Racial and Ethnic Minority Status in Country of Birth Modifies Racial and Ethnic Disparities in Influenza Vaccination among New York City Adults.

BACKGROUND: Understanding the relationship between race/ethnicity, birthplace, and health outcomes is important for reducing health disparities. This study assessed the relationship between racial/ethnic identity and minority racial/ethnic status in country of birth on influenza vaccination among New York City (NYC) adults. METHODS: Using 2015-2019 data from NYC's Community Health Surveys, we assessed the association between racial/ethnic identity and racial/ethnic minority status in birth country with past year influenza vaccination, calculating prevalence differences per 100 and assessing interaction on the additive scale using linear binomial regression, and prevalence ratios and interaction on the multiplicative scale using log-binomial regression. RESULTS: Effect modification between race/ethnicity and minority racial/ethnic status in birth country was significant on the additive scale for Hispanic (p=0.018) and Black (p=0.025) adults and the multiplicative scale for Hispanic adults (p=0.040). After stratifying by racial/ethnic minority or majority status in birth country, vaccination was significantly lower among Black adults compared with White adults among those in the minority (adjusted prevalence difference [aPD]=-12.98, 95%CI: -22.88-(-2.92)) and significantly higher among Hispanic adults compared with White adults among those in the majority (aPD=9.28, 95%CI: 7.35-11.21). CONCLUSIONS: Racial/ethnic minority status in birth country is an important factor when examining racial/ethnic differences in vaccination status.

Effects of parental childhood cultural health environment on children's influenza and COVID-19 vaccination status.

Most studies examining factors associated with pediatric influenza (flu) and coronavirus disease (COVID-19) vaccination uptake focus on parental demographics. We examined whether the childhood cultural health environment (CHE) of parents (measured by self-reported regular attendance at doctor and dentist visits during childhood) was associated with flu and COVID-19 vaccination of their children. Using 2023 survey data from 397 US parents and causal inference methods, we estimated the average causal effect of parental CHE on flu vaccination rates (0.16 [95 % confidence interval: 0.06,0.27]) and COVID-19 (0.14 [95 % confidence interval: 0.04,0.24]), indicating that if all parents had attended regular doctor/dentist visits as children, flu and COVID-19 vaccination rates in children would be 16 % and 14 % higher, respectively, than if none had. Our findings suggest that early life exposure to medical and dental care has significant and lasting effects on the health of individuals and families.

Impact of Neighborhood Social Cohesion and Rodent Sightings on Mental Health among Residents of New York City During the COVID-19 Pandemic.

Common mental disorders such as depression and anxiety are prevalent globally, and rates are especially high in New York City (NYC) since the COVID-19 pandemic. Neighborhood social and physical environments have been found to influence mental health. We investigated the impact of neighborhood social cohesion and neighborhood rodent sightings (as an indicator of neighborhood cleanliness) on nonspecific serious psychological distress (NSPD) status using 2020 NYC Community Health Survey data from 8781 NYC residents. Multivariable logistic regression was used to evaluate the relationships among social cohesion, rodent sightings, and NSPD adjusted for confounders and complex sampling and weighted to the NYC population. Effect measure modification of rodent sightings on the effect of social cohesion on NSPD was evaluated on the multiplicative scale by adding the interaction term to the multivariable model and, if significant, stratifying on the effect modifier, and on the additive scale using the relative excess risk due to interaction (RERI). Social cohesion was found to decrease the odds of NSPD, and rodent sightings were found to increase the odds of NSPD. We found significant evidence of effect measure modification on the multiplicative scale. In the stratified models, there was a protective effect of social cohesion against NSPD among those not reporting rodent sightings, but no effect among those reporting rodent sightings. Our findings suggest that both neighborhood social cohesion and rodent sightings impact the mental health of New Yorkers and that rodent infestations may diminish the benefit of neighborhood social cohesion.

Pre-exposure prophylaxis uptake concerns in the Democratic Republic of the Congo: Key population and healthcare workers perspectives.

