among men in private security services in Kampala district, Uganda. The men were eligible to participate if they were aged 18 to 60 years and had worked at the company for more than 6 months. Following HIV self-testing, participants with reactive (positive) self-test results were purposively sampled and engaged in key informant interviews. Inductive content analysis was employed to identify the motivators and barriers to the men's linkage to HIV treatment and care.

Results

Overall, 12 men participated in the study, of whom 9 (75%) were security guards, and the rest held management positions. The motivators for linkage to care coalesced under five categories. (i) Communication (open communication, phone reminders, consistent communication) (ii) Navigating health facility systems and processes (enabling health facility environment, easy access to health care, employing ART clinic counselors as part of the study team, health workers) (iii) Linkage support (linkage companions, referral forms, linkage facilitation, individualized linkage plan, pre-arranged clinic appointments) (iv) Psychosocial support (counseling sessions, family support, online and social media support, peer support) (v) workplace environment (employer's support, work schedules and policies). The barriers to linkage to HIV care included (i) Inflexible work schedules, (ii) Far distances to travel to access ART (iii) mandatory work transfers, (iv) disruptive effects of the COVID-19 pandemic, (v) Denial of HIV-positive results and (vi) fear of stigma and discrimination at health facilities.

Conclusion

The findings suggest the need for innovative interventions to facilitate regular follow-up and open communication with workplace-based HIV self-testers, to improve linkage to HIV care and treatment. Furthermore, initiating linkage plans during pre-test counseling and working in collaboration with health facilities and clinics may improve linkage to care.

Sustaining surveillance as an intervention during the COVID-19 pandemic in Cabo Verde and implications for malaria elimination

Cabo Verde reported the first case of COVID-19 on March 19, 2020. Containment measures were quickly implemented and over 80,000 COVID-19 tests were performed in 2020 with 11,840 confirmed infections (2% of the population) and 154 deaths. In a setting where the last locally acquired malaria case was reported in January 2018, any interruptions to malaria care-seeking have the potential for infections to go untreated and transmission re-establishing. This work aims to determine whether there was any change in the number of people seeking care or being tested for malaria and, using an interrupted time series analysis, identify if any change was associated with implemented COVID-19 measures. Routinely collected surveillance data for outpatient visits, testing for malaria and COVID-19 were aggregated by month for each health facility (outpatient and malaria) or by municipality (COVID-19) from 2017 through 2020. The timeline of COVID-19 measures was generated based on when and where they were implemented. Results show that there was a marked shift in care-seeking in Cabo Verde. Overall, the mean number of observed outpatient visits decreased from 2,057 visits per month during 2017-2019 to 1,088 in 2020, an estimated 28% reduction. However, malaria testing rates per 1,000 outpatient visits after the pandemic began increased by 8% compared to expected trends. Results suggest that the pandemic impacted care-seeking but led to a non-significant increase in testing for malaria per 1,000 outpatient visits. With the cessation of international travel, the risk of imported infections seeding new transmission declined suggesting the risk of undetected transmission was low. It is important for countries to understand their specific malaria risks and vulnerabilities in order to ensure that any progress towards the interruption of malaria transmission can be sustained.

Clinical Outcomes of Individuals with COVID-19 and Tuberculosis during the Pre-Vaccination Period of the Pandemic: A Systematic Review

Background: Tuberculosis, like COVID-19, is most often a pulmonary disease. The COVID-19 pandemic has severely disrupted tuberculosis services in myriad ways: health facility closures, lockdowns, travel bans, overwhelmed healthcare systems, restricted export of antituberculous drugs, etc. The effects of the shared risk on outcomes of the two diseases is not known, particularly for the first year of the pandemic, during the period before COVID-19 vaccines became widely available. Objective: We embarked on a systematic review to elucidate the consequences of tuberculosis on COVID-19 outcomes and of COVID-19 on tuberculosis outcomes during the pre-vaccination period of the pandemic. Methods: The systematic review protocol is registered in PROSPERO. We conducted an initial search of PubMed, Embase, Web of Science, WHO coronavirus database, medRxiv, bioRxiv, preprints.org, and Google Scholar using terms relating to COVID-19 and tuberculosis. We selected cohort and case–control studies for extraction and assessed quality with the Newcastle-Ottawa scale. Results and Conclusion: We identified 2108 unique abstracts published between December 2019 and January 2021. We extracted data from 18 studies from 8 countries. A total of 650,317 persons had a diagnosis of COVID-19, and 4179 had a diagnosis of current or prior tuberculosis. We explored links between tuberculosis and COVID-19 incidence, mortality, and other adverse outcomes. Nine studies reported on mortality and 13 on other adverse outcomes; results on the association between tuberculosis and COVID-19 mortality/adverse outcomes were heterogenous. Tuberculosis outcomes were not fully available in any studies, due to short follow-up (maximum of 3 months after COVID-19 diagnosis), so the effects of COVID-19 on tuberculosis outcomes could not be assessed. Much of the rapid influx of literature on tuberculosis and COVID-19 during this period was published on preprint servers, and therefore not peer-reviewed. It offered limited examination of the effect of tuberculosis on COVID-19 outcomes and even less on the effect of COVID-19 on tuberculosis treatment outcomes.

Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda

Background

The spread of COVID-19 exposed the inadequacies inherent in the health care systems of many countries. COVID-19 and the attendant demands for emergency treatment and management put a significant strain on countries' health care systems, including hitherto strong health systems. In Uganda, as the government strived to contain COVID-19, other essential health care services were either disrupted or completely crowded out. Balancing the provision of COVID-19 treatment and management services and at the same time offering sexual and reproductive health and rights services (SRHR) proved to be a considerable challenge in these circumstances. COVID-19 prevention-related travel restrictions and border closures had far-reaching negative consequences on the mobility of individuals to access essential health services in Uganda. The situation may have been worse for cross-border communities that sometimes access services across the borders.

Methods

Using quantitative data from 1521 respondents and qualitative data (20 key informant interviews and 12 focus group discussions), we investigate the disruption in accessing SRHR services for border communities in Uganda during COVID-19.

Results

Results indicate that females (adjusted odds ratio (aOR) = 1.3; 95% confidence interval CI = 1.08-1.79), those with primary education (aOR = 1.47; 95% CI = 1.61-2.57), currently employed (aOR = 2.03; 95% CI = 1.61-2.57) and those with the intention to leave current residence (aOR = 2.09; 95% CI = 1.23-3.55) were more likely to have experienced a disruption in accessing SRHR services. However, respondents aged 35 years, or more were less likely to have experienced a disruption compared to their younger counterparts.

Conclusions

Results shed light on the disruption of access toSRHR services during pandemics such as COVID-19 among a highly mobile population. There is a need to invest in building strong and resilient health care systems that can guarantee continuous access to essential health services including SRHR provisions among mobile populations during pandemics.

Validation of a COVID-19 mental health and wellness survey questionnaire

BACKGROUND AND AIM

COVID-19 affected mental health and wellbeing. Research is needed to assess its impact using validated tools. The study assessed the content validity, reliability and dimensionality of a multidimensional tool for assessing the mental health and wellbeing of adults.

METHODS

An online questionnaire collected data in the second half of 2020 from adults in different countries. The questionnaire included nine sections assessing: COVID-19 experience and sociodemographic profile; health and memory; pandemic stress (pandemic stress index, PSI); financial and lifestyle impact; social support; post-traumatic stress disorder (PTSD); coping strategies; self-care and HIV profile over 57 questions. Content validity was assessed (content validity index, CVI) and participants evaluated the test-retest reliability (Kappa statistic and intra-class correlation coefficient, ICC). Internal consistency of scales was assessed (Cronbach α). The dimensionality of the PSI sections and self-care strategies was assessed by multiple correspondence analysis (MCA) using all responses and SPSS. For qualitative validation, we used a semi-structured interview and NVivo was used for coding and thematic analysis.

RESULTS

The overall CVI = 0.83 with lower values for the memory items. Cronbach α for the memory items = 0.94 and ICC = 0.71. Cronbach α for PTSD items was 0.93 and ICC = 0.89. Test-retest scores varied by section. The 2-dimensions solution of MCA for the PSI behavior section explained 33.6% (precautionary measures dimension), 11.4% (response to impact dimension) and overall variance = 45%. The 2-dimensions of the PSI psychosocial impact explained 23.5% (psychosocial impact of the pandemic dimension), 8.3% (psychosocial impact of the precautionary measures of the pandemic dimension) and overall variance = 31.8%. The 2-dimensions of self-care explained 32.9% (dimension of self-care strategies by people who prefer to stay at home and avoid others), 9% (dimension of self-care strategies by outward-going people) and overall variance = 41.9%. Qualitative analysis showed that participants agreed that the multidimensional assessment assessed the effect of the pandemic and that it was better suited to the well-educated.

CONCLUSION

The questionnaire has good content validity and can be used to assess the impact of the pandemic in cross-sectional studies especially as individual items. The PSI and self-care strategies need revision to ensure the inclusion of items with strong discrimination.

Lessons for improved COVID-19 surveillance from the scale-up of malaria testing strategies

Effective control of infectious diseases is facilitated by informed decisions that require accurate and timely diagnosis of disease. For malaria, improved access to malaria diagnostics has revolutionized malaria control and elimination programmes. However, for COVID-19, diagnosis currently remains largely centralized and puts many low- and middle-income countries (LMICs) at a disadvantage. Malaria and COVID-19 are infectious diseases that share overlapping symptoms. While the strategic responses to disease control for malaria and COVID-19 are dependent on the disease ecologies of each disease, the fundamental need for accurate and timely testing remains paramount to inform accurate responses. This review highlights how the roll-out of rapid diagnostic tests has been fundamental in the fight against malaria, primarily within the Asia Pacific and along the Greater Mekong Subregion. By learning from the successful elements of malaria control programmes, it is clear that improving access to point-of-care testing strategies for COVID-19 will provide a suitable framework for COVID-19 diagnosis in not only the Asia Pacific, but all malarious countries. In malaria-endemic countries, an integrated approach to point-of-care testing for COVID-19 and malaria would provide bi-directional benefits for COVID-19 and malaria control, particularly due to their paralleled likeness of symptoms, infection control strategies and at-risk individuals. This is especially important, as previous disease pandemics have disrupted malaria control infrastructure, resulting in malaria re-emergence and halting elimination progress. Understanding and combining strategies may help to both limit disruptions to malaria control and support COVID-19 control.

