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1.
Chemistry ; 30(7): e202303289, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-37899311

RESUMEN

Formamides are important feedstocks for the manufacture of many fine chemicals. State-of-the-art synthesis of formamides relies on the use of an excess amount of reagents, giving copious waste and thus poor atom-economy. Here, we report the first example of direct synthesis of N-formamides by coupling two challenging reactions, namely reductive amination of carbonyl compounds, particularly biomass-derived aldehydes and ketones, and fixation of CO2 in the presence of H2 over a metal-organic framework supported ruthenium catalyst, Ru/MFM-300(Cr). Highly selective production of N-formamides has been observed for a wide range of carbonyl compounds. Synchrotron X-ray powder diffraction reveals the presence of strong host-guest binding interactions via hydrogen bonding and parallel-displaced π⋅⋅⋅π interactions between the catalyst and adsorbed substrates facilitating the activation of substrates and promoting selectivity to formamides. The use of multifunctional porous catalysts to integrate CO2 utilisation in the synthesis of formamide products will have a significant impact in the sustainable synthesis of feedstock chemicals.

2.
J Am Chem Soc ; 2023 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-37023113

RESUMEN

A cross-coupling reaction via the dehydrogenative route over heterogeneous solid atomic catalysts offers practical solutions toward an economical and sustainable elaboration of simple organic substrates. The current utilization of this technology is, however, hampered by limited molecular definition of many solid catalysts. Here, we report the development of Cu-M dual-atom catalysts (where M = Co, Ni, Cu, and Zn) supported on a hierarchical USY zeolite to mediate efficient dehydrogenative cross-coupling of unprotected phenols with amine partners. Over 80% isolated yields have been attained over Cu-Co-USY, which shows much superior reactivity when compared with our Cu1 and other Cu-M analogues. This amination reaction has hence involved simple and non-forceful reaction condition requirements. The superior reactivity can be attributed to (1) the specifically designed bimetallic Cu-Co active sites within the micropore for "co-adsorption-co-activation" of the reaction substrates and (2) the facile intracrystalline (meso/micropore) diffusion of the heterocyclic organic substrates. This study offers critical insights into the engineering of next-generation solid atomic catalysts with complex reaction steps.

3.
Chemistry ; 29(57): e202302057, 2023 Oct 13.
Artículo en Inglés | MEDLINE | ID: mdl-37449834

RESUMEN

The structure and vibrational spectroscopy of centrohexaindane, 1, was investigated. This unusual molecule has a quaternary carbon atom that is coordinated to four further such quaternary carbon atoms as its core, each pair of which is bonded to an ortho-phenylene unit. Previous NMR studies have shown that the molecule has tetrahedral (Td ) symmetry in solution. The infrared and Raman spectra of chloroform and deuterochloroform solutions of 1 are completely in agreement with this conclusion, as the only modes that are visible are those allowed for Td symmetry. This is not the case in the solid state: X-ray powder diffraction indicates that the unit cell is triclinic or monoclinic with a volume in excess of 4000 Å3 . The vibrational spectroscopy is consistent with C1 site symmetry and the presence of at least two molecules in the primitive cell. It is likely that the space group is centrosymmetric.

