Population-Level Effectiveness of an Inactivated Whole-Virion COVID-19 Vaccine: A Test Negative Case-Control Study in the Dominican Republic.

Background: A continuing nationwide vaccination campaign began in the Dominican Republic on February 16, 2021 to prevent severe consequences of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Estimates of vaccine effectiveness under real-world conditions are needed to support policy decision making and inform further vaccine selection. Methods: We conducted a test-negative case-control study to assess the real-world effectiveness of nationwide coronavirus disease 2019 (COVID-19) vaccination program using an inactivated vaccine (CoronaVac) on preventing symptomatic SARS-CoV-2 infections and hospitalizations from August to November 2021 in the Dominican Republic. Participants were recruited from 10 hospitals in 5 provinces to estimate the effectiveness of full immunization (≥14 days after receipt of the second dose) and partial immunization (otherwise with at least 1 dose ≥14 days after receipt of the first dose). Results: Of 1078 adult participants seeking medical care for COVID-19-related symptoms, 395 (36.6%) had positive polymerase chain reaction (PCR) tests for SARS-CoV-2; 142 (13.2%) were hospitalized during 15 days of follow up, including 91 (23%) among 395 PCR-positive and 51 (7.5%) among 683 PCR-negative participants. Full vaccination was associated with 31% lower odds of symptomatic infection (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.52-0.93) and partial vaccination was associated with 49% lower odds (OR, 0.51; CI, 0.30-0.86). Among 395 PCR-positive participants, full vaccination reduced the odds of COVID-19-related hospitalization by 85% (OR, 0.15; 95% CI, 0.08-0.25) and partial vaccination reduced it by 75% (OR, 0.25; 95% CI, 0.08-0.80); full vaccination was associated with reduced use of assisted ventilation by 73% (OR, 0.27; 95% CI, 0.15-0.49). Conclusions: Given the ancestral and delta viral variants circulating during this study period, our results suggest that the inactivated COVID-19 vaccine offered moderate protection against symptomatic SARS-CoV-2 infections and high protection against COVID-19-related hospitalizations and assisted ventilation. This is reassuring given that, as of August 2022, an estimated 2.6 billion inactivated CoronaVac vaccine doses had been administered worldwide. This vaccine will become a basis for developing multivalent vaccine against the currently circulating omicron variant.

Age-dependent impairment in antibody responses elicited by a homologous CoronaVac booster dose.

The emergence of the SARS-CoV-2 Omicron sublineages resulted in increased transmission rates and reduced protection from vaccines. To counteract these effects, multiple booster strategies were used in different countries, although data comparing their efficiency in improving protective immunity remain sparse, especially among vulnerable populations, including older adults. The inactivated CoronaVac vaccine was among the most widely distributed vaccine worldwide and was essential in the early control of SARS-CoV-2-related hospitalizations and deaths. However, it is not well understood whether homologous versus heterologous booster doses in those fully vaccinated with CoronaVac induce distinct humoral responses or whether these responses vary across age groups. We analyzed plasma antibody responses from CoronaVac-vaccinated younger or older individuals who received a homologous CoronaVac or heterologous BNT162b2 or ChAdOx1 booster vaccine. All three evaluated boosters resulted in increased virus-specific IgG titers 28 days after the booster dose. However, we found that both IgG titers against SARS-CoV-2 Spike or RBD and neutralization titers against Omicron sublineages were substantially reduced in participants who received homologous CoronaVac compared with the heterologous BNT162b2 or ChAdOx1 booster. This effect was specifically prominent in recipients >50 years of age. In this group, the CoronaVac booster induced low virus-specific IgG titers and failed to elevate neutralization titers against any Omicron sublineage. Our results point to the notable inefficiency of CoronaVac immunization and boosting in mounting protective antiviral humoral immunity, particularly among older adults, during the Omicron wave. These observations also point to benefits of heterologous regimens in high-risk populations fully vaccinated with CoronaVac.

Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic: a qualitative study.