Would Illness Representations of COVID-19 and COVID-19 Fears During Clinic Visits Promote or Reduce Behavioral Intention to Seek Medical Consultations for Flu Symptoms? A Random Telephone Survey in Hong Kong, China

Background

The study investigated the level of behavioral intention to consult doctors for flu symptoms (BICDFS) during the Coronavirus Disease 2019 (COVID-19) pandemic and examined its associations with illness representations of COVID-19 and fear of COVID-19 during clinic visits in a general Chinese adult population.

Methods

A random telephone survey was conducted among 300 residents in Hong Kong, China in April 2020 when the second wave of COVID-19 was just ended in the region. The participants were asked about their intention to consult doctors if they had mild or severe flu symptoms in the next week (from 1 = definitely no to 5 = definitely yes). Illness representations of COVID-19 were measured by the Chinese version of the Brief Illness Perception Questionnaire (BIPQ). The fear of COVID-19 during clinic visits were assessed by two single items. Linear regression adjusted for background variables and hierarchical strategies were employed.

Results

Of the participants, 52.3 and 92.0% showed an intention to consult doctors for mild and severe flu symptoms, respectively. Adjusted for background factors, COVID-19-related cognitive representations (consequences: standardized b = 0.15, p = 0.010; understanding: standardized b = 0.21, p = 0.001) and emotional representations (concern: standardized b = 0.17, p = 0.001; negative emotions: standardized b = 0.19, p = 0.001) were positively associated with BICDFS. In the hierarchical model, independent significant factors of BICDFS included understanding (standardized b = 0.16, p = 0.013) and negative emotions (standardized b = 0.17, p = 0.008). The fear-related variables showed non-significant associations with the BICDFS.

Conclusions

Promotion of care-seeking behaviors for flu symptoms during the COVID-19 pandemic should consider improving people's understanding of COVID-19 and providing advice on related coping strategies for emotional responses to COVID-19.

Global prevalence, treatment and outcome of tuberculosis and COVID-19 coinfection: a systematic review and meta-analysis (from November 2019 to March 2021)

INTRODUCTION

The COVID-19 outbreak poses a significant threat to the patients with tuberculosis (TB). TB and COVID-19 (TB-COVID) coinfection means the disease caused by both Mycobacterium tuberculosis and SARS-CoV-2 infection. Currently, the prevalence status, treatment and outcomes of the coinfection are poorly characterised. We aimed to systematically review the evidence on this topic and provide comprehensive information to guide the control and treatment of TB-COVID coinfection.

METHODS

An extensive screening was conducted using six electronic databases to search eligible studies from 1 November 2019 to 19 March 2021. Prevalence rate, treatment and outcomes of TB-COVID coinfection were extracted. Random-effects models were used to calculate mean fatality rates of coinfection with 95% CIs. The risks of bias were assessed with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Study Reporting Prevalence Data and JBI Critical Appraisal Checklist for Case Report. A meta-analysis was conducted for subgroups on in-hospital fatality rate.

RESULTS

Forty-two studies were included into the analysis (35 case reports and 7 retrospective cohort studies). Nineteen countries reported coinfected patients, including high and low TB prevalence countries. The only study revealing prevalence rate came from West Cape Province, South Africa (people aged above 20 years, 0.04% until 1 June 2020 and 0.06% until 9 June 2020). The treatment regimens for coinfected patients were highly heterogeneous. The mean overall and in-hospital fatality rates of coinfection were 13.9% (95% CI: 1.6% to 26.2%) and 17.5% (95% CI: 8.9% to 26.0%). The mean in-hospital fatality rates for high-income countries (Italy and Argentina) and low/middle-income countries (LMICs) (India, Philippines, South Africa) were 6.5% (95% CI: -0.8% to ~13.9%) and 22.5% (95% CI: 19.0% to ~26.0%).

CONCLUSION

TB-COVID coinfection is common globally, and the coinfected patients suffer from higher fatality risk than patients with normal COVID-19. Outcomes shared significant differences between high-income countries and LMICs.

PROSPERO REGISTRATION NUMBER

CRD42021253660.

Pathogenesis of SARS-CoV-2 and Mycobacterium tuberculosis Coinfection

Coronavirus disease-2019 (COVID-19), caused by SARS-CoV-2, is an infectious disease that poses severe threats to global public health and significant economic losses. The COVID-19 global burden is rapidly increasing, with over 246.53 million COVID-19 cases and 49.97 million deaths reported in the WHO 2021 report. People with compromised immunity, such as tuberculosis (TB) patients, are highly exposed to severe COVID-19. Both COVID-19 and TB diseases spread primarily through respiratory droplets from an infected person to a healthy person, which may cause pneumonia and cytokine storms, leading to severe respiratory disorders. The COVID-19-TB coinfection could be fatal, exacerbating the current COVID-19 pandemic apart from cellular immune deficiency, coagulation activation, myocardial infarction, and other organ dysfunction. This study aimed to assess the pathogenesis of SARS-CoV-2-Mycobacterium tuberculosis coinfections. We provide a brief overview of COVID19-TB coinfection and discuss SARS-CoV-2 host cellular receptors and pathogenesis. In addition, we discuss M. tuberculosis host cellular receptors and pathogenesis. Moreover, we highlight the impact of SARS-CoV-2 on TB patients and the pathological pathways that connect SARS-CoV-2 and M. tuberculosis infection. Further, we discuss the impact of BCG vaccination on SARS-CoV-2 cases coinfected with M. tuberculosis, as well as the diagnostic challenges associated with the coinfection.