Key populations (KP) in the Democratic Republic of the Congo (DRC), including female sex workers (SW), are disproportionally affected by HIV. Quantitative feedback surveys were conducted at seven health facilities in DRC with 70 KP clients enrolled in pre-exposure prophylaxis (PrEP) services to measure benefits and concerns. The surveys also assessed satisfaction with PrEP services and experiences of stigma at the health facilities. Thirty healthcare workers (HCW) were surveyed to measure attitudes, beliefs, and acceptability of providing services to KP. KP client survey participants were primarily female SW. KP clients reported that the primary concern about taking PrEP was fear of side effects (67%) although few KP reported having experienced side effect (14%). HCW concurred with clients that experienced and anticipated side effects were a primary PrEP uptake concern, along with costs of clinic visits.

The prevalence of SARS-CoV-2 infection and other public health outcomes during the BA.2/BA.2.12.1 surge, New York City, April-May 2022.

BACKGROUND: Routine case surveillance data for SARS-CoV-2 are incomplete, unrepresentative, missing key variables of interest, and may be increasingly unreliable for timely surge detection and understanding the true burden of infection. METHODS: We conducted a cross-sectional survey of a representative sample of 1030 New York City (NYC) adult residents ≥18 years on May 7-8, 2022. We estimated the prevalence of SARS-CoV-2 infection during the preceding 14-day period. Respondents were asked about SARS-CoV-2 testing, testing outcomes, COVID-like symptoms, and contact with SARS-CoV-2 cases. SARS-CoV-2 prevalence estimates were age- and sex-adjusted to the 2020 U.S. POPULATION: We triangulated survey-based prevalence estimates with contemporaneous official SARS-CoV-2 counts of cases, hospitalizations, and deaths, as well as SARS-CoV-2 wastewater concentrations. RESULTS: We show that 22.1% (95% CI 17.9-26.2%) of respondents had SARS-CoV-2 infection during the two-week study period, corresponding to ~1.5 million adults (95% CI 1.3-1.8 million). The official SARS-CoV-2 case count during the study period is 51,218. Prevalence is estimated at 36.6% (95% CI 28.3-45.8%) among individuals with co-morbidities, 13.7% (95% CI 10.4-17.9%) among those 65+ years, and 15.3% (95% CI 9.6-23.5%) among unvaccinated persons. Among individuals with a SARS-CoV-2 infection, hybrid immunity (history of both vaccination and infection) is 66.2% (95% CI 55.7-76.7%), 44.1% (95% CI 33.0-55.1%) were aware of the antiviral nirmatrelvir/ritonavir, and 15.1% (95% CI 7.1-23.1%) reported receiving it. Hospitalizations, deaths and SARS-CoV-2 virus concentrations in wastewater remained well below that during the BA.1 surge. CONCLUSIONS: Our findings suggest that the true magnitude of NYC's BA.2/BA.2.12.1 surge may have been vastly underestimated by routine case counts and wastewater surveillance. Hybrid immunity, bolstered by the recent BA.1 surge, likely limited the severity of the BA.2/BA.2.12.1 surge.

It is difficult to assess the true prevalence of SARS-CoV-2, the virus that causes COVID-19, due to changes in testing practices and behaviors, including increasing at-home testing and decreasing healthcare provider-based testing. We conducted a population-representative survey in New York City to estimate the prevalence of SARS-CoV-2 during the second Omicron surge in spring 2022. We compared survey-based SARS-CoV-2 prevalence estimates with data on diagnosed cases, hospitalizations, deaths, and SARS-CoV-2 concentration in wastewater. Our survey-based estimates were nearly 30 times higher than official case counts and estimates of immunity among those with active infection were high. Taken together, our results suggest that the magnitude of the second Omicron surge was likely significantly underestimated, and high levels of immunity likely prevented a major surge in hospitalizations/deaths. Our findings might inform future work on COVID-19 surveillance and how to mitigate its spread.

HIV retesting for pregnant and breastfeeding women across maternal child health services in Nampula, Mozambique.

