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[PMID]:29016634
[Au] Autor:Tiam A; Gill MM; Hoffman HJ; Isavwa A; Mokone M; Foso M; Safrit JT; Mofenson LM; Tylleskär T; Guay L
[Ad] Endereço:Centre for International Health, University of Bergen, Bergen, Norway.
[Ti] Título:Conventional early infant diagnosis in Lesotho from specimen collection to results usage to manage patients: Where are the bottlenecks?
[So] Source:PLoS One;12(10):e0184769, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Early infant diagnosis is an important step in identifying children infected with HIV during the perinatal period or in utero. Multiple factors contribute to delayed antiretroviral treatment initiation for HIV-infected children, including delays in the early infant HIV diagnosis cascade. METHODS: We conducted a retrospective study to evaluate early infant diagnosis turnaround times in Lesotho. Trained staff reviewed records of HIV-exposed infants (aged-6-8 weeks) who received an HIV test during 2011. Study sites were drawn from Highlands, Foothills and Lowlands regions of Lesotho. Central laboratory database data were linked to facility and laboratory register information. Turnaround time geometric means (with 95% CI) were calculated and compared by region using linear mixed models. RESULTS: 1,187 individual infant records from 25 facilities were reviewed. Overall, early infant diagnosis turnaround time was 61.7 days (95%CI: 55.3-68.7). Mean time from specimen collection to district laboratory was 14 days (95%CI: 12.1-16.1); from district to central laboratory, 2 days (95%CI 0.8-5.2); results from central laboratory to district hospital, 23.3 days (95%CI: 18.7-29.0); from district hospital to health facility, 3.2 days (95%CI 1.9-5.5); and from health facility to caregiver, 10.4 days (95%CI, 7.9-13.5). Mean times from specimen transfer to the central laboratory and for result transfer from central laboratory to district hospital were significantly shorter in the Lowlands Region (0.9 and 16.2 days, respectively), compared to Highlands Region (6.0 [P = 0.030] and 34.3 days [P = 0.0099]. Turnaround time from blood draw to receipt of results was significantly shorter for HIV infected infants compared to HIV uninfected infants [p = 0.0036] at an average of 47.1 days (95%CI: 38.9-56.9) and 62 days (95%CI: 55.9-68.7) respectively. Of 47 HIV-infected infants, 36 were initiated on antiretroviral therapy at an average of 1.3 days (95%CI: 0.3, 5.7) after caregiver received the result. CONCLUSION: HIV-infected infants received results earlier and were rapidly initiated on antiretroviral therapy once the result was delivered to caregiver. However, average early infant diagnosis turnaround time was two months; the longest period of delay was transfer of results from central laboratory to district hospital. Turnaround time of results based on geographical regions or between hospitals and health centres varied but did not reach statistical significance.
[Mh] Termos MeSH primário: Diagnóstico Precoce
Infecções por HIV/sangue
HIV/patogenicidade
[Mh] Termos MeSH secundário: Feminino
HIV/genética
Infecções por HIV/epidemiologia
Infecções por HIV/patologia
Infecções por HIV/virologia
Seres Humanos
Lactente
Lesoto
Gravidez
Manejo de Espécimes
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184769


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[PMID]:28877182
[Au] Autor:Rick F; Niyibizi AA; Shroufi A; Onami K; Steele SJ; Kuleile M; Muleya I; Chiller T; Walker T; Van Cutsem G
[Ad] Endereço:Médecins Sans Frontières, Cape Town, South Africa.
[Ti] Título:Cryptococcal antigen screening by lay cadres using a rapid test at the point of care: A feasibility study in rural Lesotho.