Plants as Sources of Natural and Recombinant Antimalaria Agents

Malaria is one of the severe infectious diseases that has victimized about half a civilization billion people each year worldwide. The application of long-lasting insecticides is the main strategy to control malaria; however, a surge in antimalarial drug development is also taking a leading role to break off the infections. Although, recurring drug resistance can compromise the efficiency of both conventional and novel antimalarial medicines. The eradication of malaria is significantly contingent on discovering novel potent agents that are low cost and easy to administer. In this context, plant metabolites inhibit malaria infection progression and might potentially be utilized as an alternative treatment for malaria, such as artemisinin. Advances in genetic engineering technology, especially the advent of molecular farming, have made plants more versatile in producing protein drugs (PDs) to treat infectious diseases, including malaria. These recent developments in genetic modifications have enabled the production of native pharmaceutically active compounds and the accumulation of diverse heterologous proteins such as human antibodies, booster vaccines, and many PDs to treat infectious diseases and genetic disorders. This review will discuss the pivotal role of a plant-based production system that expresses natural antimalarial agents or host protein drugs to cure malaria infections. The potential of these natural and induced compounds will support modern healthcare systems in treating malaria infections, especially in developing countries to mitigate human fatalities.

Comparison of 19 major infectious diseases during COVID-19 epidemic and previous years in Zhejiang, implications for prevention measures

BACKGROUND

The global pandemic of coronavirus disease 2019 (COVID-19) has attracted great public health efforts across the world. Few studies, however, have described the potential impact of these measures on other important infectious diseases.

METHODS

The incidence of 19 major infectious diseases in Zhejiang Province was collected from the National Notifiable Infectious Disease Surveillance System from January 2017 to October 2020. The entire epidemic control phase was divided into three stages. The government deployed the first level response from 24 January to 2 March (the most rigorous measures). When the outbreak of COVID-19 was under control, the response level changed to the second level from 3 to 23 March, and then the third level response was implemented after 24 March. We compared the epidemiological characteristics of 19 major infectious diseases during different periods of the COVID-19 epidemic and previous years.

RESULTS

A total of 1,814,881 cases of 19 infectious diseases were reported in Zhejiang from January 2017 to October 2020, resulting in an incidence rate of 8088.30 cases per 1,000,000 person-years. After the non-pharmaceutical intervention, the incidence of 19 infectious diseases dropped by 70.84%, from 9436.32 cases per 1,000,000 person-years to 2751.51 cases per 1,000,000 person-years, with the large decrease in the first response period of influenza. However, we observed that the daily incidence of severe fever with thrombocytopenia syndrome (SFTS) and leptospirosis increased slightly (from 1.11 cases per 1,000,000 person-years to 1.82 cases per 1,000,000 person-years for SFTS and 0.30 cases per 1,000,000 person-years to 1.24 cases per 1,000,000 person-years for leptospirosis). There was no significant difference in the distribution of epidemiological characteristic of most infectious diseases before and during the implementation of COVID-19 control measures.

CONCLUSION

Our study summarizes the epidemiological characteristics of 19 infectious diseases and indicates that the rigorous control measures for COVID-19 are also effective for majority of infectious diseases.

Post-Immune Antibodies in HIV-1 Infection in the Context of Vaccine Development: A Variety of Biological Functions and Catalytic Activities

Unlike many other viruses, HIV-1 is highly variable. The structure of the viral envelope changes as the infection progresses and is one of the biggest obstacles in developing an HIV-1 vaccine. HIV-1 infection can cause the production of various natural autoantibodies, including catalytic antibodies hydrolyzing DNA, myelin basic protein, histones, HIV-integrase, HIV-reverse transcriptase, β-casein, serum albumin, and some other natural substrates. Currently, there are various directions for the development of HIV-1 vaccines: stimulation of the immune response on the mucous membranes; induction of cytotoxic T cells, which lyse infected cells and hold back HIV-infection; immunization with recombinant Env proteins or vectors encoding Env; mRNA-based vaccines and some others. However, despite many attempts to develop an HIV-1 vaccine, none have been successful. Here we review the entire spectrum of antibodies found in HIV-infected patients, including neutralizing antibodies specific to various viral epitopes, as well as antibodies formed against various autoantigens, catalytic antibodies against autoantigens, and some viral proteins. We consider various promising targets for developing a vaccine that will not produce unwanted antibodies in vaccinated patients. In addition, we review common problems in the development of a vaccine against HIV-1.

