High prevalence of pre-treatment HIV drug resistance in Papua New Guinea: findings from the first nationally representative pre-treatment HIV drug resistance study.

BACKGROUND: Determining the prevalence of pre-treatment HIV drug resistance (PDR) is important to assess the effectiveness of first-line therapies. To determine PDR prevalence in Papua New Guinea (PNG), we conducted a nationally representative survey. METHODS: We used a two-stage cluster sampling method to recruit HIV treatment initiators with and without prior exposure to antiretroviral therapies (ART) in selected clinics. Dried blood spots were collected and tested for PDR. RESULTS: A total of 315 sequences were available for analysis. The overall PDR prevalence rate was 18.4% (95% CI 13.8-24.3%). The prevalence of PDR to non-nucleoside analog reverse-transcriptase inhibitors (NNRTIs) was 17.8% (95% CI 13.6-23.0%) and of PDR to nucleoside reverse transcriptase inhibitors (NRTIs) was 6.3% (95% CI 1.6-17.1%). The PDR prevalence rate among people reinitiating ART was 42.4% (95% CI 29.1-56.4%). CONCLUSIONS: PNG has a high PDR prevalence rate, especially to NNRTI-based first-line therapies. Our findings suggest that removing NNRTIs as part of first-line treatment is warranted and will lead to improving viral suppression rates in PNG.

Farmers' perceptions of climate change in Lower Mustang, Nepal.

Climate change has become one of the highlighted issues of the world, resulting in vulnerability and adverse effects on livelihoods. It leads to an undeniable challenge for policymakers, the government, and other respective associations to formulate effective strategies; however, before formulating any coping, adaptation, or mitigation strategies, understanding the reality and perception of local people is crucial. This study investigated whether local farmers inhabiting Lower Mustang are aware of climatic change. The study comprised various methodologies, such as household surveys, field visits and focus group discussions (FGD). The farmers' responses were consistent with the actual temperature and precipitation data recorded between 1973 and 2018 at meteorological stations situated near the aforementioned regions. The finding shows that the average annual temperature of this region has risen by 0.021 °C/year over the last 45 years. Similarly, the annual precipitation increased 1.83 mm/year on average, which was also acknowledged by local farmers. From the field visit, it was also noticed that the vulnerability of climate change is considerably high and has insufficient capacity to cope with climate change. Thus, the government, and other stakeholders should assist in building the adaptive capacity of this Himalayan region.

Granular activated carbon assisted biocathode for effective electrotrophic denitrification in microbial fuel cells.

Granular activated carbon (GAC) has been widely used at the anode of a microbial fuel cell (MFC) to enhance anode performance due to its outstanding capacitance property. To the best of our knowledge, there haven't been any studies on GAC in the cathode for biofilm development and nitrate reduction in MFC. In this study, by adding GAC to biocathode, we investigated the impact of different GAC amounts and stirring speeds on power generation and nitrate reduction rate in MFC. The denitrification rate was found to be nearly two-times higher in MFCs with GAC (0.046 ± 0.0016 kg m-3 d-1) compared to that deprived of GAC (0.024 ± 0.0012 kg m-3 d-1). The electrotrophic denitrification has produced a maximum power density of 37.6 ± 4.8 mW m-2, which was further increased to 79.2 ± 7.4 mW m-2 with the amount of GAC in the biocathode. A comparative study performed with chemical catalyst (Pt carbon with air sparging) cathode and GAC biocathode showed that power densities produced with GAC biocathode were close to that with Pt cathode. Cyclic voltammetry analysis conducted at 10 mV s-1 between -0.9 V and +0.3 V (vs. Ag/AgCl) showed consistent reduction peaks at -0.6V (Ag/AgCl) confirming the reduction reaction in the biocathode. This demonstrates that the GAC biocathode used in this research is effective at producing power density and denitrification in MFC. Our belief that the nitrate reduction was caused by the GAC biocathode in MFC was further strengthened when SEM analysis showing bacterial aggregation and biofilm formation on the surface of GAC. The GAC biocathode system described in this research may be an excellent substitute for MFC's dual functions of current generation and nitrate reduction.

Effects of substrate concentrations on performance of serially connected microbial fuel cells (MFCs) operated in a continuous mode.