BACKGROUND: Good governance and regulatory supervision are required to conduct research in an international public health emergency context and to ensure compliance with ethical standards. The "Strengthening research ethics governance and regulatory oversight in Central America and the Dominican Republic in response to the COVID-19 pandemic" study is a regional effort in which research ethics stakeholders participated in addressing research ethics governance and preparedness response challenges to the COVID-19 pandemic in Central America and the Dominican Republic. METHODS: A qualitative action research study was conducted following a participatory approach. Research ethics stakeholders in Central America and the Dominican Republic were mapped; a regional webinar and three virtual workshops were conducted discussing research ethics governance, ethics review and collaborative research practice during the pandemic. A roundtable session presented results and obtained feedback on a draft of a policy to strengthen regional research ethics governance. RESULTS: Countries across Central America and the Dominican Republic are at different stages in their development of research ethics systems. Countries with more established systems before COVID-19 were better organized and prepared to respond. This finding argues against improvisation and supports further work on strengthening governance of research ethics systems. Community engagement in research ethics public policy-making is practically absent in the region. Research and research ethics collaboration schemes are lacking amongst the countries; however, there are incipient initiatives in the region, such as the Central America and Caribbean Network of Research Ethics Committees. A policy brief with recommendations on how to advance towards strengthening the governance of research ethics systems was prepared and submitted to the Central American Integration System for analysis and possible approval. CONCLUSION: National research ethics systems in Central America and the Dominican Republic were unprepared to respond to the COVID-19 pandemic with respect to research oversight and effective collaboration. In most cases, national research ethics systems were found to be weak, and regional research collaboration was practically absent. To promote collaboration, a joint strategy needs to be developed with a regional vision towards sharing knowledge and best practices.

Diagnosis of paediatric tuberculosis by optically detecting two virulence factors on extracellular vesicles in blood samples.

Sensitive and specific blood-based assays for the detection of pulmonary and extrapulmonary tuberculosis would reduce mortality associated with missed diagnoses, particularly in children. Here we report a nanoparticle-enhanced immunoassay read by dark-field microscopy that detects two Mycobacterium tuberculosis virulence factors (the glycolipid lipoarabinomannan and its carrier protein) on the surface of circulating extracellular vesicles. In a cohort study of 147 hospitalized and severely immunosuppressed children living with HIV, the assay detected 58 of the 78 (74%) cases of paediatric tuberculosis, 48 of the 66 (73%) cases that were missed by microbiological assays, and 8 out of 10 (80%) cases undiagnosed during the study. It also distinguished tuberculosis from latent-tuberculosis infections in non-human primates. We adapted the assay to make it portable and operable by a smartphone. With further development, the assay may facilitate the detection of tuberculosis at the point of care, particularly in resource-limited settings.

No evidence of fetal defects or anti-syncytin-1 antibody induction following COVID-19 mRNA vaccination.

The impact of Coronavirus Disease 2019 (COVID-19) mRNA vaccination on pregnancy and fertility has become a major topic of public interest. We investigated 2 of the most widely propagated claims to determine (1) whether COVID-19 mRNA vaccination of mice during early pregnancy is associated with an increased incidence of birth defects or growth abnormalities; and (2) whether COVID-19 mRNA-vaccinated human volunteers exhibit elevated levels of antibodies to the human placental protein syncytin-1. Using a mouse model, we found that intramuscular COVID-19 mRNA vaccination during early pregnancy at gestational age E7.5 did not lead to differences in fetal size by crown-rump length or weight at term, nor did we observe any gross birth defects. In contrast, injection of the TLR3 agonist and double-stranded RNA mimic polyinosinic-polycytidylic acid, or poly(I:C), impacted growth in utero leading to reduced fetal size. No overt maternal illness following either vaccination or poly(I:C) exposure was observed. We also found that term fetuses from these murine pregnancies vaccinated prior to the formation of the definitive placenta exhibit high circulating levels of anti-spike and anti-receptor-binding domain (anti-RBD) antibodies to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) consistent with maternal antibody status, indicating transplacental transfer in the later stages of pregnancy after early immunization. Finally, we did not detect increased levels of circulating anti-syncytin-1 antibodies in a cohort of COVID-19 vaccinated adults compared to unvaccinated adults by ELISA. Our findings contradict popular claims associating COVID-19 mRNA vaccination with infertility and adverse neonatal outcomes.

Economic analysis of an educational human security model in southwestern bateyes of the Dominican Republic / Análisis económico de un modelo educativo de seguridad humana en los bateyes del suroeste de la República Dominicana

Objetivos: realizar un análisis económico para evaluar los costos de una intervención educativa, utilizando los principios de un modelo de seguridad humana en Bateyes del suroeste de la República Dominicana. Métodos: se consideraron cuatro recursos de intervención, incluyendo la capacitación del personal, los incentivos mensuales, la supervisión de las actividades de campo y el costo total asociado al tratamiento anual de la diarrea aguda. El gasto se comparó entre el programa estándar de atención (Batey Control) y la intervención con el modelo de seguridad humana (Batey Caso). Resultados: el ahorro del costo total anual para el Ministerio de Salud de República Dominicana asociado con la reducción de la incidencia de episodios de diarrea aguda fue de US$252,399. Si se extrapolan a los 300 Bateyes de República Dominicana, se podría ahorrar aproximadamente US$75 millones en prevención de enfermedades infecciosas. Conclusiones: el modelo de seguridad humana luce ser un método eficaz para mejorar el conocimiento sobre la prevención de enfermedades y aumentar el empoderamiento de la comunidad para la movilización de recursos. Aplicada a otros entornos, la intervención podría tener una incidencia beneficiosa en las poblaciones de refugiados e indocumentados bajo el impacto de la violencia estructural.