COVID-19 vaccines for children and adolescents in Africa: aligning our priorities to situational realities

The evolving COVID-19 pandemic is an unprecedented global public health crisis that continues to have a major impact on the African continent. Most countries within Africa are facing significant challenges vaccinating their populations for COVID-19. Inadequate COVID-19 vaccine supply, weaknesses in health system infrastructure, COVID-19 misinformation and disinformation, and ineffective health risk communication are contributing to low adult vaccination rates on the continent. Without sufficient COVID-19 vaccine coverage on the African continent, the prolonged social, economic and health impacts of this public health crisis are likely to exacerbate pre-existing social-structural issues in this part of the world. In this paper, we highlight trends in SARS-CoV-2 infections among children and adolescents (CA), compare COVID-19 vaccination patterns in Africa to those in high-income countries, and discuss some of the benefits, challenges and unknowns associated with vaccinating CA for COVID-19. In light of ongoing COVID-19 vaccine supply challenges and the slow progress that the African continent is making towards vaccinating the adult population, we suggest that the immediate priority for Africa is to accelerate COVID-19 vaccinations among adults (particularly high-risk populations) and vulnerable CA (ie, those who are immunocompromised and/or living with certain medical conditions). Accelerating the roll-out of COVID-19 vaccines and rapidly achieving high levels of vaccination coverage in the adult population will free up capacity to vaccinate CA sooner rather than later. While we hope that COVID-19 vaccines will soon become available to CA throughout Africa, countries must continue to prioritise non-pharmaceutical interventions.

The short-term effects of COVID-19 on HIV and AIDS control efforts among female sex workers in Indonesia

Background

The COVID-19 pandemic has raised concerns as to its impact on other health programs. One program that appears particularly vulnerable is HIV and AIDS. We undertook an assessment of COVID-19 impact on HIV control efforts in Indonesia for a sub-population that has received little attention in the global literature—female sex workers (FSW).

Methods

The study was undertaken in 23 National AIDS program priority districts. Four sources of monthly data during January–July 2020 were considered. COVID-19 infection data were extracted from national and district surveillance systems. Combination prevention program outputs were reported by civil society organizations (CSOs) providing community support services to FSW. These organizations also undertook monthly scans of levels of commercial sex activity and HIV testing availability. We also considered data from an ongoing HIV community screening trial. The primary mode of analysis entailed comparisons of levels and trends of indicators from the four data series.

Results

Commercial sex activity was severely curtailed in April–May in many districts. While recovering to pre-COVID-19 levels in “Localization” areas, the number of active FSW in July was one-third below that in February. HIV testing service availability declined by 50% at health facilities before recovering slowly, while mobile clinic services largely ceased during April–June. Numbers of FSW reached, condoms distributed, FSW tested for HIV, HIV cases detected, and FSW starting treatment all declined precipitously in April/May but had largely recovered to pre-COVID-19 levels by July. We found only a temporary dip in treatment initiation rates among HIV positive FSW and no discernible impact on treatment retention. The HIV community screening trial data revealed significant demand for HIV testing among FSW that was not being met even before the onset of COVID-19.

Conclusions

COVID-19 has had at least short-run economic effects on FSW and the national response to HIV and AIDS targeting FSW. However, the effects appear to have been cushioned by community-based services and support in study districts. The findings make a compelling case for the expansion of community-based services irrespective of the future trajectory of COVID-19. As COVID-19 has not yet been contained, the trajectory of economic activity and service delivery is uncertain.

Identifying the impact of COVID-19 on health systems and lessons for future emergency preparedness: A stakeholder analysis in Kenya

The coronavirus pandemic (COVID-19) has triggered a public health and economic crisis in high and low resource settings since the beginning of 2020. With the first case being discovered on 12th March 2020, Kenya has responded by using health and non-health strategies to mitigate the direct and indirect impact of the disease on its population. However, this has had positive and negative implications for the country's overall health system. This paper aimed to understand the pandemic's impact and develop lessons for future response by identifying the key challenges and opportunities Kenya faced during the pandemic. We conducted a qualitative study with 15 key informants, purposefully sampled for in-depth interviews from September 2020 to February 2021. We conducted direct content analysis of the transcripts to understand the stakeholder's views and perceptions of how COVID-19 has affected the Kenyan healthcare system. Most of the respondents noted that Kenya's initial response was relatively good, especially in controlling the pandemic with the resources it had at the time. This included relaying information to citizens, creating technical working groups and fostering multisectoral collaboration. However, concerns were raised regarding service disruption and impact on reproductive health, HIV, TB, and non-communicable diseases services; poor coordination between the national and county governments; shortage of personal protective equipment and testing kits; and strain of human resources for health. Effective pandemic preparedness for future response calls for improved investments across the health system building blocks, including; human resources for health, financing, infrastructure, information, leadership, service delivery and medical products and technologies. These strategies will help build resilient health systems and improve self-reliance, especially for countries transitioning from donor aid such as Kenya in the event of a pandemic.

Lessons Learned During the COVID-19 Pandemic to Strengthen TB Infection Control: A Rapid Review

In light of competing health priorities of COVID-19 and TB, we propose recommendations to strengthen health system preparedness for optimal TB control across low- and middle-income countries during and after the COVID-19 pandemic.

