Global AIDS Reporting-2001 to 2015: Lessons for Monitoring the Sustainable Development Goals.

Since 2001 the UNAIDS Secretariat has retained the responsibility for monitoring progress towards global commitments on HIV/AIDS. Key critical characteristics of the reporting system were assessed for the reporting period from 2004 to 2014 and analyses were undertaken of response rates and core indicator performance. Country submission rates ranged from 102 (53%) Member States in 2004 to 186 (96%) in 2012. There was great variance in response rates for specific indicators, with the highest response rates for treatment-related indicators. The Global AIDS reporting system has improved substantially over time and has provided key trend data on responses to the HIV epidemic, serving as the global accountability mechanism and providing reference data on the global AIDS response. It will be critical that reporting systems continue to evolve to support the monitoring of the Sustainable Development Goals, in view of ending the AIDS epidemic as a public health threat by 2030.

Adding STD services needs careful evaluation.

PIP: Although the primary prevention of sexually transmitted diseases (STDs) through information and counseling should be an integral activity at all family planning centers, this setting may not be appropriate for STD diagnosis and treatment. The laboratory facilities and antibiotics essential for STD management may not be available. Moreover, even if these factors are available, treatment of family planning clients is not the most cost-effective way to reduce the public health impact of STDs. Core transmitters--those who have a minimum of 2 episodes of STDs a year and at least 2 new sexual partners every month--are generally not reached by family planning programs. In countries where resources are limited, outreach to core transmitters such as sex workers should be prioritized. Also questionable is the effectiveness of a syndromic approach that relies on signs and symptoms rather than laboratory diagnosis of STDs. Up to 60% of STDs in women, the primary family planning program clients, have no symptoms; in other cases, symptoms such as a vaginal discharge cannot pinpoint the specific STD. Those family planning programs that do offer STD management cannot be evaluated due to a lack of indicators of success. In general, the resources required for a family planning program to add STD management to its services are access to basic epidemiologic data on STDs, STD management guidelines, clinical facilities, equipment, condoms, antibiotics, laboratory support, patient charting capability, referral services, and program monitoring.^ieng

Depression in Southeast Asian refugees.

Depressive illness is common among Southeast Asian refugees. Classic vegetative symptoms seem to cross cultural boundaries and have been found in all ethnic groups studied. A migration history is important for eliciting information about the flight experience and the current living situation. Symptomatic treatment, combined with an abbreviated form of psychotherapy, is effective for many patients.

Stool diagnosis of giardiasis using a commercially available enzyme immunoassay to detect Giardia-specific antigen 65 (GSA 65).

A commercially available enzyme immunoassay for the diagnosis of giardiasis was evaluated in a clinical trial. The ProSpecT/Giardia diagnostic test (Alexon, Inc., Mountain View, Calif.) was compared with the standard ova and parasite (O&P) microscopic examination. Additionally, several widely used stool fixatives and a commonly used transport medium were assessed for compatibility with the immunoassay. A total of 325 stool specimens were collected and used to evaluate assay performance. Of those, 93 specimens were collected from symptomatic Giardia O&P-positive patients and 232 specimens were randomly collected from patients as part of a routine health screening procedure. All 93 Giardia O&P-positive stool specimens were strongly positive by visual and spectrophotometric examination using the immunoassay. Of the 232 randomly collected specimens, 16 were positive by O&P examination and immunoassay, 6 were negative by O&P examination but positive by immunoassay, and 1 was positive by O&P examination and negative by immunoassay. There was substantial supportive evidence that indicated that the six immunoassay-positive, O&P-negative specimens were true-positives. When these six specimens were accepted as true-positives, the immunoassay detected almost 30% more cases of Giardia infection than did O&P examination. Its sensitivity and specificity were 96 and 100%, respectively, while the sensitivity and specificity of O&P examination were 74 and 100%, respectively. The immunoassay also performed well on specimens treated with 10% neutral Formalin, sodium acetate-Formalin fixative, and Cary-Blair transport medium. However, the test was not compatible with polyvinyl alcohol-treated specimens. Overall, the ProSpecT/Giardia test was a sensitive, specific immunoassay which was easy to run and interpret. It offers a simple solution to traditional difficulties encountered in diagnosing Giardia infection.