Measuring and explaining inequality of continuous care for people living with HIV receiving antiretroviral therapy in Kunming, China

Background In the context of scaling up free antiretroviral therapy (ART), healthcare equality is essential for people living with HIV. We aimed to assess socioeconomic-related inequalities in uptake of continuous care for people living with HIV receiving ART, including retention in care in the last six months, routine toxicity monitoring, adequate immunological and virological monitoring, and uptake of mental health assessment in the last 12 months. We also determined the contributions of socioeconomic factors to the degree of inequalities. Methods A hospital-based cross-sectional survey was conducted among consecutive clients visiting an HIV treatment center in Kunming, China in 2019. Participants were 702 people living with HIV aged ≥18 years (median age: 41.0 years, 69.4% male) who had been on ART for 1–5 years. Socioeconomic-related inequality and its contributing factors were assessed by a normalized concentration index (CIn) with a decomposition approach. Results The uptake of mental health assessment was low (15%) but significantly higher among the rich (CIn 0.1337, 95% CI: 0.0140, 0.2534). Retention in care, toxicity, and immunological monitoring were over 80% but non-significant in favor of the rich (CIn: 0.0117, 0.0315, 0.0736, respectively). The uptake of adequate virological monitoring was 15% and higher among the poor (CIn = -0.0308). Socioeconomic status positively contributed to inequalities of all care indicators, with the highest contribution for mental health assessment (124.9%) and lowest for virological monitoring (2.7%). Conclusions These findings suggest virological monitoring and mental health assessment be given more attention in long-term HIV care. Policies allocating need-oriented resources geared toward improving equality of continuous care should be developed.

Lessons learnt from measures taken to prevent rabies introduction and spread into a long rabies free territory (case study of the Irkutsk Oblast)

Rabies is endemic on the considerable part of the Russian Federation, and it is associated with current natural outbreaks of the infection. The highest animal morbidity rates are reported in the central and southern regions of the European part of Russia and in the southern part of Western Siberia. The Irkutsk Oblast is among the few regions of our country, which are rabies free for several decades. The research was aimed at the analysis of factors aiding to the maintenance of the rabies free status of the region. Retrospective study of archive and previously published reports on human and animal rabies cases in the Irkutsk Oblast starting from 1954 was performed. Epidemics of urban rabies ceased in the region in 1970s. Sporadic rabies cases in dogs, reported in 1976 and later, could be imported or could result from the infection from bats. Diagnostic errors were also possible. Rabies is reported in foxes in the Subjects bordering the Irkutsk Oblast: Krasnoyarsk Krai and Republic of Buryatia. It is supposed that in case of the infection introduction the forest-steppe agricultural areas near the Angara River are likely to be affected due to high population of foxes. Relative geographic isolation of the Irkutsk Oblast favors to the long animal rabies freedom of this territory. The vast area of mountain taiga with low fox population serves as an ecological barrier. In 2007–2009 and in 2019, barrier oral vaccination was carried out along the border with the Krasnoyarsk Krai and on the west coast of Baikal Lake. Measures for anti-rabies vaccination of dogs and cats were intensified. Active virological monitoring is performed on a regular basis. The paper demonstrates cartograms of fox and wolf population density along with designation of sites, where oral vaccination of wild carnivores was performed.

Pooled testing: A tool to increase efficiency of infant HIV diagnosis and virological monitoring

Background: Pooled testing, or pooling, has been used for decades to efficiently diagnose relatively rare conditions, such as infection in blood donors. Programmes for the prevention of mother-to-child transmission of HIV and for antiretroviral therapy (ART) are being rolled out in much of Africa and are largely successful. This increases the need for early infant diagnosis (EID) of HIV using qualitative nucleic acid testing and for virological monitoring of patients on ART using viral load testing. While numbers of patients needing testing are increasing, infant HIV infections and ART failures are becoming rarer, opening an opportunity for pooled testing approaches.Aim: This review highlights the need for universal EID and viral load coverage as well as the challenges faced. We introduce the concept of pooled testing and highlight some important considerations before giving an overview of studies exploring pooled testing for EID and virological monitoring.Results: For ART monitoring, pooling has been shown to be accurate and efficient; for EID it has not been tried although modelling shows it to be promising. The final part attempts to place pooling into the context of current mother-to-child transmission of HIV and ART programmes and their expected trajectories over the next years.Conclusion: Several points warrant consideration: pre-selection to exclude samples with an elevated pre-test probability of positivity from pooled testing, the use of dried blood or plasma spots, and choosing a pooling strategy that is both practically feasible and economical. Finally, novel ideas are suggested to make pooling even more attractive.

Risk Assessment and Virological Monitoring Following an Accidental Exposure to Concentrated Sabin Poliovirus Type 3 in France, November 2018

The safe and secure containment of infectious poliovirus (PV) in facilities where live PV are handled is the condition to achieve and maintain poliomyelitis eradication. Despite precautions to minimize the risk of release of PV from such facilities to the environment, breaches of containment have already been documented. Here, we report the management of an incident that occurred on 30 November 2018 in a French vaccine manufacturing plant. Five adequately vaccinated operators were exposed to a Sabin poliovirus type 3 (PV3) spill. A microbiological risk assessment was conducted and the operators were monitored for PV shedding. On day 5 after exposure, Sabin PV3 was detected only in the stool sample of the most exposed worker. Shedding of Sabin PV3 (as detected by viral culture) was restricted to a very short period (less than 15 days). Monitoring of this incident was an opportunity to assess the relevance of our national response plan. We concluded that the measures undertaken and reported here were appropriate and proportional.