Comparison of HIV prevalence, incidence, and viral load suppression in Zambia population-based HIV impact assessments from 2016 and 2021.

BACKGROUND: The Zambian government has implemented a public health response to control the HIV epidemic in the country. Zambia conducted a population-based HIV impact assessment (ZAMPHIA) survey in 2021 to assess the status of the HIV epidemic to guide its public health programs. METHODS: ZAMPHIA 2021 was a cross-sectional two-stage cluster sample household survey among persons aged ≥15 years conducted in Zambia across all 10 provinces. Consenting participants were administered a standardized questionnaire and whole blood was tested for HIV according to national guidelines. HIV-1 viral load (VL), recent HIV infection, and antiretroviral medications were tested for in HIV-seropositive samples. Viral load suppression (VLS) was defined as <1000 copies/ml. ZAMPHIA 2021 results were compared to ZAMPHIA 2016 for persons aged 15-59 years (i.e., the overlapping age ranges). All estimates were weighted to account for nonresponse and survey design. RESULTS: During ZAMPHIA 2021, of 25 483 eligible persons aged ≥15 years, 18 804 (73.8%) were interviewed and tested for HIV. HIV prevalence was 11.0% and VLS prevalence was 86.2% overall, but was <80% among people living with HIV aged 15-24 years and in certain provinces. Among persons aged 15-59 years, from 2016 to 2021, HIV incidence declined from 0.6% to 0.3% ( P -value: 0.07) and VLS prevalence increased from 59.2% to 85.7% ( P -value: <0.01). DISCUSSION: Zambia has made substantial progress toward controlling the HIV epidemic from 2016 to 2021. Continued implementation of a test-and-treat strategy, with attention to groups with lower VLS in the ZAMPHIA 2021, could support reductions in HIV incidence and improve overall VLS in Zambia.

Examining HPV Vaccination Practices and Differences Among Providers in Virginia.

Virginia has some of the lowest HPV vaccination rates, despite being one of the few states in the USA requiring adolescent girls receive the vaccine. Provider characteristics may be an important factor in HPV vaccination. Thus, the present study assessed provider vaccination, practices, knowledge about the vaccine, and confidence in performing behaviors related to the vaccine. We conducted a cross-sectional electronic survey in a large health care system in Northern Virginia. A total of 53 responses were received. Only respondents who reported seeing adolescent patients were included in analyses (N = 42). Differences in responses were examined by provider age, gender, and type. Respondents reported recommending the vaccine a high percent of the time to eligible patients and had overall high levels of knowledge and confidence. Male providers recommended the vaccine to boys ages 11-12, less frequently than female providers. Providers age 50 and over recommended the vaccine to boys ages 11-12 less frequently than younger providers. This study shows that there are some gaps in HPV vaccine recommendation practices among providers. These gaps may be one reason for the low uptake of the HPV vaccine among adolescents. Thus, educational and training interventions of providers could be considered.

Burden of genital warts in Ecuador: an observational study in the practice of physicians / Carga das verrugas genitais no Equador: estudo observacional sobre a clínica médica

Introduction: Human papillomavirus types 6 and 11 cause 90% of genital warts. Although the epidemiology of cervical cancer and the distribution of human papillomavirus genotypes have been investigated in Ecuador, little is known about the occurrence of genital warts. Objective: To estimate the incidence and prevalence of genital warts among patients routinely presenting at the practice of physicians, describe the demographics of genital warts cases and highlight the physician specialties that treat genital warts, including patterns of consultation and referral in Ecuador. Methods: Participants were a convenience sample of physicians who treat and/or diagnose genital warts in their practices. Physicians completed a daily log, recording the demographics and diagnosis of genital warts in all patients aged 18 to 60 years seen over 10 days in their practices. Physicians then completed a survey recording their practice characteristics and referral patterns of genital warts. Results: A sample of 105 physicians of different specialties participated in the study. Among 12,133 patients, the prevalence of genital warts was 5.5%, and the incidence, 3.7%. Prevalence was 6.9% in men, peaking at 12.6% in those aged from 25 to 29 years old. Prevalence was 5.1% for females, peaking at 6.5% in those aged from 30 to 34 years old. Most women were seen in direct consultations (75%) rather than by referral ones (24%). Most physicians (72%) treated females with genital warts, except for primary care physicians, who referred most cases (88%). Conclusion: Cases of genital warts are frequently encountered by physicians in Ecuador and are typically treated by specialists rather than primary care physicians.