Objectives: To conduct an economic analysis to evaluate the costs of an educational intervention, using the human security model, and potential sources of economic benefits, in Southwestern Bateyes in the Dominican Republic. Methods: Four intervention resources were considered, including staff training, monthly incentives, supervision of field activities, and total cost associated with annual treatment for acute diarrhea. The expenditure was compared between the standard program of care and the intervention using the human security model. Results: The total annual cost saving to the Dominican Republic Ministry of Health, associated with reducing the incidence of acute diarrhea episodes, was US$252,399. If this is extrapolated to the 300 Bateyes of the Dominican Republic, the Ministry of Health could save approximately US$75 million in infectious disease prevention by implementing this intervention model in these isolated rural communities. Conclusions: The educational intervention, which incorporated a human security approach, appeared to be an effective method to enhance knowledge about disease prevention and to increase empathy among community members for resource mobilization and local empowerment. Applied to other settings, the intervention could have a beneficial impact on refugee and undocumented populations under the

Perceptions of Occupational Cancer Risk and Prevention Among Dominican Republic Firefighters: A Qualitative Study.

OBJECTIVES: Characterize occupational cancer risk perceptions and attitudes toward cancer prevention practices among firefighters in the Dominican Republic. METHODS: Focus group discussions and key informant interviews were conducted in June 2019 among firefighters from three fire departments. Themes were inductively created using a qualitative descriptive approach. RESULTS: Thirty-seven firefighters were interviewed with a group mean age of 36.2 ±â€Š10.3 years, of which 97.3% were male, and 37.1% worked at least 10 years. Six themes emerged: 1) availability of personal protective equipment (PPE); 2) toxic exposure during fire suppression; 3) work-related stress; 4) lack of workplace health promotion activities; 5) Dominican culture impacts medical checkups; and 6) expensive medical copays limits healthcare access. CONCLUSION: Dominican firefighters are willing to adopt cancer prevention practices, however organizational barriers (ie, PPE availability, cultural barriers, and health promotion practices) limit engagement.

Neutralizing antibodies against the SARS-CoV-2 Delta and Omicron variants following heterologous CoronaVac plus BNT162b2 booster vaccination.

The recent emergence of the SARS-CoV-2 Omicron variant is raising concerns because of its increased transmissibility and its numerous spike mutations, which have the potential to evade neutralizing antibodies elicited by COVID-19 vaccines. Here we evaluated the effects of a heterologous BNT162b2 mRNA vaccine booster on the humoral immunity of participants who had received a two-dose regimen of CoronaVac, an inactivated vaccine used globally. We found that a heterologous CoronaVac prime vaccination of two doses followed by a BNT162b2 booster induces elevated virus-specific antibody levels and potent neutralization activity against the ancestral virus and the Delta variant, resembling the titers obtained after two doses of mRNA vaccines. Although neutralization of Omicron was undetectable in participants who had received a two-dose regimen of CoronaVac, the BNT162b2 booster resulted in a 1.4-fold increase in neutralization activity against Omicron compared with the two-dose mRNA vaccine. Despite this increase, neutralizing antibody titers were reduced by 7.1-fold and 3.6-fold for Omicron compared with the ancestral strain and the Delta variant, respectively. These findings have immediate implications for multiple countries that previously used a CoronaVac regimen and reinforce the idea that the Omicron variant is associated with immune escape from vaccines or infection-induced immunity, highlighting the global need for vaccine boosters to combat the impact of emerging variants.

Objective Measurement of Carcinogens Among Dominican Republic Firefighters Using Silicone-Based Wristbands.