Introduction:

Over the past 5 years, substantial global investment has resulted in reduced TB incidence rates by 9% and mortality rates by 14%. However, the coronavirus disease (COVID-19) pandemic has hindered access and availability of TB services to maintain robust TB control. The objective of this rapid review was to describe the challenges to be addressed and recommendations to strengthen health system preparedness for optimal TB control across low- and middle-income countries during and after the COVID-19 pandemic.

Methods:

Five databases were used to systematically search for relevant articles published in 2020. The 5-step framework proposed by Arskey and O'Malley and adapted by Levac et al. guided the review process. Thematic analysis with grounded theory principles was used to summarize themes from selected articles and integrate analyses with barriers reported from authors' previous TB research.

Results:

Of the 218 peer-reviewed articles, 20 articles met the inclusion criteria. Four emerging themes described challenges: (1) unprepared health system leadership and infrastructure, (2) coexisting health priorities, (3) insufficient health care workforce support for continued training and appropriate workplace environments, and (4) weak connections to primary health centers hindering community engagement. Four recommendations were highlighted: (1) ensuring leadership and governance for sustainable national health budgets, (2) building networks of community stakeholders, (3) supporting health care workforce training and safe workplace environments, and (4) using digital health interventions for TB care.

Conclusions:

National health systems must promote patient-centered TB care, implement ethical community interventions, support operational research, and integrate appropriate eHealth applications. TB program managers and primary care practitioners can serve as instrumental leaders and patient advocates to deliver high-quality and sustainable TB care that leads to achieving the targets of the End TB Strategy.

COVID-19 prevention measures reduce dengue spread in Yunnan Province, China, but do not reduce established outbreak

The COVID-19 pandemic and measures against it provided a unique opportunity to understand the transmission of other infectious diseases and to evaluate the efficacy of COVID-19 prevention measures on them. Here we show a dengue epidemic in Yunnan, China, during the pandemic of COVID-19 was dramatically reduced compared to non-pandemic years and, importantly, spread was confined to only one city, Ruili. Three key features characterized this dengue outbreak: (i) the urban-to-suburban spread was efficiently blocked; (ii) the scale of epidemic in urban region was less affected; (iii) co-circulation of multiple strains was attenuated. These results suggested that countermeasures taken during COVID-19 pandemic are efficient to prevent dengue transmission between cities and from urban to suburban, as well to reduce the co-circulation of multiple serotypes or genotypes. Nevertheless, as revealed by the spatial analysis, once the dengue outbreak was established, its distribution was very stable and resistant to measures against COVID-19, implying the possibility to develop a precise prediction method.

Mast cells-derived exosomes worsen the development of experimental cerebral malaria

Cerebral malaria (CM) is the most severe neurological complication caused by Plasmodium falciparum infection. The accumulating evidence demonstrated that mast cells (MCs) and its mediators played a critical role in mediating malaria severity. Earlier studies identified that exosomes were emerging as key mediators of intercellular communication and can be released from several kinds of MCs. However, the potential functions and pathological mechanisms of MCs-derived exosomes (MCs-Exo) impacting on CM pathogenesis remain largely unknown. Herein, we utilized an experimental CM (ECM) model (C57BL/6 mice infected with P. berghei ANKA strain), and then intravenously (i.v.) injected MCs-Exo into P. berghei ANKA-infected mice to unfold this mechanism and investigate the effect of MCs-Exo on ECM pathogenies. We also used an in vitro model by investigating the pathogenesis development of brain microvascular endothelial cells line (bEnd.3 cells) co-cultured with P. berghei ANKA blood-stage soluble antigen (PbAg) after MCs-Exo treatment. The higher numbers of MCs and levels of MCs degranulation were observed in skin, cervical lymph node, and brain of ECM mice than those of the uninfected mice. Exosomes were successfully isolated from culture supernatants of mouse MCs line (P815 cells) and characterized by spherical vesicles with the diameter of 30-150 nm, and expression of typical exosomal markers (e.g., CD9, CD63, and CD81). The i.v. injection of MCs-Exo dramatically elevated incidence of ECM in the P. berghei ANKA-infected mice, exacerbated liver and brain histopathological damage, promoted Th1 cytokine response, aggravated brain vascular endothelial activation and blood brain barrier breakdown in ECM mice. In addition, the treatment of MCs-Exo led to the decrease of cells viability and mRNA levels of Ang-1, ZO-1, and Claudin-5, but increase of mRNA levels of Ang-2, CCL2, CXCL1, and CXCL9 in bEnd.3 cells co-cultured with PbAg in vitro. Taken together, our data indicated that MCs-Exo could worsen pathogenesis of ECM in mice.