Introdução: Os tipos 6 e 11 do papilomavírus humano causam 90% das verrugas genitais. Embora a epidemiologia do câncer do colo do útero e a distribuição dos genótipos do papilomavírus humano tenham sido investigadas no Equador, pouco se sabe sobre a ocorrência das verrugas genitais. Objetivo: Estimar a incidência e a prevalência das verrugas genitais em pacientes atendidos rotineiramente na clínica médica, descrever os dados demográficos dos casos de verrugas genitais e determinar as especialidades médicas que tratam as verrugas genitais, incluindo os padrões de consulta e encaminhamento no Equador. Métodos: Foi realizada uma amostragem por conveniência com médicos que tratavam e/ou diagnosticam verrugas genitais em sua clínica médica. Os médicos registraram as suas atividades cotidianas em um diário, anotando dados demográficos e diagnóstico de verrugas genitais de todos os pacientes com idade entre 18 e 60 anos atendidos durante 10 dias em suas clínicas. Posteriormente, os médicos responderam a uma pesquisa sobre as características da conduta tomada e os padrões de encaminhamento médico das verrugas genitais. Resultados: Uma amostra de 105 médicos de diferentes especialidades participou do estudo. Entre 12.133 pacientes, a prevalência de verrugas genitais foi de 5,5% e a incidência foi de 3,7%. A prevalência foi de 6,9% no sexo masculino, atingindo o valor máximo de 12,6% na faixa etária de 25 a 29 anos. A prevalência foi de 5,1% para o sexo feminino, alcançando 6,5% entre 30 e 34 anos. Na maior parte dos casos, as mulheres foram tratadas predominantemente pelo médico que realizou o primeiro atendimento (75%) e não por meio de encaminhamento a outra especialidade (24%). A maioria dos médicos (72%) tratou mulheres com verrugas genitais, exceto os médicos de atenção primária, que em geral encaminharam os casos (88%). Conclusão: Casos de verrugas genitais são frequentemente diagnosticados por médicos no Equador e são mais frequentemente tratados por especialistas do que por médicos de atenção primária.

Physician clinical decision support system prompts and administration of subsequent doses of HPV vaccine: A randomized clinical trial.

BACKGROUND: HPV vaccine is effective in preventing several cancers and anogenital warts, yet rates of HPV vaccination series completion in the United States are low. A primary reason identified by parents for vaccinating children against HPV is a health care provider's recommendation. Although most clinicians embrace vaccine recommendations, they are not always carried out evenly and subsequent HPV vaccines are missed. METHODS: Using an electronic health records-based decision support system (CHICA) clinicians were randomized to either usual practice or to receive an automated reminder to recommend the 2nd or 3rd dose of HPV vaccine. The reminder was delivered to clinicians of all intervention group eligible adolescents who had already initiated the vaccine series. Logistic regression models with generalized estimating equations were used for data analysis. RESULTS: A total of 1285 clinical encounters were observed across 29 randomized pediatric providers over a 13-month time frame (50.7% control group, 49.3% intervention group). Overall, patients were 44.9% female, 59.4% Black, 22.1% Hispanic, and 48.8% were ages 11-12 yrs. Within the control group, 421 (64.7%) received a subsequent HPV vaccine, compared to 481 (75.9%) (OR: 1.72, (95% CI 1.35-2.19)). Adjusted analysis showed no difference between the groups (aOR 1.52 (95% CI 0.88-2.62)) or when examined by age (11-12yrs aOR 1.66, (95% CI 0.79-3.48)) and 13-17yrs (aOR 1.19, (95% CI 0.76-1.85)) or gender female (aOR 1.39 (95% CI 0.71-2.72)) and males (aOR 1.67 (95% CI 0.95-2.92)). When results were stratified by both age and gender, there was similarly no statistically significant effect between the two groups. CONCLUSIONS: Automated physician reminders for subsequent 2nd and 3rd doses of HPV vaccination were used. Despite increased rates of vaccination in the intervention group, the differences did not reach the level of statistical significance. Future studies with multifaceted approaches may be needed to examine the efficacy of computer-based reminders. CLINICAL TRIAL REGISTRATION: NCT02558803, "HPV Vaccination: Evaluation of Reminder Prompts for Doses 2 & 3".