OBJECTIVE: Characterize objective measurements of carcinogenic exposure using passive sampling silicone-based wristbands among Dominican firefighters. METHODS: Firefighters from a metropolitan fire service in the Dominican Republic were asked to wear a silicone-based wristband during one typical 24-hour shift. A pre- and post-shift survey collected work shift characteristics. Wristbands were processed for the type and quantity of polycyclic aromatic hydrocarbons (PAHs), a family of known carcinogenic compounds. RESULTS: Fifteen firefighters wore a wristband, of which 73.3% responded to a fire with an average of 3.7 calls during the shift. Total PAH exposure was significantly higher among firefighters who responded to a fire versus firefighters with no fire during their shift (261 parts per billion [ppb] vs 117 ppb, P = 0.003). CONCLUSIONS: Silicone-based wristbands as objective passive samplers documented exposure to carcinogenic compounds during a typical 24-hour firefighter shift.

Health care workers’ recommendations for strengthening tuberculosis infection control in the Dominican Republic

[ABSTRACT]. Objective. To describe health care workers’ practical recommendations for strengthening adherence to Mycobacterium tuberculosis infection control practices in their health institutions and elsewhere across the Dominican Republic. Methods. In this qualitative study, 10 focus groups, with a total of 40 clinicians (24 physicians, 16 nurses), were conducted in 2016 at two tertiary-level institutions in the Dominican Republic. Grounded theory guided the analysis to expand on health care workers’ recommendations for empowering clinicians to adhere to M. tuberculosis infection control practices. To ensure reliability and validity, the authors analyzed data and incorporated both peer debriefing with qualitative experts and participant feedback or validation on the final themes. Results. Six emerging themes were described: 1) education and training; 2) administrative policy; 3) infrastructure policy; 4) economic allocations; 5) research; and 6) public health policy. Conclusions. Future efforts may combine the health care workers’ recommendations with evidence-based strategies in M. tuberculosis infection control in low-resource settings. This could pave the way for interventions that empower health care workers in their application of M. tuberculosis infection control measures in clinical practice.

[RESUMEN]. Objetivo. Definir las recomendaciones prácticas de los trabajadores de salud para consolidar la adhesión a las prácticas de control de la infección por Mycobacterium tuberculosis en instituciones de salud y otros lugares de la República Dominicana. Métodos. En este estudio cualitativo, se organizaron 10 grupos de debate, con un total de 40 trabajadores clínicos (24 médicos, 16 enfermeras), en dos instituciones de nivel terciario de la República Dominicana en el 2016. El análisis para ampliar las recomendaciones de los trabajadores de salud a fin de estimular a los trabajadores clínicos a adherirse a las prácticas de control de la infección por M. tuberculosis se basó en teoría fundamentada. Para garantizar la fiabilidad y validez de los resultados, los autores analizaron los datos e incorporaron el asesoramiento sobre el diseño y el análisis del estudio a cargo de expertos cualitativos y la verificación de la información con los participantes sobre los temas finales. Resultados. Se encontraron seis temas emergentes: 1) educación y capacitación; 2) política administrativa; 3) política de infraestructura; 4) asignaciones económicas; 5) investigación; y 6) política de salud pública. Conclusiones. En iniciativas futuras para el control de la infección por M. tuberculosis en entornos de escasos recursos, se pueden combinar las recomendaciones de los trabajadores de salud con estrategias basadas en evidencia. De esta forma se podría allanar el camino para llevar a cabo intervenciones que ayuden a los trabajadores de salud a aplicar las medidas de control de la infección por M. tuberculosis en la práctica clínica.

[RESUMO]. Objetivo. Descrever as recomendações dos profissionais da saúde para reforçar a adesão às práticas de controle de infecção por Mycobacterium tuberculosis nas instituições de saúde e outros locais na República Dominicana. Métodos. Estudo qualitativo realizado com 10 grupos de discussão, ao todo 40 profissionais da área clínica (24 médicos, 16 enfermeiros), em duas instituições de nível terciário na República Dominicana em 2016. A análise foi baseada em teoria fundamentada para expandir as recomendações dos profissionais da saúde a fim de habilitar o pessoal da área clínica a aderir às práticas de controle da infecção por M. tuberculosis. Para assegurar a confiabilidade e a validade dos dados, os autores analisaram as informações e incluíram um processo de revisão com especialistas em pesquisa qualitativa (peer debriefing) e observações ou validação dos participantes sobre os temas finais. Resultados. Seis temas emergentes foram descritos: 1) educação e capacitação, 2) política administrativa, 3) política de infraestrutura, 4) alocações financeiras, 5) pesquisa e 6) política de saúde pública. Conclusões. Iniciativas futuras podem combinar as recomendações dos profissionais da saúde com estratégias baseadas em evidências para o controle de infecção por M. tuberculosis em locais com poucos recursos. Isso poderia abrir o caminho para intervenções que habilitam os profissionais da saúde a empregar medidas de controle de infecção por M. tuberculosis na prática clínica.