BACKGROUND: Repeat HIV testing during pregnancy and breastfeeding identifies women with incident infections, those living with HIV who have been lost to care, and infants at risk for HIV infection. We report data from repeat testing for women in maternal and child health (MCH) services at 10 health facilities in Mozambique. METHODS: Routinely collected data from health facility registers are reported from April-November 2019. From antenatal care (ANC), we report numbers and proportions of women eligible for retesting; returned for care when retesting eligible; retested; and HIV-positive (HIV+) at retesting. From child welfare clinics (CWC), we report mothers retested; tested HIV-positive; HIV+ mothers linked to ART services; HIV-exposed infants (HEI) tested for HIV with polymerase chain reaction (PCR) tests; HEI testing PCR positive; PCR-positive infants linked to care. RESULTS: In ANC, 28,233 pregnant women tested HIV-negative at first ANC visit, 40.7% had a follow-up visit when retesting eligible, among whom 84.8% were retested and 0.3%(N = 26) tested HIV+. In CWC, 26,503 women were tested; 0.8%(N = 212) tested HIV+ and 74.1%(N = 157) of HIV+ women were linked to care. Among 157 HEI identified in CWC, 68.4%(N = 145) received PCR testing and 19.3%(N = 28) tested positive. CONCLUSION: In ANC, less than half of pregnant women eligible for retesting returned for follow-up visits, and test positivity was low among women retested in ANC and CWC. In CWC, linkage to infant testing was poor and almost 20% of HEI were PCR-positive. Implementing retesting for pregnant and breastfeeding women is challenging due to high numbers of women and low testing yield.

The prevalence of SARS-CoV-2 infection and long COVID in U.S. adults during the BA.4/BA.5 surge, June-July 2022.

Due to changes in SARS-CoV-2 testing practices, passive case-based surveillance may be an increasingly unreliable indicator for monitoring the burden of SARS-CoV-2, especially during surges. We conducted a cross-sectional survey of a population-representative sample of 3042 U.S. adults between June 30 and July 2, 2022, during the Omicron BA.4/BA.5 surge. Respondents were asked about SARS-CoV-2 testing and outcomes, COVID-like symptoms, contact with cases, and experience with prolonged COVID-19 symptoms following prior infection. We estimated the weighted age and sex-standardized SARS-CoV-2 prevalence, during the 14-day period preceding the interview. We estimated age and gender adjusted prevalence ratios (aPR) for current SARS-CoV-2 infection using a log-binomial regression model. An estimated 17.3% (95% CI 14.9, 19.8) of respondents had SARS-CoV-2 infection during the two-week study period-equating to 44 million cases as compared to 1.8 million per the CDC during the same time period. SARS-CoV-2 prevalence was higher among those 18-24 years old (aPR 2.2, 95% CI 1.8, 2.7) and among non-Hispanic Black (aPR 1.7, 95% CI 1.4,2.2) and Hispanic adults (aPR 2.4, 95% CI 2.0, 2.9). SARS-CoV-2 prevalence was also higher among those with lower income (aPR 1.9, 95% CI 1.5, 2.3), lower education (aPR 3.7 95% CI 3.0,4.7), and those with comorbidities (aPR 1.6, 95% CI 1.4, 2.0). An estimated 21.5% (95% CI 18.2, 24.7) of respondents with a SARS-CoV-2 infection >4 weeks prior reported long COVID symptoms. The inequitable distribution of SARS-CoV-2 prevalence during the BA.4/BA.5 surge will likely drive inequities in the future burden of long COVID.

The Epidemiology of Long Coronavirus Disease in US Adults.