4.
J Med Internet Res ; 25: e42111, 2023 05 09.
Artículo en Inglés | MEDLINE | ID: mdl-37159245

RESUMEN

BACKGROUND: There is a dearth of high-quality evidence from digital health interventions in routine program settings in low- and middle-income countries. We previously conducted a randomized controlled trial (RCT) in Zimbabwe, demonstrating that 2-way texting (2wT) was safe and effective for follow-up after adult voluntary medical male circumcision (VMMC). OBJECTIVE: To demonstrate the replicability of 2wT, we conducted a larger RCT in both urban and rural VMMC settings in South Africa to determine whether 2wT improves adverse event (AE) ascertainment and, therefore, the quality of follow-up after VMMC while reducing health care workers' workload. METHODS: A prospective, unblinded, noninferiority RCT was conducted among adult participants who underwent VMMC with cell phones randomized in a 1:1 ratio between 2wT and control (routine care) in North West and Gauteng provinces. The 2wT participants responded to a daily SMS text message with in-person follow-up only if desired or an AE was suspected. The control group was requested to make in-person visits on postoperative days 2 and 7 as per national VMMC guidelines. All participants were asked to return on postoperative day 14 for study-specific review. Safety (cumulative AEs ≤day 14 visit) and workload (number of in-person follow-up visits) were compared. Differences in cumulative AEs were calculated between groups. Noninferiority was prespecified with a margin of -0.25%. The Manning score method was used to calculate 95% CIs. RESULTS: The study was conducted between June 7, 2021, and February 21, 2022. In total, 1084 men were enrolled (2wT: n=547, 50.5%, control: n=537, 49.5%), with near-equal proportions of rural and urban participants. Cumulative AEs were identified in 2.3% (95% CI 1.3-4.1) of 2wT participants and 1.0% (95% CI 0.4-2.3) of control participants, demonstrating noninferiority (1-sided 95% CI -0.09 to ∞). Among the 2wT participants, 11 AEs (9 moderate and 2 severe) were identified, compared with 5 AEs (all moderate) among the control participants-a nonsignificant difference in AE rates (P=.13). The 2wT participants attended 0.22 visits, and the control participants attended 1.34 visits-a significant reduction in follow-up visit workload (P<.001). The 2wT approach reduced unnecessary postoperative visits by 84.8%. Daily response rates ranged from 86% on day 3 to 74% on day 13. Among the 2wT participants, 94% (514/547) responded to ≥1 daily SMS text messages over 13 days. CONCLUSIONS: Across rural and urban contexts in South Africa, 2wT was noninferior to routine in-person visits for AE ascertainment, demonstrating 2wT safety. The 2wT approach also significantly reduced the follow-up visit workload, improving efficiency. These results strongly suggest that 2wT provides quality VMMC follow-up and should be adopted at scale. Adaptation of the 2wT telehealth approach to other acute follow-up care contexts could extend these gains beyond VMMC. TRIAL REGISTRATION: ClinicalTrials.gov NCT04327271; https://www.clinicaltrials.gov/ct2/show/NCT04327271.


Asunto(s)
Circuncisión Masculina , Telemedicina , Envío de Mensajes de Texto , Adulto , Humanos , Masculino , Circuncisión Masculina/efectos adversos , Estudios de Seguimiento , Sudáfrica , Población Rural , Población Urbana
5.
Br J Nurs ; 32(18): 890-896, 2023 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-37830864

RESUMEN

The clinical telephone helpline discussed here is a communication channel for family members and caregivers whose loved ones are in hospital. It makes full use of the effect families can have on the care experience and complements standard visiting as well as when hospital visits are restricted. The helpline helps to meet family members' health information and emotional wellbeing needs and is a reciprocal patient safety communication channel. Three main benefits have been identified. Flrst, communication between patients, relatives, communities and staff is enhanced. The helpline provides comprehensive patient clinical updates to relatives and caregivers using live digital healthcare records, and person-centred care is facilitated by patient-specific information being obtained by helpline clinicians from relatives. Second, it releases time to care. The helpline runs remotely, away from wards, enabling ward-based clinicians to prioritise direct patient care. Finally, clinical staff who are unable to work directly within wards maintain their active engagement in care provision, supporting relatives, patients and their ward-based colleagues.


Asunto(s)
Cuidadores , Pacientes Internos , Humanos , Cuidadores/psicología , Hospitales , Comunicación
6.
Angew Chem Int Ed Engl ; 62(48): e202306267, 2023 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-37783657

RESUMEN

Deuterium labelling of organic compounds is an important process in chemistry. We report the first example of photocatalytic dehalogenative deuteration of both arylhalides and alkylhalides (40 substrates) over a metal-organic framework, MFM-300(Cr), using CD3 CN as the deuterium source at room temperature. MFM-300(Cr) catalyses high deuterium incorporation and shows excellent tolerance to various functional groups. Synchrotron X-ray powder diffraction reveals the activation of halogenated substrates via confined binding within MFM-300(Cr). In situ electron paramagnetic resonance spectroscopy confirms the formation of carbon-based radicals as intermediates and reveals the reaction pathway. This protocol removes the use of precious-metal catalysts from state-of-the-art processes based upon direct hydrogen isotope exchange and shows high photocatalytic stability, thus enabling multiple catalytic cycles.

