Key factors associated with malaria infection among patients seeking care through the public sector in endemic townships of Ayeyarwady Region, Myanmar

BackgroundAyeyarwady Region in Myanmar has made significant progress towards malaria elimination, with confirmed cases decreasing from 13,522 in 2013 to 122 in 2019. As transmission declines, malaria becomes increasingly focalized both in geographic hotspots and among population groups sharing certain risk factors. Developing a thorough profile of high-risk activities associated with malaria infections is critical to ensure intervention approaches are evidence-based. MethodsA test-negative study was conducted from September 2017 to May 2018 in Ngaputaw, Pathein and Thabaung townships in Ayeyarwady Region. Patients that presented to selected public facilities or community health volunteers with fever answered survey questions on demographic and behavioral risk factors, including exposure to malaria interventions, and were assigned to case and control groups based on the result of a malaria rapid diagnostic test. A random-effects logistic regression model adjusted for clustering at the facility level, as well as any variables along the causal pathway described by a directed acyclic graph, was used to determine odds ratios and association with malaria infections. ResultsA total of 119 cases and 1,744 controls were recruited from 41 public facilities, with a mean age of 31.3 and 63.7% percent male. Higher risk groups were identified as males (aOR 1.8, 95% CI: 1.2–2.9) and those with a worksite located within the forest (aOR 2.8, 95% CI: 1.4–5.3), specifically working in the logging (aOR 2.7, 95% CI: 1.5–4.6) and rubber plantation (aOR 3.0, 95% CI: 1.4–6.8) industries. Additionally, links between forest travel and malaria were observed, with risk factors identified to be sleeping in the forest within the past month (aOR 2.6, 95% CI: 1.1–6.3), and extended forest travel with durations from 3 to 14 days (aOR 8.6, 95% CI: 3.5–21.4) or longer periods (aOR 8.4, 95% CI: 3.2–21.6). ConclusionMalaria transmission is highly focalized in Ayeyarwady, and results illustrate the need to target interventions to the most at-risk populations of working males and forest goers. It will become increasingly necessary to ensure full intervention coverage of at-risk populations active in forested areas as Myanmar moves closer to malaria elimination goals.

Dietary Potassium Intake Remains Low and Sodium Intake Remains High, and Most Sodium is Derived from Home Food Preparation for Chinese Adults, 1991–2015 Trends

ABSTRACT Background Intervention strategies to reduce sodium intake and increase potassium intake may decrease blood pressure; however, most are focused on reducing sodium in processed food globally. Objectives We attempt to fill important gaps in understanding the dynamics of these dietary determinants of hypertension in China. Methods We used data on 29,926 adults aged ≥20 y between 1991 and 2015 from an ongoing cohort, the China Health and Nutrition Survey. We collected detailed diet data with use of weighing methods with 3 consecutive 24-h recalls. With panel data random-effects models, we analyzed factors associated with sodium and potassium intakes and sodium to potassium (Na/K) ratios. Results Sodium intake decreased from 6.3 g/d in 1991 to 4.1 g/d in 2015, still twice the tolerable upper intake recommended by the WHO. Potassium intake was 1.7 g/d in 1991 and 1.5 g/d in 2015, below half that recommended by the WHO. The Na/K ratio decreased from 4.1 (ratios in g) in 1991 to 3.1 in 2015, 5 times the recommendation of the WHO. More than two-thirds (67%) of sodium intake was from salt added during food preparation, with 8.8% from processed foods in 2015, up from 5.0% in 1991. The most at-risk populations lived in China's central region and rural areas, were middle aged, had lower educations, or were farmers. Conclusions Sodium intake is very high across all regions in China. As part of sodium reduction efforts, China should target people living in the central region and adults aged above 60 whose sodium intakes are much higher. Strategies to decrease sodium intake and increase potassium intake should be different from those applied in the Western world where the major source is processed food. Reduced sodium higher potassium salts should become a major policy initiative in China.

Combined sexual prevention targeted to LGBTI+ migrants: between ’outdoor’ and ’indoor’ hospial

Issue It is estimated that there are about 10,000 HIV-positive and undiagnosed people in Île-de-France (French region). They are composed of 70% men, 40% of whom are MSM and 40% of sub-Saharan African migrants. A bridging process has been designed by the Public Health association AREMEDIA and developed in partnership with Fernand-Widal Hospital’s testing center, to reach underserved populations. From March 2018, a screening test session for sexually transmitted infections (STIs) is taking place weekly in the hospital walls. This action is dedicated to the population of ARDHIS association, which accompanies more than 1,000 people each year, seeking asylum because of their sexual orientation or gender identity. Description of the problem Despite the promotion of this ’indoor’ targeted consultation via ARDHIS volunteers and directly to asylum seekers during occasional community events, the consultation only allowed the screening of 23 people in 4 months. It has been decided to carry out screening ’outside the hospitals walls’, where the people are, in order to promote the return of results, treatment, access to PrEP, HBV vaccination at the weekly indoor hospital consultation. “Community health relays” training together with the development of phone contact procedures were developed to facilitate the access to the indoor consultation. Results The methodology made it possible to double the average number of consultations over the following 5 months from 5 to 10 consultations per 3-hour slot, not counting PrEP appointments and vaccines, which averaged 6 per session. By the end of 2018, 261 people were screened, 23 had a PrEP treatment and many were vaccinated. As the scheme continues to develop, the results from January to July 2019 will be reported. Leçons To reach the most at risk populations, specific public health approaches are needed, taking account the context and representations of the target populations. Community involvement has proven to be effective. Key messages To fight HIV, innovative devices are needed to reach targeted populations. This has allowed hundreds of LGBTI asylum seekers to be screened and a significant number to receive preventive treatment.

“We Need Community”: Assessing the Impact of Faculty, Advising, Campus Social Life, and Racial Formation on the Transfer Student Experience at a Diverse Island Campus

In this paper, we examine the experiences of lower division transfer students at a diverse island campus. We conducted this study to increase our understanding of why lower division transfer students are one of the most at-risk populations in relation to completing their education at Island University. The question “how might the institution better serve these students in order to increase retention” guided our research process. The intended goal was practical—to create new programming that facilitated the process of transferring to Island University and increased student retention—specifically in relation to lower division transfer students. The conclusions drawn from the data also have important implications for a more general understanding of the problem of creating socially just educational systems, which is highlighted by the issue of student retention—especially on diverse campuses that serve economically disadvantaged communities.

Trends and predictors of new HIV diagnosis and time since last test at testing encounters among adults in Kilifi, Kenya, 2006-2017

Background: Little is known about HIV retesting uptake among key populations (KP) and general populations (GP) in Kenya. We assessed trends and predictors of new HIV diagnosis, first-time testing (FTT), and late retesting (previous test more than one year ago for GP or three months for KP). Methods: Data was collected routinely at three voluntary counselling and testing (VCT) centres in Kilifi County between 2006 and 2017. We analysed test encounters among adults 18-39 years, categorized as GP men, GP women, men who have sex with men (MSM), and female sex workers (FSW). Results: Based on 25,670 test encounters (32% FTT), we observed significant declines in HIV positivity (proportion of encounters with a new HIV diagnosis) among GP men, GP women, and first-time testers, but not among MSM and FSW. FTT and late retesting decreased for both GP and KP, but remained much higher in KP than GP. In 2017, less than 20% of KP were testing quarterly as recommended. HIV positivity was higher at FTT and late retesting encounters (relative to on-time retesting); at FSW and MSM encounters; and at encounters with clients reporting lower educational attainment, sexually transmitted infection (STI) symptoms, or no religious affiliation. HIV positivity was lower in GP men and younger clients. FTT was associated with town, risk group, age 18-24 years, never-married status, low educational attainment, and STI symptoms. Late retesting was less common among encounters with GP individuals who were never married, had Muslim or no religious affiliation, had lower educational attainment, or reported STI symptoms. Conclusions: New HIV diagnoses were most common among first-time testers and late re-testers. While late retesting decreased steadily over the period reviewed, achievement of the county’s 90% HIV diagnosis target will require redoubled efforts to increase retesting among the most at risk populations.