Burden of genital warts in Peru: an observational study.

Genital warts (GW) are mucosal or skin lesions caused by sexual transmission of human papillomavirus (HPV). This study estimates the frequency of GW cases in physicians' clinics and physicians' usual practices of GW referral and diagnosis in Peru. Participants in this study were a convenience sample of 100 physicians in five specialties: primary care (17), gynecology (37), urology (10), dermatology (31), and infectious diseases (5). Physicians completed a survey and daily log of all patients aged 18-60 years seen over ten days in their offices located in Peru. The survey recorded GW referral patterns and the daily log recorded patient demographic information and GW diagnosis. Among 12,058 patients, the annual GW prevalence (95% confidence interval [CI]) was 2.28% (2.02-2.56) and cumulative incidence (95% CI) was 1.60% (1.38-1.84). Physicians reported that most GW patients were direct consult (73.5% of male and 67.9% of females) and physicians treated most GW patients themselves (73.4% of males and 76.7% of females). As reported, the most common reasons for referring were 'serious cases requiring more specialized treatment' (73.2% of male and 72.2% of female) and 'lack of resources to treat' (26.8% of male and 27.8% of female). We conclude that GW cases are commonly seen by physicians in Peru.

An Educational Intervention to Improve HPV Vaccination: A Cluster Randomized Trial.

: media-1vid110.1542/5849572217001PEDS-VA_2018-1457Video Abstract BACKGROUND: Human papillomavirus (HPV) infection can lead to serious health issues and remains the most common sexually transmitted infection. Despite availability of effective vaccines, HPV vaccination rates are suboptimal. METHODS: In a cluster randomized trial, an intervention used to target parents of adolescents (11-17 years) eligible for a dose of HPV vaccine, was tested in pediatric clinics part of an urban health system. Parents watched a digital video outlining the risks and benefits of vaccine using a tablet in the examination room. The primary outcome was change in HPV vaccine status 2 weeks after the clinic visit. An intention-to-treat analysis for the primary outcome used generalized estimating equations to accommodate the potential cluster effect of clinics. RESULTS: A total of 1596 eligible adolescents were observed during the 7-month trial. One-third of adolescents visited an intervention clinic. Adolescents who attended an intervention clinic were more likely to be younger (11-12 years) than those who attended a control clinic (72.4% vs 49.8%; P < .001). No differences in race or sex were observed. The proportion of adolescents with an observed change in vaccine status was higher for those attending an intervention clinic (64.8%) versus control clinic (50.1%; odds ratio, 1.82; 95% confidence interval, 1.47-2.25; P < .001). Adolescents whose parents watched the video had a 3-times greater odds of receiving a dose of the HPV vaccine (78.0%; odds ratio, 3.07; 95% confidence interval, 1.47-6.42; P = .003). CONCLUSIONS: Educational interventions delivered within a clinical setting hold promise to improve vaccination behaviors.

Impact of introduction of the 9-valent human papillomavirus vaccine on vaccination coverage of youth in North Carolina.

OBJECTIVES: The objective of this study was to evaluate the impact of introduction of 9vHPV vaccine on HPV vaccination uptake (doses per capita) and initiation (≥1 doses), completion (≥3 doses) and compliance (≥3 doses within 12 months) by adolescents. METHODS: We used a retrospective cohort analysis using North Carolina Immunization Registry (NCIR) data from January 2008 through October 2016. The sample included Vaccines for Children eligible adolescents aged 9 to 17 years in 2016, for whom the NCIR contains complete vaccination history. We applied an interrupted time series design to measure associations between ZIP Code Tabulation Area (ZCTA)-level HPV vaccination outcomes over time with the introduction of 9vHPV in North Carolina (NC) in July 2015. RESULTS: Each outcome displayed a linear upward trend over time with large seasonal spikes near August of each year, corresponding to the time when adolescents often receive other vaccines required for school entry. After accounting for these underlying trends, introduction of 9vHPV was not associated with a change in publicly funded HPV vaccination rates in NC. CONCLUSIONS: Our results indicate that 9vHPV substituted for 4vHPV in the first year after release in NC, but the release of 9vHPV was not associated with an overall change in HPV vaccination.