Stacking of microbial fuel cells (MFC) by connecting multiple small-sized units in a series is used for generating higher power from the MFCs. However, voltage reversal is a critical problem in a serially connected MFC unit. The voltage reversal often occurs when substrate concentration is relatively low in the anodic compartment. Two rectangular individual cells were stacked together in series: MFC1 was fed with 1 g glucose L(-1) throughout the experiment while MFC2 was fed with various concentrations of glucose (0.1, 0.2, 0.3, 0.5 and 0.8 g L(-1)). Voltage reversal occurred when the stack configuration was performed using (1 + 0.1) g glucose L(-1). The stacked configurations with (1 + 0.2, 1 + 0.3, 1 + 0.5 and 1 + 0.8) g glucose L(-1) were operated successfully without the voltage reversal. The maximum powers of 1.88, 2.04, 3.6, 2.5 and 2.18 mW were obtained with the stacked configurations of (1 + 0.2), (1 + 0.3), (1 + 0.5), (1 + 0.8) and (1 + 1) g glucose L(-1), respectively. Except in the stacked configuration with (1 + 0.1) g glucose L(-1), the stacked voltages obtained were similar.

Semi-continuous detection of toxic hexavalent chromium using a sulfur-oxidizing bacteria biosensor.

Toxicity testing is becoming a useful tool for environmental risk assessment. A biosensor based on the metabolic properties of sulfur-oxidizing bacteria (SOB) has been applied for the detection of toxic chemicals in water. The methodology exploits the ability of SOB to oxidize elemental sulfur to sulfuric acid under aerobic conditions. The reaction results in an increase in electrical conductivity (EC) and a decrease in pH. Five hours after Cr(6+) was added to the SOB biosensor operated in semi-continuous mode (1 min rapid feeding and 29 min batch reaction), a decrease in effluent EC and an increase in pH (from 2-3 to 6) were detected due to Cr(6+) toxicity to SOB. The SOB biosensor is simple; it can detect toxic levels of Cr(6+) on the order of minutes to hours, a useful time scale for early warning detection systems designed to protect the environment from further degradation.

A novel gas production bioassay of thiosulfate utilizing denitrifying bacteria (TUDB) for the toxicity assessment of heavy metals contaminated water.

This study reports for the first-time the possibility of deploying gas production by thiosulfate utilizing denitrifying bacteria (TUDB) as a proxy to evaluate water toxicity. The test relies on gas production by TUDB due to inhibited metabolic activity in the presence of toxicants. Gas production was measured using a bubble-type respirometer. Optimization studies indicated that 300 mg NO3--N/L, 0.5 mL acclimated culture, and 2100 mg S2O32-/L were the ideal conditions facilitating the necessary volume of gas production for sensitive data generation. Determined EC50 values of the selected heavy metals were: Cr6+, 0.51 mg/L; Ag+, 2.90 mg/L; Cu2+, 2.90 mg/L; Ni2+, 3.60 mg/L; As3+, 4.10 mg/L; Cd2+, 5.56 mg/L; Hg2+, 8.06 mg/L; and Pb2+, 19.3 mg/L. The advantages of this method include operational simplicity through the elimination of cumbersome preprocessing procedures which are used to eliminate interferences caused by turbidity when the toxicity of turbid samples is determined via spectrophotometry.

Large-scale STI services in Avahan improve utilization and treatment seeking behaviour amongst high-risk groups in India: an analysis of clinical records from six states.

BACKGROUND: Avahan, the India AIDS Initiative, implemented a large HIV prevention programme across six high HIV prevalence states amongst high risk groups consisting of female sex workers, high risk men who have sex with men, transgenders and injecting drug users in India. Utilization of the clinical services, health seeking behaviour and trends in syndromic diagnosis of sexually transmitted infections amongst these populations were measured using the individual tracking data. METHODS: The Avahan clinical monitoring system included individual tracking data pertaining to clinical services amongst high risk groups. All clinic visits were recorded in the routine clinical monitoring system using unique identification numbers at the NGO-level. Visits by individual clinic attendees were tracked from January 2005 to December 2009. An analysis examining the limited variables over time, stratified by risk group, was performed. RESULTS: A total of 431,434 individuals including 331,533 female sex workers, 10,280 injecting drug users, 82,293 men who have sex with men, and 7,328 transgenders visited the clinics with a total of 2,700,192 visits. Individuals made an average of 6.2 visits to the clinics during the study period. The number of visits per person increased annually from 1.2 in 2005 to 8.3 in 2009. The proportion of attendees visiting clinics more than four times a year increased from 4% in 2005 to 26% in 2009 (p<0.001). The proportion of STI syndromes diagnosed amongst female sex workers decreased from 39% in 2005 to 11% in 2009 (p<0.001) while the proportion of STI syndromes diagnosed amongst high risk men who have sex with men decreased from 12% to 3 % (p<0.001). The proportion of attendees seeking regular STI check-ups increased from 12% to 48% (p<0.001). The proportion of high risk groups accessing clinics within two days of onset of STI-related symptoms and acceptability of speculum and proctoscope examination increased significantly during the programme implementation period. CONCLUSIONS: The programme demonstrated that acceptable and accessible services with marginalised and often difficult-to-reach populations can be brought to a very large scale using standardized approaches. Utilization of these services can dramatically improve health seeking behaviour and reduce STI prevalence.