BACKGROUND: We estimated the prevalence of long COVID and impact on daily living among a representative sample of adults in the United States. METHODS: We conducted a population-representative survey, 30 June-2 July 2022, of a random sample of 3042 US adults aged 18 years or older and weighted to the 2020 US population. Using questions developed by the UK's Office of National Statistics, we estimated the prevalence of long COVID, by sociodemographics, adjusting for gender and age. RESULTS: An estimated 7.3% (95% confidence interval: 6.1-8.5%) of all respondents reported long COVID, corresponding to approximately 18 828 696 adults. One-quarter (25.3% [18.2-32.4%]) of respondents with long COVID reported their day-to-day activities were impacted "a lot" and 28.9% had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection more than 12 months ago. The prevalence of long COVID was higher among respondents who were female (adjusted prevalence ratio [aPR]: 1.84 [1.40-2.42]), had comorbidities (aPR: 1.55 [1.19-2.00]), or were not (vs were) boosted (aPR: 1.67 [1.19-2.34]) or not vaccinated (vs boosted) (aPR: 1.41 [1.05-1.91]). CONCLUSIONS: We observed a high burden of long COVID, substantial variability in prevalence of SARS-CoV-2, and risk factors unique from SARS-CoV-2 risk, suggesting areas for future research. Population-based surveys are an important surveillance tool and supplement to ongoing efforts to monitor long COVID.

Road traffic injuries in Tanzanian children and adolescents: A cross-sectional household survey.

OBJECTIVE: To measure annual rates of road traffic injuries (RTI) and to describe the characteristics of road traffic crashes experienced by children and adolescents in Tanga, Tanzania. METHODS: We conducted a cross-sectional household survey using geospatial population-weighted sampling in the city of Tanga in northern Tanzania. Data were collected in February and March of 2022. We report 12-month rates of road traffic crashes and RTI (reported by adult caregivers) among children and adolescents <18 years of age. RESULTS: A total of 2,794 adult respondents reported data on 6563 children and adolescents, among whom, 180 were reported to have experienced road traffic crashes in the past 12 months (crash incidence: 27.4 per 1,000 children, 95%CI 23.5-31.4) and 158 sustained injuries (RTI incidence: 24.1 per 1000 children, 95%CI 20.4-27.8). Almost a quarter of RTI (23%) were reported to be major (resulting in ≥30 days of missed activities). RTI was higher among adolescents (13-17 years) than children <5 years (21.5 vs. 14.1 per 1,000, p=0.039). Few children always or sometimes wore helmets when riding on motorcycles/motorbikes (12.8%) or wore safety restraints/seat belts in cars or other vehicles (11.9%). CONCLUSION: The high rate of road traffic crashes and RTI observed among children and adolescents in a medium-sized city in Tanzania underscores the urgent need to improve road safety and increase use of safety equipment in low resource settings.

Estimating the Period Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection During the Omicron (BA.1) Surge in New York City (NYC), 1 January to 16 March 2022.

In a population-based survey of adults in New York City, we assessed positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests (including via exclusive at-home testing) and possible cases among untested respondents. An estimated 27.4% (95% confidence interval [CI]: 22.8%-32.0%) or 1.8 million adults (95% CI: 1.6-2.1 million) had SARS-CoV-2 infection between 1 January and 16 March 2022.

Tuberculosis prevalence, incidence and prevention in a south african cohort of children living with HIV.

BACKGROUND: We describe tuberculosis (TB) disease among antiretroviral treatment (ART) eligible children living with HIV (CLHIV) in South Africa to highlight TB prevention opportunities. METHODS: In our secondary analysis among 0- to 12-year-old ART-eligible CLHIV in five Eastern Cape Province health facilities from 2012 to 2015, prevalent TB occurred 90 days before or after enrollment; incident TB occurred >90 days after enrollment. Characteristics associated with TB were assessed using logistic and Cox proportional hazards regression with generalized estimating equations. RESULTS: Of 397 enrolled children, 114 (28.7%) had prevalent TB. Higher-income proxy [adjusted odds ratio (aOR) 1.8 [95% confidence interval (CI) 1.3-2.6] for the highest, 1.6 (95% CI 1.6-1.7) for intermediate]; CD4+ cell count <350 cells/µl [aOR 1.6 (95% CI 1.1-2.2)]; and malnutrition [aOR 1.6 (95% CI 1.1-2.6)] were associated with prevalent TB. Incident TB was 5.2 per 100 person-years and was associated with delayed ART initiation [hazard ratio (HR) 4.7 (95% CI 2.3-9.4)], malnutrition [HR 1.8 (95% CI 1.1-2.7)] and absence of cotrimoxazole [HR 2.3 (95% CI 1.0-4.9)]. Among 362 children with data, 8.6% received TB preventive treatment. CONCLUSIONS: Among these CLHIV, prevalent and incident TB were common. Early ART, cotrimoxazole and addressing malnutrition may prevent TB in these children.