7.
J Am Chem Soc ; 144(41): 18967-18975, 2022 10 19.
Artículo en Inglés | MEDLINE | ID: mdl-36198137

RESUMEN

Increasing levels of air pollution are driving the need for the development of new processes that take "waste-to-chemicals". Herein, we report the capture and conversion under ambient conditions of a major air pollutant, NO2, using a robust metal-organic framework (MOF) material, Zr-bptc (H4bptc = 3,3',5,5'-biphenyltetracarboxylic acid), comprising {Zr6(µ3-O)4(µ3-OH)4(COO)12} clusters linked by 4-connected bptc4- ligands in an ftw topology. At 298 K, Zr-bptc shows exceptional stability and adsorption of NO2 at both low (4.9 mmol g-1 at 10 mbar) and high pressures (13.8 mmol g-1 at 1.0 bar), as measured by isotherm experiments. Dynamic breakthrough experiments have confirmed the selective retention of NO2 by Zr-bptc at low concentrations under both dry and wet conditions. The immobilized NO2 can be readily transformed into valuable nitro compounds relevant to construction, agrochemical, and pharmaceutical industries. In situ crystallographic and spectroscopic studies reveal strong binding interactions of NO2 to the {Zr6(µ3-O)4(µ3-OH)4(COO)12} cluster node. This study paves a circular pathway to enable the integration of nitrogen-based air pollutants into the production of fine chemicals.


Asunto(s)
Contaminantes Atmosféricos , Estructuras Metalorgánicas , Dióxido de Nitrógeno , Estructuras Metalorgánicas/química , Nitrocompuestos , Ligandos , Contaminantes Atmosféricos/análisis , Agroquímicos , Nitrógeno
8.
J Am Chem Soc ; 144(27): 11969-11974, 2022 Jul 13.
Artículo en Inglés | MEDLINE | ID: mdl-35775201

RESUMEN

The development of materials showing rapid proton conduction with a low activation energy and stable performance over a wide temperature range is an important and challenging line of research. Here, we report confinement of sulfuric acid within porous MFM-300(Cr) to give MFM-300(Cr)·SO4(H3O)2, which exhibits a record-low activation energy of 0.04 eV, resulting in stable proton conductivity between 25 and 80 °C of >10-2 S cm-1. In situ synchrotron X-ray powder diffraction (SXPD), neutron powder diffraction (NPD), quasielastic neutron scattering (QENS), and molecular dynamics (MD) simulation reveal the pathways of proton transport and the molecular mechanism of proton diffusion within the pores. Confined sulfuric acid species together with adsorbed water molecules play a critical role in promoting the proton transfer through this robust network to afford a material in which proton conductivity is almost temperature-independent.

9.
Nat Mater ; 20(1): 84-92, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32839589

RESUMEN

Ni-rich layered cathode materials are among the most promising candidates for high-energy-density Li-ion batteries, yet their degradation mechanisms are still poorly understood. We report a structure-driven degradation mechanism for NMC811 (LiNi0.8Mn0.1Co0.1O2), in which a proportion of the material exhibits a lowered accessible state of charge at the end of charging after repetitive cycling and becomes fatigued. Operando synchrotron long-duration X-ray diffraction enabled by a laser-thinned coin cell shows the emergence and growth in the concentration of this fatigued phase with cycle number. This degradation is structure driven and is not solely due to kinetic limitations or intergranular cracking: no bulk phase transformations, no increase in Li/Ni antisite mixing and no notable changes in the local structure or Li-ion mobility of the bulk are seen in aged NMCs. Instead, we propose that this degradation stems from the high interfacial lattice strain between the reconstructed surface and the bulk layered structure that develops when the latter is at states of charge above a distinct threshold of approximately 75%. This mechanism is expected to be universal in Ni-rich layered cathodes. Our findings provide fundamental insights into strategies to help mitigate this degradation process.

10.
Chemistry ; 28(50): e202201659, 2022 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-35726763

RESUMEN

The development of cost-effective sorbents for direct capture of trace CO2 (<1 %) from the atmosphere is an important and challenging task. Natural or commercial zeolites are promising sorbents, but their performance in adsorption of trace CO2 has been poorly explored to date. A systematic study on capture of trace CO2 by commercial faujasite zeolites reveals that the extra-framework cations play a key role on their performance. Under dry conditions, Ba-X displays high dynamic uptake of 1.79 and 0.69 mmol g-1 at CO2 concentrations of 10000 and 1000 ppm, respectively, and shows excellent recyclability in the temperature-swing adsorption processes. K-X exhibits perfect moisture resistance, and >95 % dry CO2 uptake can be preserved under relative humidity of 74 %. In situ solid-state NMR spectroscopy, synchrotron X-ray diffraction and neutron diffraction reveal two binding sites for CO2 in these zeolites, namely the basic framework oxygen atoms and the divalent alkaline earth metal ions. This study unlocks the potential of low-cost natural zeolites for applications in direct air capture.