Assessing acute toxicity of effluent from a textile industry and nearby river waters using sulfur-oxidizing bacteria in continuous mode.

Bioassays are becoming an important tool for assessing the toxicity of complex mixtures of substances in aquatic environments in which Daphnia magna is routinely used as a test organism. Bioassays outweigh physicochemical analyses and are valuable in the decision-making process pertaining to the final discharge of effluents from wastewater treatment plants as they measure the total effect of the discharge which is ecologically relevant. In this study, the aquatic toxicity of a textile plant effluent and river water downstream from the plant were evaluated with sulfur-oxidizing bacterial biosensors in continuous mode. Collected samples were analysed for different physicochemical parameters and 1,4-dioxane was detected in the effluent. The effluent contained a relatively high chemical oxygen demand of 60 mg L(-1), which exceeded the limit set by the Korean government for industrial effluent discharges. Results showed that both the effluent and river waters were toxic to sulfur-oxidizing bacteria. These results show the importance of incorporating bioassays to detect toxicity in wastewater effluents for the sustainable management of water resources.

Strategic options for syphilis control in Papua New Guinea- impact and cost-effectiveness projections using the syphilis interventions towards elimination (SITE) model.

OBJECTIVES: Papua New Guinea (PNG) has among the highest rates of sexually transmitted infections (STIs) globally and is committed to reducing their incidence. The Syphilis Interventions Towards Elimination (SITE) model was used to explore the expected impact and cost of alternative syphilis intervention scale-up scenarios. METHODS: SITE is a dynamical model of syphilis transmission among adults 15-49 years. Individuals are divided into nine groups based on sexual behaviour and into six stages of infection. The model was calibrated to PNG using data from routine surveillance, bio-behavioural surveys, research studies and program records. Inputs included syphilis prevalence, risk behaviours, intervention coverage and service delivery unit costs. Scenarios compared different interventions (clinical treatment, contact tracing, syphilis screening, and condom promotion) for incidence and cost per infection averted over 2021-2030. RESULTS: Increasing treatment coverage of symptomatic primary/secondary-stage syphilis cases from 25-35% in 2020 to 60% from 2023 onwards reduced estimated incidence over 2021-2030 by 55%, compared to a scenario assuming constant coverage at 2019-2020 levels. The introduction of contact tracing in 2020, assuming 0.4 contacts per symptomatic person treated, reduced incidence over 2021-2030 by 10%. Increasing screening coverage by 20-30 percentage points from the 2019-2020 level reduced incidence over 2021-2030 by 3-16% depending on the target population. Scaling-up clinical, symptom-driven treatment and contact tracing had the lowest cost per infection averted, followed by condom promotion and periodic screening of female sex workers and men who have sex with men. CONCLUSIONS: PNG could considerably reduce its syphilis burden by scaling-up clinical treatment and contact tracing alongside targeted behavioural risk reduction interventions. SITE is a useful tool countries can apply to inform national STI programming and resource allocation.

Prevalence of syphilis, gonorrhoea and chlamydia in women in Fiji, the Federated States of Micronesia, Papua New Guinea and Samoa, 1995-2017: Spectrum-STI model estimates.

OBJECTIVE: To estimate prevalence levels of and time trends for active syphilis, gonorrhoea and chlamydia in women aged 15-49 years in four countries in the Pacific (Fiji, the Federated States of Micronesia [FSM], Papua New Guinea [PNG] and Samoa) to inform surveillance and control strategies for sexually transmitted infections (STIs). METHODS: The Spectrum-STI model was fitted to data from prevalence surveys and screenings of adult female populations collected during 1995-2017 and adjusted for diagnostic test performance and to account for undersampled high-risk populations. For chlamydia and gonorrhoea, data were further adjusted for age and differences between urban and rural areas. RESULTS: Prevalence levels were estimated as a percentage (95% confidence interval). In 2017, active syphilis prevalence was estimated in Fiji at 3.89% (2.82 to 5.06), in FSM at 1.48% (0.93 to 2.16), in PNG at 3.91% (1.67 to 7.24) and in Samoa at 0.16% (0.07 to 0.37). For gonorrhoea, the prevalence in Fiji was 1.63% (0.50 to 3.87); in FSM it was 1.59% (0.49 to 3.58); in PNG it was 11.0% (7.25 to 16.1); and in Samoa it was 1.61% (1.17 to 2.19). The prevalence of chlamydia in Fiji was 24.1% (16.5 to 32.7); in FSM it was 23.9% (18.5 to 30.6); in PNG it was 14.8% (7.39 to 24.7); and in Samoa it was 30.6% (26.8 to 35.0). For each specific disease within each country, the 95% confidence intervals overlapped for 2000 and 2017, although in PNG the 2017 estimates for all three STIs were below the 2000 estimates. These patterns were robust in the sensitivity analyses. DISCUSSION: This study demonstrated a persistently high prevalence of three major bacterial STIs across four countries in WHO's Western Pacific Region during nearly two decades. Further strengthening of strategies to control and prevent STIs is warranted.