COVID-19 in Patients with Active Tuberculosis

Data on the coincidence of tuberculosis (TB) and COVID-19 are limited, and previous observations are based on the results of just a few studies, which has led to polarized views on the course of infection with SARS-CoV-2 in patients with active TB. We present the first two cases of TB and COVID-19 coinfection in the population of patients in Poland, diagnosed shortly after the outbreak of the global pandemic. In the first patient, TB was very advanced at the time of infection with SARS-CoV-2. From the third day of hospitalisation, respiratory failure was increasing, with no improvement after the use of high-flow oxygen therapy and mechanical ventilation. On the seventh day of hospitalization, the patient died. In the second presented case, therapeutic success was achieved despite the coincidence of COVID-19, infection with HIV, and extrapulmonary and pulmonary TB. The patient had symptoms of renal failure and the SARS-CoV-2 infection was mild and asymptomatic. Because both patients were in the care of a homeless shelter, a molecular epidemiological investigation was carried out. Different DNA profiles of Mycobacterium tuberculosis complex isolates detected in clinical materials from patients ruled out the transmission of tuberculosis. Based on our analysis, it is impossible to clearly define the influence of active TB on the course of SARS-CoV-2 infection. We can only suggest that coinfection is particularly dangerous for socially disadvantaged people, the elderly, and people with other comorbidities. In the coming years, a negative impact of the current pandemic on control programmes will be observed for many infectious diseases, including TB.

Impacts of COVID-19 on Diverse Farm Systems in Tanzania and South Africa

Emerging information on the interactions between the COVID-19 pandemic and global food systems have highlighted how the pandemic is accentuating food crises across Africa. Less clear, however, are how the impacts differ between farming systems. Drawing on 50 key informant interviews with farmers, village leaders and extension officers in South Africa and Tanzania, we identify the effects of COVID-19 and associated measures to curb the spread of the disease on farming production systems, the coping mechanisms adopted by farmers, and explore their longer-term plans for adaptation. We focus on a diverse range of production systems, from small-scale mixed farming systems in Tanzania to large-scale corporate farms in South Africa. Our findings highlight how COVID-19 restrictions have interrupted the supply chains of agricultural inputs and commodities, increasing the storage time for produce, decreasing income and purchasing power, and reducing labour availability. Farmers’ responses were heterogeneous, with highly diverse small-scale farming systems and those less engaged with international markets least affected by the associated COVID-19 measures. Large-scale farmers were most able to access capital to buffer short-term impacts, whereas smaller-scale farms shared labour, diversified to subsistence produce and sold assets. However, compounded shocks, such as recent extreme climate events, limited the available coping options, particularly for smaller-scale and emerging farmers. The study highlights the need to understand the characteristics of farm systems to better equip and support farmers, particularly in contexts of uncertainty. We propose that policy actions should focus on (i) providing temporary relief and social support and protection to financially vulnerable stakeholders, (ii) job assurance for farmworkers and engaging an alternative workforce in farming, (iii) investing in farming infrastructure, such as storage facilities, digital communication tools and extension services, and (iv) supporting diversified agroecological farming systems.

Ribosome hibernation: a new molecular framework for targeting nonreplicating persisters of mycobacteria

Treatment of tuberculosis requires a multi-drug regimen administered for at least 6 months. The long-term chemotherapy is attributed in part to a minor subpopulation of nonreplicating Mycobacterium tuberculosis cells that exhibit phenotypic tolerance to antibiotics. The origins of these cells in infected hosts remain unclear. Here we discuss some recent evidence supporting the hypothesis that hibernation of ribosomes in M. tuberculosis, induced by zinc starvation, could be one of the primary mechanisms driving the development of nonreplicating persisters in hosts. We further analyse inconsistencies in previously reported studies to clarify the molecular principles underlying mycobacterial ribosome hibernation.

Public health-relevant consequences of the COVID-19 pandemic on malaria in sub-Saharan Africa: a scoping review

BACKGROUND

The COVID-19 pandemic has resulted in unprecedented challenges to health systems worldwide, including the control of non-COVID-19 diseases. Malaria cases and deaths may increase due to the direct and indirect effects of the pandemic in malaria-endemic countries, particularly in sub-Saharan Africa (SSA). This scoping review aims to summarize information on public health-relevant effects of the COVID-19 pandemic on the malaria situation in SSA.

METHODS

Review of publications and manuscripts on preprint servers, in peer-reviewed journals and in grey literature documents from 1 December, 2019 to 9 June, 2021. A structured search was conducted on different databases using predefined eligibility criteria for the selection of articles.

RESULTS

A total of 51 papers have been included in the analysis. Modelling papers have predicted a significant increase in malaria cases and malaria deaths in SSA due to the effects of the COVID-19 pandemic. Many papers provided potential explanations for expected COVID-19 effects on the malaria burden; these ranged from relevant diagnostical and clinical aspects to reduced access to health care services, impaired availability of curative and preventive commodities and medications, and effects on malaria prevention campaigns. Compared to previous years, fewer country reports provided data on the actual number of malaria cases and deaths in 2020, with mixed results. While highly endemic countries reported evidence of decreased malaria cases in health facilities, low endemic countries reported overall higher numbers of malaria cases and deaths in 2020.

CONCLUSIONS

The findings from this review provide evidence for a significant but diverse impact of the COVID-19 pandemic on malaria in SSA. There is the need to further investigate the public health consequences of the COVID-19 pandemic on the malaria burden. Protocol registered on Open Science Framework: https://doi.org/10.17605/OSF.IO/STQ9D.

