National Hepatitis Testing Day: rapid hepatitis C testing

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The use of rapid hepatitis C virus tests could be a powerful tool for conducting hepatitis C screening, conveying prevention information, and initiating treatment in a population with high prevalence of hepatitis C infection, according to a study of persons at increased risk for infection in Wisconsin.

An estimated 3.2 million persons in the United States are infected with hepatitis C. Most new hepatitis C transmissions occur among injection drug users, often within the first few years of their injection drug use. During 2003–2012, reports of hepatitis C infection increased from 15 to 54 cases per 100,000 among persons under age 30 years in Wisconsin, and 58 percent of persons in this age group with acute hepatitis C reported injecting drugs.

To increase hepatitis C detection, the Wisconsin Division of Public Health piloted a program during October 2012–October 2013 that offered rapid hepatitis C testing to persons with drug dependence. Of these, 20 percent had positive hepatitis C test results—72 percent of the infections had not been reported previously—and 70 percent of those that tested positive had active infection.

The study found that use of the rapid test detected previously unreported infections and raised awareness of hepatitis C. Persons identified with active hepatitis C infection should be referred to medical care and counseled on ways to prevent transmission to others.

1. Stockman LJ, Guilfoyle SM, Benoit AL, et al. Rapid Hepatitis C Testing Among Persons at Increased Risk for Infection — Wisconsin, 2012–2013. Morbidity and Mortality Weekly Report 2014; 63(14): 309-311 (open access)

Positive impact of mass media campaign on bed net use in Cameroon

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A mass media health education intervention in support of investments in malaria control commodities such as insecticide-treated mosquito bed nets can result in significant, large-scale positive health changes, according to a study conducted in Cameroon.

Bed net, Photo by Gates Foundation on Flickr, Creative Commons licenseThe study found that Cameroonians with at least one bed net in their household were more likely to use the bed nets after being exposed to the “KO Palu” (Knock Out Malaria) national campaign. Approximately 298,000 adults and more than 221,000 of their children under age five slept under a bed net because of the knowledge, motivation, and/or timely reminder provided by KO Palu NightWatch activities.

The health communication program cost less than $0.16 per adult reached, and less than $1.62 per additional person protected by a net.

According to the World Health Organization’s World Malaria Report 2011, every one of Cameroon’s 19.6 million citizens is at risk of malaria, with 71 percent of them living in high transmission areas. More than 1.8 million suspected cases of malaria were recorded countrywide in 2010, along with over 4,500 recorded malaria-attributed deaths. Malaria was estimated to be responsible for 19 percent of under-five child deaths in 2008, more than any other single cause.

1. Bowen HL. Impact of a mass media campaign on bed net use in Cameroon. Malaria Journal 2013; 12: 36. (open access)

Slowdown in fight against malaria

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An effective concerted effort to strengthen malaria control globally in the last decade has had the greatest impact in countries with high malaria transmission. Close to 60 percent of the 1.1 million lives saved during this period were in the 10 highest burden countries. However, the expansion of funding for malaria prevention and control has leveled off in recent years, and progress in the delivery of some life-saving commodities has slowed. These developments are signs of a slowdown that could threaten to reverse the recent gains in the fight against one of the world’s leading infectious diseases, according to the World Malaria Report 2012.

World Malaria Report 2012The number of long-lasting insecticidal neets delivered to endemic countries in sub-Saharan Africa dropped from a peak of 145 million in 2010 to an estimated 66 million in 2012. The expansion of indoor residual spraying programs also leveled off, with coverage levels in the World Health Organization (WHO) African Region staying at 11 percent of the population at risk (77 million people) between 2010-2011.

The malaria burden is concentrated in 14 endemic countries, which account for an estimated 80 percent of malaria deaths. The Democratic Republic of the Congo and Nigeria are the most affected countries in sub-Saharan Africa, while India is the most affected country in South-East Asia.

The report indicates that international funding for malaria appears to have reached a plateau well below the level required to reach the health-related Millennium Development Goals and other internationally-agreed global malaria targets.

While the plateauing of funding is affecting the scale-up of some interventions, the report documents a major increase in the sales of rapid diagnostics tests, from 88 million in 2010 to 155 million in 2011, as well as a substantial improvement in the quality of tests over recent years. Deliveries to countries of artemisinin-based combination therapies (ACTs), the treatment recommended by the WHO for the treatment of falciparum malaria, also increased substantially, from 181 million in 2010 to 278 million in 2011, largely as a result of increased sales of subsidized ACTs in the private sector.