BACKGROUND: We describe tuberculosis (TB) in children living with HIV (CLHIV) eligible for HIV treatment in South Africa to highlight opportunities to prevent TB. METHODS: We analyzed additional data from our original study of CLHIV who were 0­12 years old and due to start HIV treatment in five health facilities in Eastern Cape Province from 2012 to 2015 and assessed characteristics associated with existing and new TB. RESULTS: Of 397 enrolled children, 114 (28.7%) had existing TB. Children with a higher measure of household income had higher odds of existing TB. CD4+ cell count <350 cells/µl and malnutrition were also associated with existing TB. There were 5.2 new cases of TB for every 100 child-years. New TB was 4.7 times more likely for children with delayed HIV treatment start, 1.8 times more likely for children with malnutrition and 2.3 times more likely for children who did not get cotrimoxazole. Among 362 children with data, 8.6% received treatment to prevent TB. CONCLUSIONS: Among these CLHIV, existing and new TB were common. Early HIV treatment, cotrimoxazole and addressing malnutrition may prevent TB in these children.

Acceptability of COVID-19 vaccine mandates among New York City parents, November 2021.

School-based vaccine mandates improve vaccination coverage in children. We conducted a cross-sectional survey of parents in New York City (NYC) in November 2021 to measure acceptability of COVID-19 vaccine mandates for students, and for teachers and school staff. Random address-based sampling was used to recruit parents of children 5-11 years of age. Among 2,506 parents surveyed, 44.3% supported school-based vaccine mandates for students and 69.1% supported mandates for teachers and school staff. Asian parents, male parents, those with higher income, college education, those voting for the 2021 Democratic mayoral candidate and parents from Manhattan were most likely to support vaccine mandates for students. Among all parents, 25.1% said they would not vaccinate their child if required. Our data show only modest support for school-based COVID-19 vaccine mandates for children despite their importance in improving vaccination coverage.

COVID-19 Vaccine Coverage and Hesitancy Among New York City Parents of Children Aged 5-11 Years.

Objectives. To measure vaccine uptake and intentions among New York City (NYC) parents of children aged 5 to 11 years following emergency use authorization. Methods. We conducted a survey of 2506 NYC parents of children aged 5 to 11 years. We used survey weights to generate prevalence estimates of vaccine uptake and intentions. Multivariable Poisson regression models generated adjusted prevalence ratios (APRs) of vaccine hesitancy, defined as parents who reported being not very likely or not at all likely to vaccinate their children, or unsure about whether to do so. Results. Overall, 11.9% of NYC parents reported that their child was vaccinated; 51.0% were very or somewhat likely to vaccinate; 8.0% were not sure; 29.1% were not very likely or not at all likely to vaccinate their child. Among vaccine-hesitant parents, 89.9% reported safety concerns and 77.8% had concerns about effectiveness. In multivariable models, more vaccine hesitancy was expressed by non-Hispanic Black parents than by non-Hispanic White parents (APR = 1.41; 95% confidence interval [CI] = 1.17, 1.72) and by parents who were not themselves vaccinated than by parents who were vaccinated (APR = 1.53; 95% CI = 1.32, 1.77). Conclusions. In a survey conducted after authorization of COVID-19 vaccines for children aged 5 to 11 years, significant hesitancy among parents was observed. (Am J Public Health. 2022;112(6):931-936. https://doi.org/10.2105/AJPH.2022.306784).

Group antenatal care for improving retention of adolescent and young pregnant women living with HIV in Kenya.