Real-time monitoring of water quality of stream water using sulfur-oxidizing bacteria as bio-indicator.

In aquatic ecosystems, real-time water-quality (WQ) biomonitoring has become the most effective technology for monitoring toxic events by using living organisms as a biosensor. In this study, an online WQ monitoring system using sulfur oxidizing bacteria (SOB) was tested to monitor WQ changes in real-time in natural stream water. The WQ monitoring system consisted of three SOB reactors (one continuous and two semi-continuous mode reactors). The SOB system did not detect any toxicity in relatively-unpolluted, natural stream water when operated for more than six months. When diluted swine wastewater (50:1) was added to the influent of the reactors, the system detected toxic conditions in both the continuous and semi-continuous operational modes, showing 90% inhibition of SOB activity within 1 h of operation. The addition of 30 mg/L NO2--N or 2 mg/L of Cr6+ to the influents of SOB reactors resulted in the complete inhibition of the SOB activity within 1-2 h. The results demonstrated the successful application of an SOB bioassay as an online toxicity monitoring system for detecting pollutants from stream or river waters.

High Levels of Transmitted HIV Drug Resistance in a Study in Papua New Guinea.

INTRODUCTION: Papua New Guinea is a Pacific Island nation of 7.3 million people with an estimated HIV prevalence of 0.8%. ART initiation and monitoring are guided by clinical staging and CD4 cell counts, when available. Little is known about levels of transmitted HIV drug resistance in recently infected individuals in Papua New Guinea. METHODS: Surveillance of transmitted HIV drug resistance in a total of 123 individuals recently infected with HIV and aged less than 30 years was implemented in Port Moresby (n = 62) and Mount Hagen (n = 61) during the period May 2013-April 2014. HIV drug resistance testing was performed using dried blood spots. Transmitted HIV drug resistance was defined by the presence of one or more drug resistance mutations as defined by the World Health Organization surveillance drug resistance mutations list. RESULTS: The prevalence of non-nucleoside reverse transcriptase inhibitor transmitted HIV drug resistance was 16.1% (95% CI 8.8%-27.4%) and 8.2% (95% CI 3.2%-18.2%) in Port Moresby and Mount Hagen, respectively. The prevalence of nucleoside reverse transcriptase inhibitor transmitted HIV drug resistance was 3.2% (95% CI 0.2%-11.7%) and 3.3% (95% CI 0.2%-11.8%) in Port Moresby and Mount Hagen, respectively. No protease inhibitor transmitted HIV drug resistance was observed. CONCLUSIONS: The level of non-nucleoside reverse transcriptase inhibitor drug resistance in antiretroviral drug naïve individuals recently infected with HIV in Port Moresby is amongst the highest reported globally. This alarming level of transmitted HIV drug resistance in a young sexually active population threatens to limit the on-going effective use of NNRTIs as a component of first-line ART in Papua New Guinea. To support the choice of nationally recommended first-line antiretroviral therapy, representative surveillance of HIV drug resistance among antiretroviral therapy initiators in Papua New Guinea should be urgently implemented.

Evaluation of electricity generation from ultrasonic and heat/alkaline pretreatment of different sludge types using microbial fuel cells.

This study investigated the effects of different sludge pretreatment methods (ultrasonic vs. combined heat/alkali) with varied sources of municipal sewage sludge (primary sludge (PS), secondary excess sludge (ES), anaerobic digestion sludge (ADS)) on electricity generation in microbial fuel cells (MFCs). Introduction of ultrasonically pretreated sludge (PS, ES, ADS) to MFCs generated maximum power densities of 13.59, 9.78 and 12.67mW/m(2) and soluble COD (SCOD) removal efficiencies of 87%, 90% and 57%, respectively. The sludge pretreated by combined heat/alkali (0.04N NaOH at 120°C for 1h) produced maximum power densities of 10.03, 5.21 and 12.53mW/m(2) and SCOD removal efficiencies of 83%, 75% and 74% with PS, ES and ADS samples, respectively. Higher SCOD by sludge pretreatment enhanced performance of the MFCs and the electricity generation was linearly proportional to the SCOD removal, especially for ES.

