Using concept mapping to explore the challenges associated with affording and accessing medications among people living with HIV in Ontario, Canada.

Antiretroviral medications are expensive, and people living with HIV often experience challenges accessing and paying for medication due to various obstacles. We used concept mapping to explore the challenges people living with HIV in Ontario, Canada, face when accessing medication. In brainstorming, 68 participants generated 447 statements in response to the focus prompt "Some people living with HIV have trouble getting and paying for prescription drugs because … ". These were consolidated into 77 statements, which were sorted (n = 30) and rated (n = 32) on importance and commonality. A ten-cluster concept map consisting of individual- and health system-related clusters was generated. Clusters included: (1) Stigma, (2) Medication-Related Issues, (3) Individual Challenges, (4) Basic Needs, (5) Immigration, (6) Coverage, (7) Trillium Drug Program, (8) Access to Services, (9) System-Level Issues and (10) Access to Professional Services. Statements in Coverage and Basic Needs were rated most important and common although there was variability by Ontario residence and drug coverage mechanisms. Strategies to address challenges were generated in Interpretation (n = 25 participants). Given that continuous access to antiretroviral therapy is necessary to fully realize treatment benefits, policies and interventions that address these challenges are needed.

Human rights, public health and COVID-19 in Canada.

Faced with the extraordinary global public health crisis of COVID-19, governments across Canada must decide, often with limited and imperfect evidence, how to implement measures to reduce its spread. Drawing on a health and human rights framework, this commentary explores several features of the Canadian response to date that raise human rights concerns. Our discussion focuses on criminal law, fines, data collection, and so-called snitch lines. We argue that the approach of governmental and public health authorities must be grounded in the best available scientific evidence and align with human rights standards. Our aim is to encourage dialogue within the public health community in Canada about the importance of human rights-based responses to COVID-19.

RéSUMé: Face à la crise de santé publique sans précédent que représente la COVID-19 à l'échelle mondiale, les gouvernements des provinces et territoires du Canada doivent décider, souvent en se fondant sur des preuves limitées et imparfaites, comment mettre en œuvre des mesures pour réduire sa propagation. En s'appuyant sur un cadre de travail relatif à la santé et aux droits de la personne, cette analyse explore plusieurs éléments de la réponse canadienne apportée à ce jour qui soulèvent des préoccupations en matière de droits de la personne. Notre analyse porte en particulier sur le droit criminel, les amendes, la collecte de données et ce qu'on appelle les « lignes de dénonciation ¼. Nous estimons que l'approche des autorités gouvernementales et de santé publique doit être fondée sur les preuves scientifiques disponibles les plus solides et s'aligner sur les normes en matière de droits de la personne. Nous avons pour objectif d'encourager le dialogue au sein de la communauté du secteur de la santé publique au Canada sur l'importance des réponses à la COVID-19 fondées sur les droits de la personne.

Meso-Scale Particle Image Velocimetry Studies of Neurovascular Flows In Vitro.

Particle image velocimetry (PIV) is used in a wide variety of fields, due to the opportunity it provides for precisely visualizing and quantifying flows across a large spatiotemporal range. However, its implementation typically requires the use of expensive and specialized instrumentation, which limits its broader utility. Moreover, within the field of bioengineering, in vitro flow visualization studies are also often further limited by the high cost of commercially sourced tissue phantoms that recapitulate desired anatomical structures, particularly for those that span the mesoscale regime (i.e., submillimeter to millimeter length scales). Herein, we present a simplified experimental protocol developed to address these limitations, the key elements of which include 1) a relatively low-cost method for fabricating mesoscale tissue phantoms using 3-D printing and silicone casting, and 2) an open-source image analysis and processing framework that reduces the demand upon the instrumentation for measuring mesoscale flows (i.e., velocities up to tens of millimeters/second). Collectively, this lowers the barrier to entry for nonexperts, by leveraging resources already at the disposal of many bioengineering researchers. We demonstratethe applicability of this protocol within the context of neurovascular flow characterization; however, it is expected to be relevant to a broader range of mesoscale applications in bioengineering and beyond.