[So] Source:PLoS One;12(9):e0183656, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Cryptococcal meningitis is one of the leading causes of death among people with HIV in Africa, primarily due to delayed presentation, poor availability and high cost of treatment. Routine cryptococcal antigen (CrAg) screening of patients with a CD4 count less than 100 cells/mm3, followed by pre-emptive therapy if positive, might reduce mortality in high prevalence settings. Using the cryptococcal antigen (CrAg) lateral flow assay (LFA), screening is possible at the point of care (POC). However, critical shortages of health staff may limit adoption. This study investigates the feasibility of lay counsellors conducting CrAg LFA screening in rural primary care clinics in Lesotho. METHODS: From May 2014 to June 2015, individuals who tested positive for HIV were tested for CD4 count and those with CD4 <100 cells/mm3 were screened with CrAg LFA. All tests were performed by lay counsellors. CrAg-positive asymptomatic patients received fluconazole, while symptomatic patients were referred to hospital. Lay counsellors were trained and supervised by a laboratory technician and counsellor activity supervisor. Additionally, nurses and doctors were trained on CrAg screening and appropriate treatment. RESULTS: During the study period, 1,388 people were newly diagnosed with HIV, of whom 129 (9%) presented with a CD4 count <100 cells/mm3. Of these, 128 (99%) were screened with CrAg LFA and 14/128 (11%) tested positive. Twelve of the 14 (86%) were asymptomatic, and received outpatient fluconazole. All commenced ART with a median time to initiation of 15.5 days [IQR: 14-22]. Of the asymptomatic patients, nine (75%) remained asymptomatic after a median time of 5 months [IQR; 3-6] of follow up. One (8%) became co-infected with tuberculosis and died and two were transferred out. The two patients with symptomatic cryptococcal meningitis (CM) were referred to hospital, where they later died. CONCLUSIONS: CrAg LFA screening by lay counsellors followed by pre-emptive fluconazole treatment for asymptomatic cases, or referral to hospital for symptomatic cases, proved feasible. However, regular follow-up to ensure proper management of cryptococcal disease was needed. These early results support the wider use of CrAg LFA screening in remote primary care settings where upper cadres of healthcare staff may be in short supply.
[Mh] Termos MeSH primário: Antígenos de Fungos/imunologia
Sistemas Automatizados de Assistência Junto ao Leito
Reologia/métodos
População Rural
[Mh] Termos MeSH secundário: Adolescente
Adulto
Algoritmos
Estudos de Viabilidade
Feminino
Seres Humanos
Lesoto
Masculino
Meningite Criptocócica/imunologia
Meia-Idade
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antigens, Fungal)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170907
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0183656


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[PMID]:28792502
[Au] Autor:De Neve JW; Garrison-Desany H; Andrews KG; Sharara N; Boudreaux C; Gill R; Geldsetzer P; Vaikath M; Bärnighausen T; Bossert TJ
[Ad] Endereço:Institute of Public Health, Heidelberg University, Heidelberg, Germany.
[Ti] Título:Harmonization of community health worker programs for HIV: A four-country qualitative study in Southern Africa.
[So] Source:PLoS Med;14(8):e1002374, 2017 Aug.
[Is] ISSN:1549-1676
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Community health worker (CHW) programs are believed to be poorly coordinated, poorly integrated into national health systems, and lacking long-term support. Duplication of services, fragmentation, and resource limitations may have impeded the potential impact of CHWs for achieving HIV goals. This study assesses mediators of a more harmonized approach to implementing large-scale CHW programs for HIV in the context of complex health systems and multiple donors. METHODS AND FINDINGS: We undertook four country case studies in Lesotho, Mozambique, South Africa, and Swaziland between August 2015 and May 2016. We conducted 60 semistructured interviews with donors, government officials, and expert observers involved in CHW programs delivering HIV services. Interviews were triangulated with published literature, country reports, national health plans, and policies. Data were analyzed based on 3 priority areas of harmonization (coordination, integration, and sustainability) and 5 components of a conceptual framework (the health issue, intervention, stakeholders, health system, and context) to assess facilitators and barriers to harmonization of CHW programs. CHWs supporting HIV programs were found to be highly fragmented and poorly integrated into national health systems. Stakeholders generally supported increasing harmonization, although they recognized several challenges and disadvantages to harmonization. Key facilitators to harmonization included (i) a large existing national CHW program and recognition of nongovernmental CHW programs, (ii) use of common incentives and training processes for CHWs, (iii) existence of an organizational structure dedicated to community health initiatives, and (iv) involvement of community leaders in decision-making. Key barriers included a wide range of stakeholders and lack of ownership and accountability of non-governmental CHW programs. Limitations of our study include subjectively selected case studies, our focus on decision-makers, and limited generalizability beyond the countries analyzed. CONCLUSION: CHW programs for HIV in Southern Africa are fragmented, poorly integrated, and lack long-term support. We provide 5 policy recommendations to harmonize CHW programs in order to strengthen and sustain the role of CHWs in HIV service delivery.