Health care workers' recommendations for strengthening tuberculosis infection control in the Dominican Republic.

OBJECTIVE: To describe health care workers' practical recommendations for strengthening adherence to Mycobacterium tuberculosis infection control practices in their health institutions and elsewhere across the Dominican Republic. METHODS: In this qualitative study, 10 focus groups, with a total of 40 clinicians (24 physicians, 16 nurses), were conducted in 2016 at two tertiary-level institutions in the Dominican Republic. Grounded theory guided the analysis to expand on health care workers' recommendations for empowering clinicians to adhere to M. tuberculosis infection control practices. To ensure reliability and validity, the authors analyzed data and incorporated both peer debriefing with qualitative experts and participant feedback or validation on the final themes. RESULTS: Six emerging themes were described: 1) education and training; 2) administrative policy; 3) infrastructure policy; 4) economic allocations; 5) research; and 6) public health policy. CONCLUSIONS: Future efforts may combine the health care workers' recommendations with evidence-based strategies in M. tuberculosis infection control in low-resource settings. This could pave the way for interventions that empower health care workers in their application of M. tuberculosis infection control measures in clinical practice.

Health care workers' recommendations for strengthening tuberculosis infection control in the Dominican Republic / Recomendaciones de los trabajadores de salud para fortalecer el control del contagio de la tuberculosis en la República Dominicana / Recomendações dos profissionais da saúde para reforçar o controle de infecção pelo bacilo da tuberculose na República Dominicana

ABSTRACT Objective To describe health care workers' practical recommendations for strengthening adherence to Mycobacterium tuberculosis infection control practices in their health institutions and elsewhere across the Dominican Republic. Methods In this qualitative study, 10 focus groups, with a total of 40 clinicians (24 physicians, 16 nurses), were conducted in 2016 at two tertiary-level institutions in the Dominican Republic. Grounded theory guided the analysis to expand on health care workers' recommendations for empowering clinicians to adhere to M. tuberculosis infection control practices. To ensure reliability and validity, the authors analyzed data and incorporated both peer debriefing with qualitative experts and participant feedback or validation on the final themes. Results Six emerging themes were described: 1) education and training; 2) administrative policy; 3) infrastructure policy; 4) economic allocations; 5) research; and 6) public health policy. Conclusions Future efforts may combine the health care workers' recommendations with evidence-based strategies in M. tuberculosis infection control in low-resource settings. This could pave the way for interventions that empower health care workers in their application of M. tuberculosis infection control measures in clinical practice.

RESUMEN Objetivo Definir las recomendaciones prácticas de los trabajadores de salud para consolidar la adhesión a las prácticas de control de la infección por Mycobacterium tuberculosis en instituciones de salud y otros lugares de la República Dominicana. Métodos En este estudio cualitativo, se organizaron 10 grupos de debate, con un total de 40 trabajadores clínicos (24 médicos, 16 enfermeras), en dos instituciones de nivel terciario de la República Dominicana en el 2016. El análisis para ampliar las recomendaciones de los trabajadores de salud a fin de estimular a los trabajadores clínicos a adherirse a las prácticas de control de la infección por M. tuberculosis se basó en teoría fundamentada. Para garantizar la fiabilidad y validez de los resultados, los autores analizaron los datos e incorporaron el asesoramiento sobre el diseño y el análisis del estudio a cargo de expertos cualitativos y la verificación de la información con los participantes sobre los temas finales. Resultados Se encontraron seis temas emergentes: 1) educación y capacitación; 2) política administrativa; 3) política de infraestructura; 4) asignaciones económicas; 5) investigación; y 6) política de salud pública. Conclusiones En iniciativas futuras para el control de la infección por M. tuberculosis en entornos de escasos recursos, se pueden combinar las recomendaciones de los trabajadores de salud con estrategias basadas en evidencia. De esta forma se podría allanar el camino para llevar a cabo intervenciones que ayuden a los trabajadores de salud a aplicar las medidas de control de la infección por M. tuberculosis en la práctica clínica.

RESUMO Objetivo Descrever as recomendações dos profissionais da saúde para reforçar a adesão às práticas de controle de infecção por Mycobacterium tuberculosis nas instituições de saúde e outros locais na República Dominicana. Métodos Estudo qualitativo realizado com 10 grupos de discussão, ao todo 40 profissionais da área clínica (24 médicos, 16 enfermeiros), em duas instituições de nível terciário na República Dominicana em 2016. A análise foi baseada em teoria fundamentada para expandir as recomendações dos profissionais da saúde a fim de habilitar o pessoal da área clínica a aderir às práticas de controle da infecção por M. tuberculosis. Para assegurar a confiabilidade e a validade dos dados, os autores analisaram as informações e incluíram um processo de revisão com especialistas em pesquisa qualitativa (peer debriefing) e observações ou validação dos participantes sobre os temas finais. Resultados Seis temas emergentes foram descritos: 1) educação e capacitação, 2) política administrativa, 3) política de infraestrutura, 4) alocações financeiras, 5) pesquisa e 6) política de saúde pública. Conclusões Iniciativas futuras podem combinar as recomendações dos profissionais da saúde com estratégias baseadas em evidências para o controle de infecção por M. tuberculosis em locais com poucos recursos. Isso poderia abrir o caminho para intervenções que habilitam os profissionais da saúde a empregar medidas de controle de infecção por M. tuberculosis na prática clínica.

Couples HIV counselling and couple relationships in India, Georgia and the Dominican Republic.

BACKGROUND: Couples HIV counseling and testing is essential for combination HIV prevention, but its uptake remains very low. We aimed to evaluate factors associated with couples HIV counseling uptake in India, Georgia and the Dominican Republic, as part of the ANRS 12127 Prenahtest intervention trial. METHODS: Pregnant women ≥15 years, attending their first antenatal care (ANC) session between March and September 2009, self-reporting a stable partner, and having received couple-oriented post-test HIV counseling (trial intervention) were included. Individuals and couple characteristics associated with the acceptability of couples HIV counseling were assessed using multivariable logistic regression for each study site. RESULTS: Among 711 women included (232, 240 and 239 in the Dominican Republic, Georgia and India, respectively), the uptake of couples HIV counseling was 9.1% in the Dominican Republic, 13.8% in Georgia and 36.8% in India. The uptake of couples HIV counseling was associated with women having been accompanied by their partner to ANC, and never having used a condom with their partner in the Dominican Republic; with women having been accompanied by their partner to ANC in India; with women having a higher educational level than their partner and having ever discussed HIV with their partner in Georgia. CONCLUSION: Couple HIV counseling uptake was overall low. Strategies adapted to local socio-cultural contexts, aiming at improving women's education level, or tackling gender norms to facilitate the presence of men in reproductive health services, should be considered. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01494961 . Registered December 15, 2011. (Retrospectively registered).

The Role of Powerlessness Among Health Care Workers in Tuberculosis Infection Control.

Due to their occupational exposure in health care settings, health care workers (HCW) have increased risk of Mycobacterium tuberculosis infection. They face challenges to remain up-to-date with evidence-based clinical practices and translate educational information into actions in infection control practices. Our purpose was to examine this "knowledge-action" gap about how HCWs understand their occupational M. tuberculosis risk and use recommended infection control measures in clinical practices in the Dominican Republic (DR). We conducted 10 focus groups with 40 physicians and nurses at two tertiary-level DR institutions. Using grounded theory methods, we developed a theoretical model to describe the decision-making process related to adherence to M. tuberculosis infection control measures in clinical practice. Findings highlight intrinsic and extrinsic factors that influenced the observed knowledge-action gap related to M. tuberculosis infection control practices in two DR health institutions.

Perceived Barriers to Adherence to Tuberculosis Infection Control Measures among Health Care Workers in the Dominican Republic.

INTRODUCTION Health care workers have an increased risk of infection due to occupational Mycobacterium tuberculosis exposure, including multidrug-resistant strains. Health care workers' risk of developing tuberculosis is greater than that of the general population, whether in low-, intermediate- or high-incidence countries. Adherence to infection control measures (administrative controls, environmental controls, and personal respiratory protection) is essential to reduce risk of disease transmission between suspected tuberculosis patients and health care workers, but for different reasons, both objective and subjective, adherence is low. Identifying the causes of low adherence is a prerequisite to effective programming to reduce risk. OBJECTIVE Identify perceived barriers to adherence to tuberculosis infection control measures among health care workers in the Dominican Republic. METHODS During August 2014, a qualitative study was conducted in two tertiary-level hospitals in different regions of the Dominican Republic. A semi-structured interview guide of nine questions was developed, based on the scientific literature and with consensus of clinical experts. Nine semi-structured interviews were conducted with a purposive sample of seven physicians (five men, two women) and two baccalaureate nurses (both women) working in the emergency medicine, internal medicine or nursing departments of those institutions. Question topics included clinical experience of M. tuberculosis infection and disease; knowledge of disease transmission and preventive practices; clinical management strategies; and perceptions of effectiveness of directly observed treatment, short-course, and disease coping strategies. RESULTS Perceived barriers were described as: 1) sense of invincibility of health care workers; 2) personal beliefs of health care workers related to direct patient communication; 3) low provider-to-patient ratios in hospitals; 4) absence of tuberculosis isolation units for patients within hospitals; and 5) limited availability of protective masks for health care workers. CONCLUSIONS Our results highlight that perceived barriers at the individual or institutional level may hinder how health care workers understand and comply with preventive strategies to reduce risk of tuberculosis transmission. Addressing these barriers by strengthening infection control program infrastructure and implementing educational interventions within institutions may reduce risk of nosocomial tuberculosis transmission to health care workers. KEYWORDS Health care providers, infection control, infectious disease transmission, health care associated infection, nosocomial infection, Mycobacterium tuberculosis occupational exposure, occupational health, qualitative research, tuberculosis, Dominican Republic.

Prognostic value of diffusion tensor imaging parameters for Gamma Knife radiosurgery in meningiomas.

OBJECTIVE Diffusion tensor imaging (DTI) parameters are able to differentiate between meningioma subtypes. The hypothesis that there is a correlation between DTI parameters and the change in tumor size after Gamma Knife radiosurgery (GKRS) was analyzed. METHODS DTI parameters were measured using MRI before GKRS in 26 patients with meningiomas. The findings were correlated with the change in tumor size after treatment as measured at the last follow-up (range 12.5-45 months). RESULTS Only those meningiomas that showed the highest fractional anisotropy (FA), the lowest spherical index of the tensor ellipsoid (Cs), and the lowest radial diffusivity (RD) either increased or remained stable in terms of volume, whereas all other meningiomas decreased in volume. The correlation between the DTI parameters (correlation values of -0.81 for FA, 0.75 for Cs, 0.66 for RD, and 0.66 for mean diffusivity) and the rate of volume change per month was significant (p ≤ 0.001). Other factors, including original tumor size, prescription dose, and patient age, did not correlate significantly. CONCLUSIONS Meningiomas that show high FA values-as well as low Cs, low RD, and low mean diffusivity values-do not respond as well to GKRS in comparison with meningiomas with low FA values. This finding might be due to their higher content level of fibrous tissue. In particular, the meningioma with the highest FA value (0.444) considerably increased in volume (by 32.3% after 37 months), whereas the meningioma with the lowest FA value (0.151) showed the highest rate of reduction (3.3% per month) in this study.

Atrophy, focal spinal cord lesions and alterations of diffusion tensor imaging (DTI) parameters in asymptomatic virus carriers and patients suffering from human T-lymphotrophic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP).

In tropical spastic paraparesis, spinal cord atrophy is a well-known finding in magnetic resonance imaging. But in contrast to histological reports, focal lesions of the spinal cord have only been described in imaging reports in exceptional acute cases. Here, we looked for such focal lesions and for alterations of diffusion tensor imaging parameters of the long fibre tracts in the usual case of a long-standing and slowly progressive disease. We examined 10 symptomatic patients, 11 seropositive, but asymptomatic human T-lymphotrophic virus type 1 carriers and 18 seronegative volunteers as controls. Sagittal and transversal T2-weighted images were visually assessed for atrophy and focal cord lesions. The spinal cord cross-sectional areas and the segmental cord volumes were measured at all levels. High-resolution diffusion tensor imaging was performed in sagittal planes from the bregma down to the cervical spine. For tractography and calculation of fractional anisotropy and mean diffusivity, we used manufacturer-provided software. Two-thirds of patients showed focal lesions affecting the antero-lateral columns and in two cases also the dorsal columns. Compared to carriers and volunteers, patients presented a significant spinal cord atrophy and a reduction of fractional anisotropy (p < 0.05), correlating more to duration of symptoms than to clinical impairment. Because our carriers did not show a significant atrophy, focal lesions or a change of diffusion tensor imaging parameters, we need further long-term studies to see if these parameters at some stage may be used as early indicators of spinal cord affection in virus carriers.

Grey matter alterations in patients with Pantothenate Kinase-Associated Neurodegeneration (PKAN).

BACKGROUND: Pantothenate Kinase-Associated Neurodegeneration (PKAN) is a rare heritable disease marked by dystonia and loss of movement control. In contrast to the well-known "Eye-of-the-Tiger" sign affecting the globus pallidus, little is known about other deviations of brain morphology, especially about grey matter changes. METHODS: We investigated 29 patients with PKAN and 29 age-matched healthy controls using Magnet Resonance Imaging and Voxel-Based Morphometry. RESULTS: As compared to controls, children with PKAN showed increased grey matter density in the putamen and nucleus caudatus and adults with PKAN showed increased grey matter density in the ventral part of the anterior cingulate cortex. A multiple regression analysis with dystonia score as predictor showed grey matter reduction in the cerebellum, posterior cingulate cortex, superior parietal lobule, pars triangularis and small frontal and temporal areas and an analysis with age as predictor showed grey matter decreases in the putamen, nucleus caudatus, supplementary motor area and anterior cingulate cortex. CONCLUSIONS: The grey matter increases may be regarded as a secondary phenomenon compensating the increased activity of the motor system due to a reduced inhibitory output of the globus pallidus. With increasing age, the grey matter reduction of cortical midline structures however might contribute to the progression of dystonic symptoms due to loss of this compensatory control.

Aetiology of paediatric pneumonia with effusion in the Dominican Republic and the potential impact of pneumococcal conjugate vaccines.

Pleural effusion is a serious complication of pneumonia, and Streptococcus pneumoniae is a leading cause. We describe the aetiology of pneumonia with effusion among children in the Dominican Republic before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV) in 2013 and the performance characteristics of a rapid immunochromatographic test (ICT) for detecting S. pneumoniae in pleural fluid. From July 2009 to June 2011, we enrolled children <15 years old admitted with pneumonia and pleural effusion to Robert Reid Cabral Children's Hospital, Dominican Republic. Pleural fluid was tested by culture, polymerase chain reaction (PCR) for bacterial (S. pyogenes, S. pneumoniae) and viral (respiratory syncytial virus and human rhinovirus) pathogens, and by ICT for S. pneumoniae. We calculated the performance of ICT and culture compared with PCR. Among 121 cases, the median age was 31 months (range 1 week to 14 years). Pleural fluid culture (n = 121) and PCR testing (n = 112) identified an aetiology in 85 (70.2%) cases, including 62 S. pneumoniae (51.2%) and 19 Staphylococcus aureus (15.7%). The viruses tested were not detected. The most prevalent pneumococcal serotypes were 14 (n = 20), 1 (n = 13), and 3 (n = 12). Serotype coverage of the 10- and 13-valent PCVs would be 70.5% and 95.1%, respectively. The sensitivity of point-of-care ICT was 100% (95% confidence interval [CI] 94.1%-100%), while specificity was 86.3% (95% CI 73.7%-94.3%). S. pneumoniae caused more than half of paediatric pneumonia with effusion cases; introduction of PCV in the Dominican Republic could reduce the burden by 36-49%. ICT is a practical, valid diagnostic tool for clinical care and surveillance in settings with limited laboratory capacity.

Increasing HIV testing among male partners.

OBJECTIVE: Couple-oriented posttest HIV counselling (COC) provides pregnant women with tools and strategies to invite her partner to HIV counselling and testing. We conducted a randomized trial of the efficacy of COC on partner HIV testing in low/medium HIV prevalence settings (Cameroon, Dominican Republic, Georgia, India). METHODS: Pregnant women were randomized to receive standard posttest HIV counselling or COC and followed until 6 months postpartum. Partner HIV testing events were notified by site laboratories, self-reported by women or both combined. Impact of COC on partner HIV testing was measured in intention-to-treat analysis. Socio-behavioural factors associated with partner HIV testing were evaluated using multivariable logistic regression. RESULTS: Among 1943 pregnant women enrolled, partner HIV testing rates (combined indicator) were 24.7% among women from COC group versus 14.3% in standard posttest HIV counselling group in Cameroon [odds ratio (OR) = 2.0 95% CI (1.2-3.1)], 23.1 versus 20.3% in Dominican Republic [OR = 1.2 (0.8-1.8)], 26.8 versus 1.2% in Georgia [OR = 29.6 (9.1-95.6)] and 35.4 versus 26.6% in India [OR = 1.5 (1.0-2.2)]. Women having received COC did not report more conjugal violence or union break-ups than in the standard posttest HIV counselling group. The main factors associated with partner HIV testing were a history of HIV testing among men in Cameroon, Dominican Republic and Georgia and the existence of couple communication around HIV testing in Georgia and India. CONCLUSION: A simple prenatal intervention taking into account the couple relationship increases the uptake of HIV testing among men in different socio-cultural settings. COC could contribute to the efforts towards eliminating mother-to-child transmission of HIV.