BACKGROUND: Pregnant and breastfeeding adolescents and young women living with HIV (AYWLH) have lower retention in prevention of mother-to-child transmission (PMTCT) services compared to older women. METHODS: We evaluated a differentiated service model for pregnant and postnatal AYWLH at seven health facilities in western Kenya aimed at improving retention in antiretroviral treatment (ART) services. All pregnant AYWLH < 25 years presenting for antenatal care (ANC) were invited to participate in group ANC visits including self-care and peer-led support sessions conducted by health facility nurses per national guidelines. ART register data were used to assess loss to follow-up (LTFU) among newly-enrolled pregnant adolescent (< 20 years) and young women (20-24 years) living with HIV starting ART in the pre-period (January-December 2016) and post-period (during implementation; December 2017-January 2019). Poisson regression models compared LTFU incidence rate ratios (IRR) in the first six months after PMTCT enrollment and risk ratios compared uptake of six week testing for HIV-exposed infants (HEI) between the pre- and post-periods. RESULTS: In the pre-period, 223 (63.2%) of 353 pregnant AYWLH newly enrolled in ANC had ART data, while 320 (71.1%) of 450 in the post-period had ART data (p = 0.02). A higher proportion of women in the post-period (62.8%) had known HIV-positive status at first ANC visit compared to 49.3% in the pre-period (p < 0.001). Among pregnant AYWLH < 20 years, the incidence rate of LTFU in the first six months after enrollment in ANC services declined from 2.36 per 100 person months (95%CI 1.06-5.25) in the pre-period to 1.41 per 100 person months (95%CI 0.53-3.77) in the post-period. In both univariable and multivariable analysis, AYWLH < 20 years in the post-period were almost 40% less likely to be LTFU compared to the pre-period, although this finding did not meet the threshold for statistical significance (adjusted incidence rate ratio 0.62, 95%CI 0.38-1.01, p = 0.057). Testing for HEI was 10% higher overall in the post-period (adjusted risk ratio 1.10, 95%CI 1.01-1.21, p = 0.04). CONCLUSIONS: Interventions are urgently needed to improve outcomes among pregnant and postnatal AYWLH. We observed a trend towards increased retention among pregnant adolescents during our intervention and a statistically significant increase in uptake of six week HEI testing.

Missed routine pediatric care and vaccinations in US children during the first year of the COVID-19 pandemic.

The COVID-19 pandemic has decreased uptake of pediatric preventive care, including immunizations. We estimate the prevalence of missed pediatric routine medical visits and vaccinations over the first year of the COVID-19 pandemic. We conducted a cross-sectional online survey of 2074 US parents of children ≤12 years in March 2021 to measure the proportion of children who missed pediatric care and vaccinations over the first 12 months of the COVID-19 pandemic. Poisson regression models were fitted to estimate adjusted prevalence ratios (aPR). All analyses were weighted to represent the target population. Overall, 41.3% (95%CI 38.3-43.8) of parents reported their youngest child missed a routine medical visit due to the COVID-19 pandemic. Missed care was more common among children ≥2 years compared to <2 years (aPR 1.82; 95%CI 1.47-2.26) and Hispanics compared to non-Hispanic Whites (aPR 1.31; 95%CI 1.14-1.51). A third of parents (33.1%; 95%CI 30.7-35.5) reported their child had missed a vaccination. Compared to the 2019-20 flu season, pediatric influenza vaccination decreased in 2020-21 (51.3% vs. 62.2%; p < 0.0001). A high proportion of US children ≤12 years missed routine pediatric care during the COVID-19 pandemic. Catch-up efforts are needed to ensure continuity of preventive care for all children.

Estimates of the prevalence of undiagnosed HIV among children living with HIV in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Zambia, and Zimbabwe from 2015 to 2017: an analysis of data from the cross-sectional Population-based HIV Impact Assessment surveys.

BACKGROUND: In 2020, there were an estimated 1·7 million children younger than 15 years living with HIV worldwide, but there are few data on the proportion of children living with HIV who are undiagnosed. We aimed to estimate the prevalence of undiagnosed HIV among children living with HIV in Eswatini, Lesotho, Malawi, