Simultaneous screening for COVID-19 and tuberculosis, India.

Objective: To evaluate the implementation of new operational workflows for simultaneous screening of coronavirus disease 2019 (COVID-19) and tuberculosis at four high-volume COVID-19 testing centres located in tertiary hospitals in Mumbai, India. Methods: Each centre already offering antigen-detecting rapid diagnostic tests were equipped with a rapid molecular testing platform for COVID-19 and tuberculosis, sufficient laboratory staff, and reagents and consumables for screening. Using a verbal tuberculosis questionnaire, a patient follow-up agent screened individuals visiting the COVID-19 testing centres. Presumptive tuberculosis patients were asked to provide sputum samples for rapid molecular testing. Subsequently, we reversed our operational workflow to also screen patients visiting tuberculosis outpatient departments for COVID-19, using rapid diagnostic tests. Results: From March to December 2021, we screened 14 588 presumptive COVID-19 patients for tuberculosis, of whom 475 (3.3%) were identified as having presumptive tuberculosis. Of these, 288 (60.6%) were tested and 32 individuals (11.1%) were identified as tuberculosis positive (219 cases per 100 000 individuals screened). Of the tuberculosis-positive individuals, three had rifampicin-resistant tuberculosis. Among the remaining 187 presumptive tuberculosis cases not tested, 174 reported no symptoms at follow-up and 13 individuals either refused testing or could not be traced. Of the 671 presumptive tuberculosis cases screened for COVID-19, 17 (2.5%) were positive by antigen rapid diagnostic tests, and five (0.7%) who tested negative, later tested positive on the molecular testing platform (2483 COVID-19 cases per 100 000 individuals screened). Conclusion: Simultaneous screening for COVID-19 and tuberculosis in India is operationally feasible and can improve real-time on-site detection of COVID-19 and tuberculosis.

The impact of casirivimab-imdevimab antibody cocktail in patients amidst and post COVID 19 treatment: A retro-prospective comparative study in India.

BACKGROUND: Monoclonal antibodies have gained attention in developing countries owing to its benefits portrayed by few clinical trials. However, no studies until now have been undergone in India. METHODS: A retro-prospective comparative observational study was conducted in symptomatic COVID19 patients to evaluate the impact of Casirivimab and Imdevimab antibody cocktail in the high-risk population. Through an extensive data retrieval for 6 months, 152 samples were documented and sorted into test (Casirivimab and Imdevimab treated patients, n = 79) and control (Non- Casirivimab and Imdevimab treated individuals, n = 73) subsets. The research had two phases; first, estimation of mechanical ventilation and high flow oxygen requirement and mortality in samples amidst the treatment, and second was the post COVID19 patients' feedback through validated (Cronbach's alpha coefficient = 0.7) questionnaire that evaluated their health and vaccination status, and treatment satisfaction. RESULTS: We noticed lesser requisite for mechanical ventilation (6.3%; p < 0.001), high flow oxygen (5.1%; p < 0.001) and no death during Casirivimab and Imdevimab therapy. Meanwhile, non-vaccinated test groups were not on mechanical ventilation and those fully immunized seldom entailed high flow oxygen (test, 6.3%; control, 41.9%, p < 0.01). On evaluating the post COVID19 status of each patient in the study, 90.1% of the test samples were healthy and 97.2% were satisfied with the treatment than those in control group. CONCLUSIONS: Casirivimab and Imdevimab regimen was clinically beneficial for high risk COVID19 patients than those treated without the antibody cocktail.

Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD): Toward improving the adherence of the patients with drug-sensitive tuberculosis in Nashik, Maharashtra.

Introduction: Adherence to tuberculosis (TB) medication is one of the critical challenges to tuberculosis elimination in India. Digital adherence technologies (DAT) have the potential to facilitate medication adherence and monitor it remotely. Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD) is one such DAT piloted in Nasik, Maharashtra, from April 2020 to December 2021. The study aims to assess the adherence and cost-effectiveness of TMEAD compared to the standard of care among patients with drug-sensitive tuberculosis (DSTB) residing in the urban areas of Nasik, Maharashtra, India. Methods: A quasi-experimental study was conducted among new cases of TB as per the National TB Elimination Programme (NTEP) residing in the urban geography of Nasik. The intervention and control arms were purposively selected from non-contaminating TB units (TUs). A total of 400 DSTB patients (200 in the intervention group and 200 in the control group) were enrolled. After enrolment, patients in the intervention arm were provided with the TMEAD device and followed for 24 weeks to assess treatment outcomes. Adherence was measured as those patients who have completed 80% of prescribed doses, as reported during patient follow-up, and further validated by analyzing the trace of rifampicin in urine among 20% of patients from both arms. A budget impact analysis was done to assess the impact of the TMEAD program on the overall state health budget. Results: Out of 400 enrolled DSTB patients, 261 patients completed treatment, 108 patients were on treatment, 15 patients died, and 16 patients were defaulters over the study period. The study reported overall treatment adherence of 94% among those who completed treatment. Patient reports indicated high levels of treatment adherence in the intervention group (99%) as compared to the control group (90%). Adherence assessed through analyzing trace of rifampicin in the urine sample for the intervention arm was 84% compared to the control arm (80%). Per beneficiary (discounted) cost for TMEAD was Indian rupees (INR) 6,573 (USD 83). The incremental cost-effectiveness ratio of the intervention is INR 11,599 (USD 146), which shows that the intervention is highly cost-effective. Conclusion: This study revealed that patient-reported treatment adherence was high in TMEAD when compared to standard therapy of care for DSTB patients and the intervention is cost-effective. TMEAD could complement the national strategy to end TB by improving adherence to the treatment regimen in India.

War termination and women's political rights.

Does the manner in which a civil war is terminated affect women's political rights developments? In this article, we develop an analytical framework showing how the context of war termination type affects both the opportunity and willingness of warring parties and their openness towards the influence of international actors, thereby making it possible to translate social ruptures and pressures from women's groups into post-war improvements in women's political rights. Studying 205 civil war terminations in 69 countries since 1989, we find support for our claim that a conflict terminated through the negotiation and implementation of a comprehensive peace agreement significantly improved women's political rights in the post-war period when compared to other types of conflict termination. This finding holds after controlling for the women's rights provisions negotiated in the agreement. Our results carry substantial policy relevance by underlining the significance of women's inclusion in peace processes.

Harvesting Social Signals to Inform Peace Processes Implementation and Monitoring.

Peace processes are complex, protracted, and contentious involving significant bargaining and compromising among various societal and political stakeholders. In civil war terminations, it is pertinent to measure the pulse of the nation to ensure that the peace process is responsive to citizens' concerns. Social media yields tremendous power as a tool for dialogue, debate, organization, and mobilization, thereby adding more complexity to the peace process. Using Colombia's final peace agreement and national referendum as a case study, we investigate the influence of two important indicators: intergroup polarization and public sentiment toward the peace process. We present a detailed linguistic analysis to detect intergroup polarization and a predictive model that leverages Tweet structure, content, and user-based features to predict public sentiment toward the Colombian peace process. We demonstrate that had proaccord stakeholders leveraged public opinion from social media, the outcome of the Colombian referendum could have been different.

Who kills whom? The micro-dynamics of civilian targeting in civil war.

Prior research on civilian targeting in civil war has focused on characteristics of either the government or rebel group that make them more or less likely to target civilians. However, no government or rebel group targets a population, but rather individuals within it. To date, no study has explored the issue of why particular civilians would be chosen by one actor versus the other. This study examines the divergent civilian-targeting strategies of governments and rebel groups. We argue that unique identification problems facing each political actor in civil war leads the parties to resort to social stereotypes based on data derived from known enemy subjects killed in combat. We specify and then test a model that accounts for time and space and the demographic characteristics of each victim utilizing a new dataset on the personal, political, and demographic characteristics of individual civilians targeted by the state and rebels in the civil war in Nepal (1996-2006). The findings demonstrate for the first time that governments (and rebels) tend to kill the same types of individuals in non-combat settings as they kill in combat exchanges, and the civilians targeted by each actor differ significantly in the extent that they share certain social traits.

Comprehensive peace agreement implementation and reduction in neonatal, infant and under-5 mortality rates in post-armed conflict states, 1989-2012.

BACKGROUND: Previous studies suggest that countries with a higher child mortality rate are more susceptible to armed conflict onset as well as recurrence. Studies do not explain conditions under which child mortality declines among post-armed conflict states. This article argues that where armed conflict is terminated through negotiation and implementation of comprehensive peace agreements (CPAs), the child mortality rate declines. This is due to the implementation of provisions in CPAs, which addresses underlying grievances of the poor, underserved and marginalized segments of the population, as well as the successful reconstruction of the health sector. CPA implementation resolves hostilities between armed rivals and facilitates the return process for internally displaced persons and refugees. The CPA implementation may also encourage the return of aid workers and health professionals to conflict-affected zones. METHOD: This study utilizes new data on CPA implementation and examines neonatal, infant and under-5 mortality rates among 73 post-armed conflict countries between 1989 and 2012. Multivariate cross-sectional time series correlation (fixed effect) methods are used to analyze the data. RESULTS: Within post-armed conflict states, a decline in neonatal, infant and under-5 mortality rates is associated with higher CPA implementation rates. Additionally, this study shows that higher GDP per capita, higher levels of democracy, and more primary school enrollment are also associated with lower child mortality rates. On the other hand, child mortality rates increase following a rebel victory in armed conflict. CONCLUSION: Ongoing armed conflicts are responsible for massive displacements and the destruction of economic, healthcare and human infrastructure, thus hindering improvements in child survival. For better health outcomes in post-armed conflict countries, ongoing armed conflict must cease through the signing and implementation of a CPA. Short-term and long-term public health issues are discussed in concluding comments.