Apples to apples? Neural correlates of emotion regulation differences between high- and low-risk adolescents

Adolescence has been noted as a period of increased risk taking. The literature on normative neurodevelopment implicates aberrant activation of affective and regulatory regions as key to inhibitory failures. However, many of these studies have not included adolescents engaging in high rates of risky behavior, making generalizations to the most at-risk populations potentially problematic. We conducted a comparative study of nondelinquent community (n = 24, mean age = 15.8 years, 12 female) and delinquent adolescents (n = 24, mean age = 16.2 years, 12 female) who completed a cognitive control task during functional magnetic resonance imaging, where behavioral inhibition was assessed in the presence of appetitive and aversive socioaffective cues. Community adolescents showed poorer behavioral regulation to appetitive relative to aversive cues, whereas the delinquent sample showed the opposite pattern. Recruitment of the inferior frontal gyrus, medial prefrontal cortex, and tempoparietal junction differentiated community and high-risk adolescents, as delinquent adolescents showed significantly greater recruitment when inhibiting their responses in the presence of aversive cues, while the community sample showed greater recruitment when inhibiting their responses in the presence of appetitive cues. Accounting for behavioral history may be key in understanding when adolescents will have regulatory difficulties, highlighting a need for comparative research into normative and nonnormative risk-taking trajectories.

Understanding Global HIV Stigma and Discrimination: Are Contextual Factors Sufficiently Studied? (GAPRESEARCH)

Stigma and discrimination are among the greatest challenges that people living with human immunodeficiency virus (HIV) face, and both are known to negatively affect quality of life as well as treatment outcomes. We analyzed the growing research and current understanding of HIV-related stigma and contextual factors in HIV/AIDS (human Immunodeficiency virus/ acquired immunodeficiency syndrome) bibliography. A total of 5984 publications published from 1991 to 2017 were retrieved from the Web of Science database. The number of papers and their impacts have been considerably grown in recent years. Research landscapes related to stigma and discrimination include clinical, physical and mental health outcomes, risk behaviors of most-at-risk populations, and HIV-related services. We found a lack of empirical studies not only on social, cultural and economic contexts, but also on specific interventions for particular settings and sub-populations. This study highlights certain gaps and provides a basis for future studies and interventions on this critical issue given the changing drivers of HIV epidemics.

Using social networks to understand and overcome implementation barriers in the global HIV response

Despite the development of several efficacious HIV prevention and treatment methods in the past decades, HIV continues to spread globally. Uptake of interventions is non-randomly distributed across populations, and such inequality is socially patterned both statically (due to homophily) and dynamically (due to social selection and influence). Social network analysis (SNA) methods, including egocentric, sociocentric, and respondent-driven sampling, provide tools to measure most-at-risk populations, to understand how epidemics spread, and to evaluate intervention take-up. SNA informed designs can improve intervention effectiveness by reaching otherwise inaccessible populations and improve efficiency by maximizing spillovers to at-risk but susceptible individuals through social ties; they thus have the potential to be both more effective and less unequal in their effects than SNA-naïve approaches. While SNA-informed designs are often resource-intensive, they are uniquely able to help reach those most in need of HIV prevention and treatment interventions. Increased collection of social network data during both research and implementation work would provide important information to improve the roll-out of existing studies in the present and to inform the design of more data-efficient, SNA-informed interventions in the future.

Apples to apples? Neural correlates of emotion regulation differences between high and low risk adolescents

Adolescence has been noted as a period of increased risk taking. The literature on normative neurodevelopment implicates aberrant activation of affective and regulatory regions as key to inhibitory failures. However, many of these studies have not included adolescents engaging in high rates of risky behavior, making generalizations to the most at-risk populations potentially problematic. We conducted a comparative study of non-delinquent community (N=24, Mage = 15.8 years, 12 female) and delinquent adolescents (N=24, Mage = 16.2 years, 12 female) who completed a cognitive control task during fMRI, where behavioral inhibition was assessed in the presence of appetitive and aversive socioaffective cues. Community adolescents showed poorer behavioral regulation to appetitive relative to aversive cues, whereas the delinquent sample showed the opposite pattern. Recruitment of the inferior frontal gyrus, medial prefrontal cortex, and tempoparietal junction differentiated community and high-risk adolescents, as delinquent adolescents showed significantly greater recruitment when inhibiting their responses in the presence of aversive cues, while the community sample showed greater recruitment when inhibiting their responses in the presence of appetitive cues. Accounting for behavioral history may be key in understanding when adolescents will have regulatory difficulties, highlighting a need for comparative research into normative and non-normative risk-taking trajectories.