[Mh] Termos MeSH primário: Serviços de Saúde Comunitária/métodos
Agentes Comunitários de Saúde
Infecções por HIV/prevenção & controle
[Mh] Termos MeSH secundário: Serviços de Saúde Comunitária/organização & administração
Agentes Comunitários de Saúde/organização & administração
Agentes Comunitários de Saúde/estatística & dados numéricos
Seres Humanos
Lesoto
Moçambique
África do Sul
Suazilândia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170810
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pmed.1002374


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[PMID]:28771456
[Au] Autor:Schwitters AM
[Ad] Endereço:Division of Global HIV and TB, Center for Global Health, CDC.
[Ti] Título:Notes from the Field: Preliminary Results After Implementation of a Universal Treatment Program (Test and Start) for Persons Living with HIV Infection - Lesotho, October 2015-February 2017.
[So] Source:MMWR Morb Mortal Wkly Rep;66(30):813-814, 2017 Aug 04.
[Is] ISSN:1545-861X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Lesotho, a small, mountainous country completely surrounded by the Republic of South Africa, has a population of approximately 2 million persons with an estimated gross national income of $1,280 per capita; 73% of the population resides in rural areas (1). Lesotho has a generalized human immunodeficiency virus (HIV) epidemic (2). In 2014, the prevalence of HIV infection among persons aged 15-49 years was 24.6%, with an incidence of 1.9 new infections per 100 person-years of exposure (3). As the leading cause of premature death, HIV/AIDS (acquired immunodeficiency syndrome) has contributed to Lesotho's reporting the shortest life expectancy at birth among 195 countries and territories (4). In 2015, antiretroviral therapy (ART) coverage among HIV-positive persons in Lesotho was estimated to be 42% (5). In April 2016, Lesotho became the first country in sub-Saharan Africa to adopt the World Health Organization (WHO) recommendations for universal initiation of antiretroviral therapy for all HIV-positive persons, regardless of CD4 count (known as the "Test and Start" program or approach), with nationwide implementation occurring in June 2016 (6,7). Before implementation of Test and Start, many persons living with HIV infection in Lesotho were not eligible to initiate treatment until their CD4 count was <500 cells/mm .
[Mh] Termos MeSH primário: Fármacos Anti-HIV/uso terapêutico
Infecções por HIV/tratamento farmacológico
Implementação de Plano de Saúde
Programas Nacionais de Saúde
Cobertura Universal
[Mh] Termos MeSH secundário: Adolescente
Adulto
Contagem de Linfócito CD4
Feminino
Infecções por HIV/epidemiologia
Seres Humanos
Incidência
Lesoto/epidemiologia
Masculino
Meia-Idade
Prevalência
Avaliação de Programas e Projetos de Saúde
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170808
[Lr] Data última revisão:
170808
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170804
[St] Status:MEDLINE
[do] DOI:10.15585/mmwr.mm6630a4


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[PMID]:28498835
[Au] Autor:Maffioli EM
[Ad] Endereço:Department of Economics, Duke University Durham, NC, United States of America.
[Ti] Título:Is traditional male circumcision effective as an HIV prevention strategy? Evidence from Lesotho.
[So] Source:PLoS One;12(5):e0177076, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In many developing countries, male circumcision has been promoted as an effective HIV prevention strategy, and medical randomized controlled trials have indeed shown a causal link. However, there is limited empirical evidence to support this conclusion in countries where individuals can voluntary opt for different types of circumcision. The present study considers male circumcision in Lesotho, where HIV prevalence is among the highest in the world (23%). Here, men can opt for one of two types of circumcision: traditional male circumcision in initiation schools, or the medical option in health clinics. This paper investigates whether the former has medical effects on individual HIV status that are as beneficial as those shown for the latter. Controlling for the potential individual behavioral response after the operation, it was found that circumcision performed in initiation schools wholly offset the medical benefits of the surgical procedure. This supports anecdotal evidence that the operation performed by traditional circumcisers does not have the same protective effect against HIV transmission as the medical operation. No evidence of "disinhibition" behavior among circumcised men was found, nor differential risky sexual behavior among men circumcised, traditionally or medically. Considering that, in Lesotho, traditional male circumcision is undertaken by more than 90% of circumcised men, the findings highlight the need for further research into how the operation in initiation schools is performed and its medical benefits.