Development of an online sulfur-oxidizing bacteria biosensor for the monitoring of water toxicity.

A toxicity monitoring system based on the metabolic properties of sulfur-oxidizing bacteria (SOB) in continuous and fed-batch modes has been applied for the detection of nitrite (NO2 (-)-N). In this study, the effects of different concentrations of NO2 (-)-N (0.1 to 5 mg/L) on the SOB bioreactors were tested. We found that 5 mg/L NO2 (-)-N was very toxic to the SOB bioreactors in both continuous (R1) and fed-batch (R2) modes, showing complete inhibition of SOB activity within 2 h of operation. R1 and R2 were operated in different ways; however, the EC inhibition and recovery patterns were very similar. The EC rate increased with an increasing NO2 (-)-N concentration in both continuous and fed-batch modes. The addition of 5 mg/L NO2 (-)-N in continuous mode decreased the average EC rate by 14.38 ± 2.1 µS/cm/min; while in fed-batch mode, the EC rate decreased by 23 µS/cm/min. Although the toxicity monitoring system could detect 0.5-5 mg/L NO2 (-)-N, it could not detect 0.1 mg/L NO2 (-)-N in either continuous or fed-batch operation. Thus, the SOB biosensor method presented is useful to detect toxic agents such as NO2 (-)-N within a few minutes or hours.

Integrating syphilis screening in a large-scale HIV prevention program for key populations: the Avahan experience from India.

INTRODUCTION: Documented experiences from India on the implementation of syphilis screening in large-scale HIV prevention programs for "key populations at higher risk" (KPs) are limited. Avahan is a large-scale HIV prevention program providing services to more than 300,000 KPs in six high HIV prevalence states of India since 2004. Avahan clinics provide a sexually transmitted infection service package which includes bi-annual syphilis screening. The trends in the coverage of syphilis screening among Avahan clinic attendees were studied retrospectively. METHODOLOGY: Screening was performed using either the Rapid Plasma Reagin (RPR) test or point-of-care immunochromatographic strip test (ICST). Clinic records from 2005 to 2009 were collated in an individual tracking database and analyzed with STATA-10. RESULTS: Initially the coverage of syphilis screening (2.6% in 2005) was constrained by the availability and operational complexity of the RPR test. After its introduction in 2007, the use of ICST for screening increased from 7.4% to 77.0% and the proportion of clinic attendees screened increased from 9.0% to 21.6% during 2007-2009. The RPR reactivity rates declined from 6.6% (2006) to 4.4% (2009). CONCLUSION: The data showed improved rates of screening of clinic attendees and declining trends in sero-reactivity over time. The introduction of point-of-care syphilis tests may have contributed to the improved coverage of syphilis screening. The ICST may be considered for initial syphilis screening at other resource-constrained primary care sites in India such as ante-natal clinics and other KP interventions.

Dynamics of PM2.5 concentrations in Kathmandu Valley, Nepal.

This study analyzed daily patterns and dynamics of PM(2.5) concentrations in the Kathmandu Valley during three winters. The PM(2.5) data showed a daily repetitive cycle which represents influence of local air flow and dispersion and accumulation of air pollutants in the valley. Two concentration peaks were observed in the morning and in the evening periods, and they fell down during the daytime and the nighttime periods. This indicates local emission sources as major contributors in the valley. The more pronounced morning peak compared to the evening peak showed that the upslope wind in the morning helped to move the polluted inversion layer downward, subsequently adding to freshly emitted pollutants and causing a sharp pollutant concentration rise in the morning. Katabatic wind and rise of temperature in the basin during the day helped the pollutant upflow and dilution, resulting in a sharp PM(2.5) concentration decline. Through the afternoon, the decrease in air temperature followed by decrease in wind speed caused to lower PM(2.5) peaks in the evening. Also, higher morning peaks of PM(2.5) concentrations compared to the evening indicated pollution from the previous day is added to the fresh emission. The valley had increased PM(2.5) from the beginning of October which continued till the first week of February. The increase in PM(2.5) peak fit the logistic equation y=[k/(1+exp (p-qx)]+asin(bx) where k, p, q, a, and b are constants.