The report summarizes information received from 99 countries with on-going transmission and other sources, and updates the analyses presented in the 2011 report. Malaria is an entirely preventable and treatable vector-borne disease. In 2010, an estimated 219 million cases occurred globally, while the disease killed about 660,000 people, mostly children under age five years.

1. World Health Organization. World Malaria Report 2012. Geneva, Switzerland: WHO, 2012.

Motivating HIV testing among MSM using internet and mobile phones

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Men who have sex with men (MSM) have the highest HIV prevalence in Peru, yet they are underserved by traditional preventive programs. In Peru, the Internet and mobile phones have emerged as an effective and convenient tool to reach this population. A study published in PLoS ONE identifies five key themes that should be considered when designing an effective campaign to motivate HIV testing.

  1. Overcome fear of getting tested for HIV. Previous studies identify “fear of the consequences of a positive test result” as the main barrier for not getting tested among MSM. Since the 1980s, HIV testing campaigns in Peru have focused on fear, stigmatizing the disease and causing people to avoid getting tested out of fear of being positive. Future campaigns need to counteract this by providing motivational messages that transmit calmness and explain that HIV is now a chronic and treatable disease.
  2. Increase risk perception. MSM with high-risk practices often do not perceive themselves at risk. A brief explanation on the modes of transmission along with messages that can prompt participants to remember common risk situations they may have experienced would be useful to better understand the risks.
  3. Explain logistics. A successful campaign should include the marketing of the personnel, the place, information about the process, including the test itself, and the price of testing. The personnel include the professionals who will perform the HIV test and who will provide the results. The place includes the physical location where the test will be conducted, the operating hours, general attractiveness, comfort and accessibility. The price refers not only to monetary cost but also intangible costs such as embarrassment and psychological strain.
  4. Avoid stigmatizing and stereotyping content. Avoid language that implies gay men are promiscuous or more likely to have HIV. Use neutral characters (not stereotyped caricatures of gay men), as well as neutral language (absence of gay-related jargon) because either they were considered stigmatizing for gay-identified MSM, or because they will not feel identified within the heterosexually-identified MSM.
  5. Use appropriate layout and language. Study participants recommended that all text based information, when possible, should always be presented with images. Language should be simple and colloquial but not vulgar. The Layout should avoid the use of red, dark or gloomy colors. When possible, use humor because it makes information easier to understand and to remember.

These results serve as the basis to design an effective campaign to motivate HIV testing among gay and non-gay identified MSM in Lima, Peru, the study concludes.

1. Blas MM, Menacho LA, Alva IE, et al. Motivating Men Who Have Sex with Men to Get Tested for HIV through the Internet and Mobile Phones: A Qualitative Study. PLoS ONE 2013; 8(1): e54012. (open access)

Stigma, discrimination against HIV-positive patients by healthcare providers

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Equipping healthcare providers with knowledge of HIV, through the provision of protocols and trainings, is of paramount importance in reducing stigma and discrimination against people living with HIV amongst healthcare providers, according to a study conducted in Southwest Ethiopia.

The healthcare providers who were aware of anti-stigma and anti-discrimination rules and regulations were less likely to contribute to stigma and discrimination.

The study also found that healthcare providers share stigma and discrimination not only related to their occupation but also present in their communities. This implies that community-based anti-stigma and anti-discrimination interventions may also be helpful.

The study makes the following recommendations for ministries/departments of health at the national, regional, or local levels, as well as healthcare institutions and non-governmental organizations working with HIV-positive patients:

  • Make available protocols related to HIV to each healthcare provider in healthcare settings.
  • Orient healthcare providers about the contents and relevance of the HIV-related policies.
  • Provide the opportunity for trainings on stigma and discrimination to healthcare providers from time to time.
  • Extend HIV-related care and support services and anti-discrimination interventions to local areas.
  • Involve people living with HIV and religious leaders in these activities.

And lastly, healthcare providers themselves should strive to update their knowledge on HIV/AIDS.

1. Feyissa GT, Abebe L, Girma E, Woldie M. Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health 2012; 12: 522. (open access)

World Health Statistics 2012

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World Health Statistics 2012 is the World Health Organization’s annual report of health-related data from all 194 WHO member states. The report includes a summary of the progress made towards achieving the health-related Millennium Development Goals and associated targets. This year, it also includes highlight summaries on the topics of noncommunicable diseases, universal health coverage and civil registration coverage.