[Mh] Termos MeSH primário: Circuncisão Masculina/normas
Infecções por HIV/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Adulto
Algoritmos
Ensaio de Imunoadsorção Enzimática
Infecções por HIV/epidemiologia
Seres Humanos
Lesoto/epidemiologia
Masculino
Meia-Idade
Comportamento Sexual
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170513
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0177076


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[PMID]:28342180
[Au] Autor:Labhardt ND; Müller UF; Ringera I; Ehmer J; Motlatsi MM; Pfeiffer K; Hobbins MA; Muhairwe JA; Muser J; Hatz C
[Ad] Endereço:Swiss Tropical and Public Health Institute, Basel, Switzerland.
[Ti] Título:Metabolic syndrome in patients on first-line antiretroviral therapy containing zidovudine or tenofovir in rural Lesotho, Southern Africa.
[So] Source:Trop Med Int Health;22(6):725-733, 2017 Jun.
[Is] ISSN:1365-3156
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To assess the prevalence of metabolic syndrome (MetS) among patients in rural Lesotho who are taking first-line antiretroviral therapy (ART) containing either zidovudine or tenofovir disoproxil. METHODS: Cross-sectional survey in 10 facilities in Lesotho among adult (≥16 years) patients on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line ART for ≥6 months. MetS was defined according to the International Diabetes Federation criteria. RESULTS: Among 1166 patients (65.8% female), 22.2% (95% CI: 19.3-25.3) of women and 6.3% (4.1-9.1) of men met the IDF definition of MetS (P < 0.001). In both sexes, there was no significant difference in MetS prevalence between NNRTIs. However, in women taking zidovudine as nucleoside reverse transcriptase inhibitor (NRTI), MetS prevalence was 27.9%, vs. 18.8% in those taking tenofovir. In the multivariate logistic regression allowing for socio-demographic and clinical covariates, ART containing zidovudine was associated with MetS in women (aOR 2.17 (1.46-3.22), P < 0.001) but not in men. CONCLUSION: In this study, taking ART containing zidovudine instead of tenofovir disoproxil was an independent predictor of MetS in women but not in men. This finding endorses WHO's recommendation of tenofovir as preferred NRTI.
[Mh] Termos MeSH primário: Fármacos Anti-HIV
Síndrome Metabólica/etiologia
Inibidores da Transcriptase Reversa
Tenofovir/uso terapêutico
Zidovudina/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Fármacos Anti-HIV/efeitos adversos
Fármacos Anti-HIV/uso terapêutico
Estudos Transversais
Feminino
Infecções por HIV/tratamento farmacológico
Seres Humanos
Lesoto
Modelos Logísticos
Masculino
Síndrome Metabólica/epidemiologia
Meia-Idade
Prevalência
Inibidores da Transcriptase Reversa/efeitos adversos
Inibidores da Transcriptase Reversa/uso terapêutico
População Rural
Fatores Sexuais
Zidovudina/uso terapêutico
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Anti-HIV Agents); 0 (Reverse Transcriptase Inhibitors); 4B9XT59T7S (Zidovudine); 99YXE507IL (Tenofovir)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170326
[St] Status:MEDLINE
[do] DOI:10.1111/tmi.12872


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[PMID]:28320397
[Au] Autor:Mugomeri E; Bekele BS; Mafaesa M; Maibvise C; Tarirai C; Aiyuk SE
[Ad] Endereço:Department of Pharmacy, Faculty of Health Sciences, National University of Lesotho, Roma Campus, P.O. Roma 180, Maseru, Lesotho. emugomeri@nul.ls.
[Ti] Título:A 30-year bibliometric analysis of research coverage on HIV and AIDS in Lesotho.
[So] Source:Health Res Policy Syst;15(1):21, 2017 Mar 21.