Determinants of the receipt of the 9-valent human papillomavirus vaccine in the first year after introduction in North Carolina.

OBJECTIVES: The objective of this study was to describe the transition from bi- and quadrivalent HPV vaccines to 9vHPV in aggregate and identify determinants of the receipt of 9vHPV among youth following the introduction of 9vHPV in North Carolina. METHODS: The study used a retrospective cohort design with data from the North Carolina Immunization Registry (NCIR). Our sample included all doses of HPV vaccine administered between July 2015 and October 2016 to age-eligible youth (ages 9-17). We used a logistic regression model to associate individual child-level and ZIP Code Tabulation Area (ZCTA)-level characteristics with an indicator variable for receiving 9vHPV (vs. other HPV vaccines). RESULTS: Youth receiving the HPV vaccine were more likely to receive 9vHPV if they lived in a ZCTA with a larger age-eligible (i.e., 9-17) population, a health professional shortage area, or a higher number of annual outpatient visits per capita. They were less likely to receive 9vHPV if they were older, received a publicly-funded dose, or lived in a ZCTA with a higher percentage of the population with less than a high-school education or a higher number of religious organizations. CONCLUSIONS: While the transition from other HPV vaccines to 9vHPV was relatively quick, there were disparities in the diffusion of 9vHPV across North Carolina.

Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience.

Prophylactic human papillomavirus (HPV) vaccination programs constitute major public health initiatives worldwide. We assessed the global effect of quadrivalent HPV (4vHPV) vaccination on HPV infection and disease. PubMed and Embase were systematically searched for peer-reviewed articles from January 2007 through February 2016 to identify observational studies reporting the impact or effectiveness of 4vHPV vaccination on infection, anogenital warts, and cervical cancer or precancerous lesions. Over the last decade, the impact of HPV vaccination in real-world settings has become increasingly evident, especially among girls vaccinated before HPV exposure in countries with high vaccine uptake. Maximal reductions of approximately 90% for HPV 6/11/16/18 infection, approximately 90% for genital warts, approximately 45% for low-grade cytological cervical abnormalities, and approximately 85% for high-grade histologically proven cervical abnormalities have been reported. The full public health potential of HPV vaccination is not yet realized. HPV-related disease remains a significant source of morbidity and mortality in developing and developed nations, underscoring the need for HPV vaccination programs with high population coverage.

Serratia marcescens is injurious to intestinal epithelial cells.

Diarrhea causes substantial morbidity and mortality in children in low-income countries. Although numerous pathogens cause diarrhea, the etiology of many episodes remains unknown. Serratia marcescens is incriminated in hospital-associated infections, and HIV/AIDS associated diarrhea. We have recently found that Serratia spp. may be found more commonly in the stools of patients with diarrhea than in asymptomatic control children. We therefore investigated the possible enteric pathogenicity of S. marcescens in vitro employing a polarized human colonic epithelial cell (T84) monolayer. Infected monolayers were assayed for bacterial invasion, transepithelial electrical resistance (TEER), cytotoxicity, interleukin-8 (IL-8) release and morphological changes by scanning electron microscopy. We observed significantly greater epithelial cell invasion by S. marcescens compared to Escherichia coli strain HS (p = 0.0038 respectively). Cell invasion was accompanied by reduction in TEER and secretion of IL-8. Lactate dehydrogenase (LDH) extracellular concentration rapidly increased within a few hours of exposure of the monolayer to S. marcescens. Scanning electron microscopy of S. marcescens-infected monolayers demonstrated destruction of microvilli and vacuolization. Our results suggest that S. marcescens interacts with intestinal epithelial cells in culture and induces dramatic alterations similar to those produced by known enteric pathogens.