Intense and Mild First Epidemic Wave of Coronavirus Disease, The Gambia

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is evolving differently in Africa than in other regions. Africa has lower SARS-CoV-2 transmission rates and milder clinical manifestations. Detailed SARS-CoV-2 epidemiologic data are needed in Africa. We used publicly available data to calculate SARS-CoV-2 infections per 1,000 persons in The Gambia. We evaluated transmission rates among 1,366 employees of the Medical Research Council Unit The Gambia (MRCG), where systematic surveillance of symptomatic cases and contact tracing were implemented. By September 30, 2020, The Gambia had identified 3,579 SARS-CoV-2 cases, including 115 deaths; 67% of cases were identified in August. Among infections, MRCG staff accounted for 191 cases; all were asymptomatic or mild. The cumulative incidence rate among nonclinical MRCG staff was 124 infections/1,000 persons, which is >80-fold higher than estimates of diagnosed cases among the population. Systematic surveillance and seroepidemiologic surveys are needed to clarify the extent of SARS-CoV-2 transmission in Africa.

COVID-19 and lung pathologies

COVID-19 is a global emergency with over 10 million cases and over 500, 000 deaths worldwide. The SARS CoV-2 is a RNA virus belonging to the family coronaviridae. It has high infectivity. The manifestations of the disease range from asymptomatic or mild symptoms to severe pneumonia and ARDS. The CT scan of lung shows consolidation and "Ground Glass Opacities". The persons with other comorbidities are considered to be at a higher rate of acquiring the infection. Asthma and other allergies have not been identified as major risk factors for COVID-19 as the number of asthmatic patients having COVID-19 is not high enough for it to be considered so. The occurrence of COVID-19 in COPD patients can be related with smoking. The ACE-2 expression in such patients was considerably high. The relation between COVID-19 and Tuberculosis can also be reflected in terms of the stigma associated with diagnosis and treatment of such diseases in some communities, eventually increasing the chances of people's reluctance to seek medical help. Cancer patients are usually more susceptible to infections. Lung cancer is no different. Additionally, lung cancer also has strong association with smoking further increasing the risk. The risk of getting infection and its severity is high for autoimmune disorders as well as fungal infections. Currently there is no definite treatment of COVID-19. However, some of the currently used modalities are hydroxychloroquine and antiviral drugs.

Challenges with the proposed approach in enhancing the accessibility of antimalarial activities during COVID 19 pandemic

COVID 19 has hardly left any part of the world untouched. Two hundred thirteen countries have been affected by this disease, with 17,208,324 cases and 670,626 deaths as of July 30, 2020. If we look at the death toll caused by Malaria, this year, it is closely nearing COVID 19 deaths, 5, 68,700 deaths. Malaria mostly occurs in poor, tropical, and subtropical regions across the globe. In 2018, Malaria was most rampant in Africa, followed by Southeast Asian Regions (SEAR). SEAR is at the greatest risk of both COVID 19 and malaria. Strategies for essential commodities and antimalarial activities are affected by COVID 19 when the rainy season registers the maximum malaria load. We searched the literature to explore the evidence regarding efficacious antimalarial activities and the gap created by the COVID 19 pandemic, responsible barriers, and challenges, with the possible approaches towards accomplishing a target for malaria control.

Assessing the Potential Impact of Disruptions Due to COVID-19 on HIV Among Key and Lower-Risk Populations in the Largest Cities of Cameroon and Benin

BACKGROUND

The COVID-19 pandemic indirectly impacts HIV epidemiology in Central/West Africa. We estimated the potential impact of COVID-19-related disruptions to HIV prevention/treatment services and sexual partnerships on HIV incidence and HIV-related deaths among key populations including female sex workers (FSW), their clients, men who have sex with men, and overall.

SETTING

Yaoundé (Cameroon) and Cotonou (Benin).

METHODS

We used mathematical models of HIV calibrated to city population-specific and risk population-specific demographic/behavioral/epidemic data. We estimated the relative change in 1-year HIV incidence and HIV-related deaths for various disruption scenarios of HIV prevention/treatment services and decreased casual/commercial partnerships, compared with a scenario without COVID-19.

RESULTS

A 50% reduction in condom use in all partnerships over 6 months would increase 1-year HIV incidence by 39%, 42%, 31%, and 23% among men who have sex with men, FSW, clients, and overall in Yaoundé, respectively, and 69%, 49%, and 23% among FSW, clients, and overall, respectively, in Cotonou. Combining a 6-month interruption of ART initiation and 50% reduction in HIV prevention/treatment use would increase HIV incidence by 50% and HIV-related deaths by 20%. This increase in HIV infections would be halved by a simultaneous 50% reduction in casual and commercial partnerships.

CONCLUSIONS

Reductions in condom use after COVID-19 would increase infections among key populations disproportionately, particularly FSW in Cotonou, who need uninterrupted condom provision. Disruptions in HIV prevention/treatment services have the biggest impacts on HIV infections and deaths overall, only partially mitigated by equal reductions in casual/commercial sexual partnerships. Maintaining ART provision must be prioritized to minimize short-term excess HIV-related deaths.