[Is] ISSN:1478-4505
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Given the well documented undesired impacts of HIV/AIDS globally, there is a need to create a statistical inventory of research output on HIV/AIDS. This need is particularly important for a country such as Lesotho, whose HIV/AIDS prevalence is one of the highest globally. Research on HIV/AIDS in sub-Saharan Africa continues to trail behind that of other regions, especially those of the developed countries. Lesotho, a sub-Saharan country, is a developing country with lower research output in this area when longitudinally compared to other countries. This study reviewed the volume and scope of the general research output on HIV/AIDS in Lesotho and assessed the coverage of the national research agenda on HIV/AIDS, making recourse to statistical principles. METHODS: A bibliometric review of studies on HIV/AIDS retrieved from the SCOPUS and PubMed databases, published within the 30-year period between 1985 and 2016, was conducted. The focus of each of the studies was analysed and the studies were cross-matched with the national research agenda in accordance with bibliometric methodologies. RESULTS: In total, 1280 studies comprising 1181 (92.3%) journal articles, 91 (7.1%) books and 8 (0.6%) conference proceedings were retrieved. By proportion, estimation of burden of infection (40.7%) had the highest research volume, while basic (5.5%) and preventive measures (24.4%) and national planning (29.4%) had the lowest. Out of the total studies retrieved, only 516 (40.3%) matched the national research agenda. Research on maternal and child health quality of care, viral load point-of-care devices, and infant point-of-care diagnosis had hardly any publications in the high priority research category of the agenda. CONCLUSION: Notwithstanding a considerable research output on HIV/AIDS for Lesotho, there is insufficient coverage of the national research agenda in this research area. The major research gaps on general research output are in basic and preventive measures as well as national planning. There is also a need to increase targeted funding for HIV/AIDS research to appropriately address the most compelling gaps and national needs.
[Mh] Termos MeSH primário: Pesquisa Biomédica/estatística & dados numéricos
Infecções por HIV
Publicações Periódicas como Assunto/estatística & dados numéricos
[Mh] Termos MeSH secundário: Síndrome de Imunodeficiência Adquirida
Pesquisa Biomédica/tendências
Livros
Congressos como Assunto/estatística & dados numéricos
Congressos como Assunto/tendências
Prioridades em Saúde
Seres Humanos
Lesoto
Publicações Periódicas como Assunto/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170606
[Lr] Data última revisão:
170606
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170322
[St] Status:MEDLINE
[do] DOI:10.1186/s12961-017-0183-y


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[PMID]:28179008
[Au] Autor:Moser W; Labhardt ND; Cheleboi M; Muhairwe J; Keiser J
[Ad] Endereço:Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.
[Ti] Título:Unexpected low soil-transmitted helminth prevalence in the Butha-Buthe district in Lesotho, results from a cross-sectional survey.
[So] Source:Parasit Vectors;10(1):72, 2017 Feb 08.
[Is] ISSN:1756-3305
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Soil-transmitted helminth (STH) infections with Ascaris lumbricoides, hookworm and Trichuris trichiura affect large parts of the world's population. For the implementation of national STH control programs, e.g. preventive chemotherapy (treatment with albendazole and mebendazole), the spatial distribution and prevalence of STH infections must be known. However, for Lesotho only little data were available and the STH distribution remains largely unknown. METHODS: In early 2016, a cross-sectional parasitological STH survey was conducted including six different primary schools in the Butha-Buthe district of Lesotho. In each school stool samples were collected from 50 children (age 8-14 years) and analysed with a duplicate Kato-Katz thick smear for the presence of A. lumbricoides, hookworm and T. trichiura. RESULTS: A total of 301 children provided a stool sample. All children were negative for A. lumbricoides and T. trichiura. Only two children from one primary school showed a light hookworm infection. CONCLUSION: Our data indicate a low prevalence of STH infections in the Butha-Buthe district of Lesotho. Additional parasitological surveys on the prevalence and the spatial distributions of STH infections across the entire country of Lesotho are needed.
[Mh] Termos MeSH primário: Helmintíase/parasitologia
Helmintos/isolamento & purificação
Solo/parasitologia
[Mh] Termos MeSH secundário: Adolescente
Animais
Criança
Estudos Transversais
Fezes/parasitologia
Feminino
Helmintíase/epidemiologia
Helmintíase/transmissão
Helmintos/classificação
Helmintos/genética
Seres Humanos
Lesoto/epidemiologia
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Soil)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170210
[St] Status:MEDLINE
[do] DOI:10.1186/s13071-017-1995-x


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[PMID]:27930610
[Au] Autor:Hirsch-Moverman Y; Daftary A; Yuengling KA; Saito S; Ntoane M; Frederix K; Maama LB; Howard AA
[Ad] Endereço:*ICAP, Mailman School of Public Health, Columbia University, New York, NY; †Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; ‡McGill International TB Centre, McGill University, Montreal, Quebec, Canada; §CAPRISA MRC HIV-TB Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal, Durban, South Africa; and ‖National Tuberculosis Program, Lesotho Ministry of Health, Maseru, Lesotho.
[Ti] Título:Using mHealth for HIV/TB Treatment Support in Lesotho: Enhancing Patient-Provider Communication in the START Study.