11.
J Theor Biol ; 554: 111274, 2022 12 07.
Artículo en Inglés | MEDLINE | ID: mdl-36116525

RESUMEN

Understanding and predicting critical transitions in spatially explicit ecological systems is particularly challenging due to their complex spatial and temporal dynamics and high dimensionality. Here, we explore changes in population distribution patterns during a critical transition (an extinction event) using computational topology. Computational topology allows us to quantify certain features of a population distribution pattern, such as the level of fragmentation. We create population distribution patterns via a simple coupled patch model with Ricker map growth and nearest neighbors dispersal on a two dimensional lattice. We observe two dominant paths to extinction within the explored parameter space that depend critically on the dispersal rate d and the rate of parameter drift, Δϵ. These paths to extinction are easily topologically distinguishable, so categorization can be automated. We use this population model as a theoretical proof-of-concept for the methodology, and argue that computational topology is a powerful tool for analyzing dynamical changes in systems with noisy data that are coarsely resolved in space and/or time. In addition, computational topology can provide early warning signals for chaotic dynamical systems where traditional statistical early warning signals would fail. For these reasons, we envision this work as a helpful addition to the critical transitions prediction toolbox.


Asunto(s)
Ecosistema , Modelos Biológicos , Dinámica Poblacional
12.
Cult Health Sex ; 24(9): 1168-1180, 2022 09.
Artículo en Inglés | MEDLINE | ID: mdl-34236291

RESUMEN

Compelling evidence from three randomised controlled trials, which showed that voluntary medical male circumcision (VMMC) reduces HIV acquisition from women to men by up to 60%, led to WHO recommending that VMMC be implemented in 14 priority countries. As one of the priority countries, Eswatini aimed to reach 80% VMMC coverage among boys and men aged 10-49 years since programme inception in 2009. By the end of 2019, however, the country had reached a modest 40%. VMMC is intrinsically tied to perceptions of masculinity and male gender identity. Comprehending the role of context-specific masculinity as it relates to VMMC may contribute to our understanding of community attitudes towards VMMC and men's decision-making. Drawing on focus group discussion data, this study aimed to explore the linkage between sexuality, masculinity and health interventions within Eswatini. Using critical discourse analysis, the study identified two discourses: sexuality, masculinity and circumcision, and income, masculinity, and circumcision. In the first discourse, participants constructed discursive linkages between circumcision as an adult and loss of penile sensitivity, decreased libido and sexual performance, and adverse events. The second discourse, income, masculinity, and circumcision located circumcision within the social and material realities faced by Swazi men, gender norms and provision within family structures.


Asunto(s)
Circuncisión Masculina , Infecciones por VIH , Adulto , Esuatini , Femenino , Infecciones por VIH/prevención & control , Humanos , Masculino , Masculinidad , Conducta Sexual
13.
Br J Community Nurs ; 27(3): 108-112, 2022 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-35274972

RESUMEN

The economic value of community nursing is not well understood, meaning it can be a challenge to make the case for investment in the service. The breadth of the service is so vast that it can be difficult to define all the activity and measure the outcomes achieved, which is essential to assess value. A roundtable, hosted by the Healthcare Financial Management Association, considered the challenge of measuring economic value in community nursing, to identify where further work is needed. Community nursing has a key role to play in the development of integrated care systems, as it demonstrates the integration of services at a patient level. Assessment of value needs to recognise the part that the service should play in an integrated care system. However, investment and cultural change is needed within community nursing to ensure activity data is recorded accurately to enable value to be assessed.

14.
Angew Chem Int Ed Engl ; 61(27): e202204500, 2022 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-35471635

RESUMEN

Zeolites have found tremendous applications in the chemical industry. However, the dynamic nature of their active sites under the flow of adsorbate molecules for adsorption and catalysis is unclear, especially in operando conditions, which could be different from the as-synthesized structures. In the present study, we report a structural transformation of the adsorptive active sites in SAPO-34 zeolite by using acetone as a probe molecule under various temperatures. The combination of solid-state nuclear magnetic resonance, in situ variable-temperature synchrotron X-ray diffraction, and in situ diffuse-reflectance infrared Fourier-transform spectroscopy allow a clear identification and quantification that the chemisorption of acetone can convert the classical Brønsted acid site adsorption mode to an induced Frustrated Lewis Pairs adsorption mode at increasing temperatures. Such facile conversion is also supported by the calculations of ab-initio molecular-dynamics simulations. This work sheds new light on the importance of the dynamic structural alteration of active sites in zeolites with adsorbates at elevated temperatures.