Select data from the report:

  • Measles deaths declined by 74% between 2000 and 2010.
  • In 2010, 85% of children age 12-23 months worldwide were immunized against measles.
  • Hypertension is considered directly responsible for 7.5 million deaths in 2004–about 12.8% of all global deaths.
  • In Africa, more than one third of people are estimated to have high blood pressure and this condition is increasing.
  • Globally, 2.8 million people die each year as a result of being overweight or obese.
  • Worldwide prevalence of obesity almost doubled between 1980 and 2008.
  • In 2008, 10% of men and 14% of women (half a billion people) in the world were obese.

The report is available in English, French and Spanish.

1. World Health Organization. World Health Statistics 2012. Geneva: WHO, 2012.

UNESCO HIV and AIDS Education Clearinghouse

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The United Nations Educational, Scientific and Cultural Organization (UNESCO) offers the UNESCO HIV and AIDS Education Clearinghouse to support education professionals, ministries of education, development agencies, civil society, researchers and other partners by providing a comprehensive knowledge base and information exchange service for the development of HIV/AIDS policies, programs and advocacy within the education sector.

The clearinghouse provides:

  • a trilingual (English, French and Spanish) website and database
  • a virtual library, updated monthly, currently containing over 4,000 references
  • alerts to scientific journal articles
  • a calendar of HIV/AIDS-related events
  • electronic newsletter subscriptions
  • an email discussion group for HIV/AIDS professionals (Asia Pacific region)
  • enquiry and literature search services

Click here to access the UNESCO HIV and AIDS Education Clearinghouse.

Diabetes linked to higher risk of tuberculosis in U.S./Mexico border

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Patients with diabetes are at higher risk of contracting tuberculosis (TB) than non-diabetic patients, according to a study conducted in the Texas/Mexico border.

The prevalence of diabetes among TB patients was 39 percent in Texas and 36 percent in Mexico. Diabetes contributed 25 percent of the TB cases studied, whereas HIV infection contributed only five percent or fewer.

Among TB patients, fewer Mexicans than Texans were aware that they had diabetes before this study (four percent and 19 percent, respectively). Men were also less frequently aware than women that they had diabetes. Patients who knew that they had diabetes before the study had an eight-year history of the disease, on average, before being diagnosed with TB.

1. Restrepo BI, Camerlin AJ, Rahbar MH, et al. Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases. Bulletin of the World Health Organization 2011; 89: 352-359. (open access)

Sexual behavior changes reduce HIV rates in Malawi

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The HIV epidemic in Malawi has been on the decline. A study indicates that between 2000-2004 the prevalence of HIV dropped from 26 percent to 15 percent in urban areas among pregnant women and reduced by 40 percent among women aged 15-24 years. The study linked substantial positive changes in sexual behavior—such as increased condom use and fewer sex partners—to the decline.

In the 2000-2004 study period, the percentage of adolescents aged 15–19 years who first had sex before age 15 decreased from 29 percent to 18 percent among males and 17 percent to 14 percent among females. The proportion of men who had sex with multiple partners reduced from 15 percent to nine percent among men aged 15–49 years and from 12 percent to seven percent among young adults aged 15–24 years. Only one percent of women reported having two or more partners and this did not change between 2000-2004. The rate of men with multiple partners that used condoms increased from 14 percent to 20 percent among men aged 15–49 years and from 27 percent to 35 percent among young men aged 15–24 years.

“The declines in prevalence in urban areas were associated with the behaviour changes and…if the changes are maintained, this will have cumulatively averted 140,000 HIV infections by 2010,” the study concluded.

1. Bello G, Simwaka B, Ndhlovu T, et al. Evidence for changes in behaviour leading to reductions in HIV prevalence in urban Malawi. Sexually Transmitted Infections, published online 23 March 2011. (open access)

Intestinal parasitic infections in rural west Malaysia

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Intestinal parasitic infections have a worldwide distribution and have been identified as one of the most significant causes of illnesses and diseases among disadvantaged populations. A study finds that intestinal parasitic infections are highly prevalent (nearly 75 percent) among the poor rural communities in west Malaysia.

Soil-transmitted helminth infections (73.2 percent) were significantly more common compared to protozoa infections (21.4 percent). Those aged 12 years and younger showed significantly higher rates of intestinal parasitic infections.

Poverty and low socioeconomic with poor environmental sanitation were indicated as important predictors of these types of infections.

“Effective poverty reduction programs, promotion of deworming, and mass campaigns to heighten awareness on health and hygiene are urgently needed to reduce [intestinal parasitic infections],” the study concluded.

1. Ngui R, Ishak S, Chuen CS, et al. Prevalence and risk factors of intestinal parasitism in rural and remote west Malaysia. PLoS Neglected Tropical Diseases 2011; 5(3): e974. (open access)

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