[So] Source:J Acquir Immune Defic Syndr;74 Suppl 1:S37-S43, 2017 Jan 01.
[Is] ISSN:1944-7884
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: mHealth is a promising means of supporting adherence to treatment. The Start TB patients on ART and Retain on Treatment (START) study included real-time adherence support using short-text messaging service (SMS) text messaging and trained village health workers (VHWs). We describe the use and acceptability of mHealth by patients with HIV/tuberculosis and health care providers. METHODS: Patients and treatment supporters received automated, coded medication and appointment reminders at their preferred time and frequency, using their own phones, and $3.70 in monthly airtime. Facility-based VHWs were trained to log patient information and text message preferences into a mobile application and were given a password-protected mobile phone and airtime to communicate with community-based VHWs. The use of mHealth tools was analyzed from process data over the study course. Acceptability was evaluated during monthly follow-up interviews with all participants and during qualitative interviews with a subset of 30 patients and 30 health care providers at intervention sites. Use and acceptability were contextualized by monthly adherence data. FINDINGS: From April 2013 to August 2015, the automated SMS system successfully delivered 39,528 messages to 835 individuals, including 633 patients and 202 treatment supporters. Uptake of the SMS intervention was high, with 92.1% of 713 eligible patients choosing to receive SMS messages. Patient and provider interviews yielded insight into barriers and facilitators to mHealth utilization. The intervention improved the quality of health communication between patients, treatment supporters, and providers. HIV-related stigma and technical challenges were identified as potential barriers. CONCLUSIONS: The mHealth intervention for HIV/tuberculosis treatment support in Lesotho was found to be a low-tech, user-friendly intervention, which was acceptable to patients and health care providers.
[Mh] Termos MeSH primário: Infecções por HIV/terapia
Comunicação em Saúde/métodos
Telemedicina
Tuberculose/terapia
[Mh] Termos MeSH secundário: Adulto
Agendamento de Consultas
Telefone Celular
Feminino
Infecções por HIV/prevenção & controle
Infecções por HIV/virologia
Seres Humanos
Lesoto
Masculino
Meia-Idade
Cooperação do Paciente
Sistemas de Alerta
Estigma Social
Mensagem de Texto
Tuberculose/microbiologia
Tuberculose/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:161209
[St] Status:MEDLINE


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[PMID]:27838627
[Au] Autor:Montinaro F; Busby GB; Gonzalez-Santos M; Oosthuitzen O; Oosthuitzen E; Anagnostou P; Destro-Bisol G; Pascali VL; Capelli C
[Ad] Endereço:Department of Zoology, University of Oxford, OX1 3PS, UK francesco.montinaro@gmail.com.
[Ti] Título:Complex Ancient Genetic Structure and Cultural Transitions in Southern African Populations.
[So] Source:Genetics;205(1):303-316, 2017 Jan.
[Is] ISSN:1943-2631
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The characterization of the structure of southern African populations has been the subject of numerous genetic, medical, linguistic, archaeological, and anthropological investigations. Current diversity in the subcontinent is the result of complex events of genetic admixture and cultural contact between early inhabitants and migrants that arrived in the region over the last 2000 years. Here, we analyze 1856 individuals from 91 populations, comprising novel and published genotype data, to characterize the genetic ancestry profiles of 631 individuals from 51 southern African populations. Combining both local ancestry and allele frequency based analyses, we identify a tripartite, ancient, Khoesan-related genetic structure. This structure correlates neither with linguistic affiliation nor subsistence strategy, but with geography, revealing the importance of isolation-by-distance dynamics in the area. Fine-mapping of these components in southern African populations reveals admixture and cultural reversion involving several Khoesan groups, and highlights that Bantu speakers and Coloured individuals have different mixtures of these ancient ancestries.
[Mh] Termos MeSH primário: Grupo com Ancestrais do Continente Africano/genética
DNA Antigo/análise
Estruturas Genéticas
[Mh] Termos MeSH secundário: África Austral
DNA Antigo/química
Frequência do Gene
Variação Genética
Genética Populacional/métodos
Genótipo
Haplótipos
Seres Humanos
Lesoto
Namíbia
Filogeografia/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (DNA, Ancient)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170613
[Lr] Data última revisão:
170613
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161114
[St] Status:MEDLINE
[do] DOI:10.1534/genetics.116.189209



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