15.
Angew Chem Int Ed Engl ; 61(36): e202207259, 2022 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-35735124

RESUMEN

We report reversible high capacity adsorption of SO2 in robust Zr-based metal-organic framework (MOF) materials. Zr-bptc (H4 bptc=biphenyl-3,3',5,5'-tetracarboxylic acid) shows a high SO2 uptake of 6.2 mmol g-1 at 0.1 bar and 298 K, reflecting excellent capture capability and removal of SO2 at low concentration (2500 ppm). Dynamic breakthrough experiments confirm that the introduction of amine, atomically-dispersed CuII or heteroatomic sulphur sites into the pores enhance the capture of SO2 at low concentrations. The captured SO2 can be converted quantitatively to a pharmaceutical intermediate, aryl N-aminosulfonamide, thus converting waste to chemical values. In situ X-ray diffraction, infrared micro-spectroscopy and inelastic neutron scattering enable the visualisation of the binding domains of adsorbed SO2 molecules and host-guest binding dynamics in these materials at the atomic level. Refinement of the pore environment plays a critical role in designing efficient sorbent materials.

16.
J Am Chem Soc ; 143(8): 3205-3218, 2021 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-33596070

RESUMEN

Understanding structural responses of metal-organic frameworks (MOFs) to external stimuli such as the inclusion of guest molecules and temperature/pressure has gained increasing attention in many applications, for example, manipulation and manifesto smart materials for gas storage, energy storage, controlled drug delivery, tunable mechanical properties, and molecular sensing, to name but a few. Herein, neutron and synchrotron diffractions along with Rietveld refinement and density functional theory calculations have been used to elucidate the responsive adsorption behaviors of defect-rich Zr-based MOFs upon the progressive incorporation of ammonia (NH3) and variable temperature. UiO-67 and UiO-bpydc containing biphenyl dicarboxylate and bipyridine dicarboxylate linkers, respectively, were selected, and the results establish the paramount influence of the functional linkers on their NH3 affinity, which leads to stimulus-tailoring properties such as gate-controlled porosity by dynamic linker flipping, disorder, and structural rigidity. Despite their structural similarities, we show for the first time the dramatic alteration of NH3 adsorption profiles when the phenyl groups are replaced by the bipyridine in the organic linker. These molecular controls stem from controlling the degree of H-bonding networks/distortions between the bipyridine scaffold and the adsorbed NH3 without significant change in pore volume and unit cell parameters. Temperature-dependent neutron diffraction also reveals the NH3-induced rotational motions of the organic linkers. We also demonstrate that the degree of structural flexibility of the functional linkers can critically be affected by the type and quantity of the small guest molecules. This strikes a delicate control in material properties at the molecular level.

17.
J Am Chem Soc ; 143(23): 8761-8771, 2021 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-34076425

RESUMEN

There has been a long debate on how and where active sites are created for molecular adsorption and catalysis in zeolites, which underpin many important industrial applications. It is well accepted that Lewis acidic sites (LASs) and basic sites (LBSs) as active sites in pristine zeolites are generally believed to be the extra-framework Al species and residue anion (OH-) species formed at fixed crystallographic positions after their synthesis. However, the dynamic interactions of adsorbates/reactants with pristine zeotype materials to "create" sites during real conditions remain largely unexplored. Herein, direct experimental observation of the establishment of induced active sites in silicoaluminophosphate (SAPO) by an adsorbate is for the first time made, which contradicts the traditional view of the fixed active sites in zeotype materials. Evidence shows that an induced frustrated Lewis pair (FLP, three-coordinated framework Al as LAS and SiO (H) as LBS) can be transiently favored for heterolytic molecular binding/reactions of competitive polar adsorbates due to their ineffective orbital overlap in the rigid framework. High-resolution magic-angle-spinning solid-state NMR, synchrotron X-ray diffraction, neutron powder diffraction, in situ diffuse reflectance infrared Fourier transform spectroscopy, and ab initio molecular dynamics demonstrate the transformation of a typical Brønsted acid site (Al(OH)Si) in SAPO zeolites to new induced FLP structure for hetereolytic binding upon adsorption of a strong polar adsorbate. Our unprecedented finding opens up a new avenue to understanding the dynamic establishment of active sites for adsorption or chemical reactions under molecular bombardment of zeolitic structures.

18.
J Am Chem Soc ; 143(37): 15440-15452, 2021 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-34478267

RESUMEN

Neutral ketene is a crucial intermediate during zeolite carbonylation reactions. In this work, the roles of ketene and its derivates (viz., acylium ion and surface acetyl) associated with direct C-C bond coupling during the carbonylation reaction have been theoretically investigated under realistic reaction conditions and further validated by synchrotron radiation X-ray diffraction (SR-XRD) and Fourier transformed infrared (FT-IR) studies. It has been demonstrated that the zeolite confinement effect has significant influence on the formation, stability, and further transformation of ketene. Thus, the evolution and the role of reactive and inhibitive intermediates depend strongly on the framework structure and pore architecture of the zeolite catalysts. Inside side pockets of mordenite (MOR), rapid protonation of ketene occurs to form a metastable acylium ion exclusively, which is favorable toward methyl acetate (MA) and acetic acid (AcOH) formation. By contrast, in 12MR channels of MOR, a relatively longer lifetime was observed for ketene, which tends to accelerate deactivation of zeolite due to coke formation by the dimerization of ketene and further dissociation to diene and alkyne. Thus, we resolve, for the first time, a long-standing debate regarding the genuine role of ketene in zeolite catalysis. It is a paradigm to demonstrate the confinement effect on the formation, fate, and catalytic consequence of the active intermediates in zeolite catalysis.

19.
Nanotechnology ; 32(10): 105704, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33242848

RESUMEN

Two-dimensional (2D) hexagonal boron nitride (h-BN) is becoming increasingly interesting for wider engineering applications. Thermal exfoliation is being suggested as a facile technology to produce large quantities of 2D h-BN. Further optimization of the process requires fundamental understanding of the exfoliation mechanism, which is hardly realized by ex situ techniques. In this study, in situ synchrotron x-ray powder diffraction experiments are conducted while heat treating bulk h-BN up to 1273 K. During the heating process, linear expansion of c-axis is observed and the contraction of a-axis up to around 750 K is consistent with previous research. However, a changing behavior from contraction to expansion in a-axis direction is newly observed when heating over 750 K. With the consideration of previous thermally oxidation studies, a hypothesis of thermal assisted exfoliation with oxygen interstitial and substitution of nitrogen at high temperature is proposed.

20.
BMC Health Serv Res ; 21(1): 1176, 2021 Oct 29.
Artículo en Inglés | MEDLINE | ID: mdl-34711236

RESUMEN

BACKGROUND: Mobile HIV testing approaches are a key to reaching the global targets of halting the HIV epidemic by 2030. Importantly, the number of clients reached through mobile HIV testing approaches, need to remain high to maintain the cost-effectiveness of these approaches. Advances in rapid in-vitro tests such as INSTI® HIV-1/HIV-2 (INSTI) which uses flow-through technologies, offer opportunities to reduce the HIV testing time to about one minute. Using data from a routine mobile HTS programme which piloted the use of the INSTI point-of-care (POC) test, we sought to estimate the effect of using a faster test on client testing volumes and the number of people identified to be living with HIV, in comparison with standard of care HIV rapid tests. METHODS: In November 2019, one out of four mobile HTS teams operating in Ekurhuleni District (South Africa) was randomly selected to pilot the field use of INSTI-POC test as an HIV screening test (i.e., the intervention team). We compared the median number of clients tested for HIV and the number of HIV-positive clients by the intervention team with another mobile HTS team (matched on performance and area of operation) which used the standard of care (SOC) HIV screening test (i.e., SOC team). RESULTS: From 19 to 20 December 2019, the intervention team tested 7,403 clients, and the SOC team tested 2,426 clients. The intervention team tested a median of 442 (IQR: 288-522) clients/day; SOC team tested a median of 97 (IQR: 40-187) clients/day (p<0.0001). The intervention team tested about 180 more males/day compared to the SOC team, and the median number of adolescents and young adults tested/day by the intervention team were almost four times the number tested by the SOC team. The intervention team identified a higher number of HIV-positive clients compared to the SOC team (142 vs. 88), although the proportion of HIV-positive clients was lower in the intervention team due to the higher number of clients tested. CONCLUSIONS: This pilot programme provides evidence of high performance and high reach, for men and young people through the use of faster HIV rapid tests, by trained lay counsellors in mobile HTS units.


Asunto(s)
Infecciones por VIH , Sistemas de Atención de Punto , Adolescente , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Prueba de VIH , Humanos , Masculino , Tamizaje Masivo , Pruebas en el Punto de Atención , Sudáfrica/epidemiología , Adulto Joven
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