Ultrahigh Resolution Titanium Deep Reactive Ion Etching.

Titanium (Ti) represents a promising new material for microelectromechanical systems (MEMS) because of its unique properties. Recently, this has been made possible with the advent of processes that enable deep reactive ion etching (DRIE) of high-aspect-ratio (HAR) structures in bulk Ti substrates. However, to date, these processes have been limited to minimum feature sizes (MFS) ≥750 nm. Although this is sufficient for many applications, MFS reduction to the deep submicrometer range opens potential for further device miniaturization and an opportunity for endowing devices with unique functionalities that are derived from precisely defined structures within this length scale regime. Herein, we report results from studies seeking to create means for realizing such opportunities through extension of Ti DRIE to the deep submicrometer scale. The effects of key process parameters on etch performance were investigated, and the understanding gained from these studies formed the development of a new ultrahigh resolution (UHR) Ti DRIE process. Using this process, we demonstrate, for the first time, fabrication of HAR structures in bulk Ti substrates with 150 nm MFS, smooth vertical sidewalls (88°), good etch rate (587 nm/min), and mask selectivity (11.1). This represents a fivefold or greater improvement in MFS relative to our previously reported processes and a 29-fold or greater improvement over more recent processes reported by others. As such, the UHR Ti DRIE process extends the state-of-the-art considerably, and it opens important new opportunities for Ti MEMS, particularly in the implantable medical device realm.

Systematic review of HIV transmission between heterosexual serodiscordant couples where the HIV-positive partner is fully suppressed on antiretroviral therapy.

BACKGROUND: The risk of sexual HIV transmission in serodiscordant couples when the HIV-positive partner has full virologic suppression on combination antiretroviral therapy (cART) is debated. This study aims to systematically review observational studies and randomized controlled trials (RCTs), evaluating rates of sexual HIV transmission between heterosexual serodiscordant couples when the HIV-positive partner has full suppression on cART. METHODS AND FINDINGS: We searched major bibliographic databases to November 2012 for relevant observational studies and RCTs without language restrictions. Conference proceedings, key journals and bibliographies were also searched. Studies reporting HIV transmission rates, cART histories and viral loads of the HIV-positive partners were included. Two reviewers extracted methodologic characteristics and outcomes. Of 20,252 citations, 3 studies met all eligibility criteria with confirmed full virologic suppression in the HIV-positive partner. We included 3 additional studies (2 cohort studies, 1 RCT) that did not confirm viral suppression in the HIV-positive partner at transmission in a secondary meta-analysis. Methodologic quality was reasonable. The rate of transmission in the 3 studies confirming virologic suppression was 0 per 100 person-years (95% CI = 0-0.05), with low heterogeneity (I(2) = 0%). When we included the 3 studies that did not confirm virologic suppression, the rate of transmission was 0.14 per 100 person-years (95%CI = 0.04-0.31) (I(2) = 0%). In a sensitivity analysis including all 6 studies, the rate of transmission was 0 per 100 person-years (95%CI = 0-0.01) after omitting all transmissions with known detectable or unconfirmed viral loads, as full suppression in these cases was unlikely. Limitations included lack of data on same-sex couples, type of sexual intercourse (vaginal vs. anal), direction of HIV transmission, exact viral load at the time of transmission, sexually transmitted infections (STI) rates, and extent of condom use. CONCLUSIONS: Our findings suggest minimal risk of sexual HIV transmission for heterosexual serodiscordant couples when the HIV-positive partner has full viral suppression on cART with caveats regarding information on sexual intercourse type, STIs, and condom use. These findings have implications when counseling heterosexual serodiscordant couples on sexual and reproductive health. More research is needed to explore HIV transmission risk between same-sex couples.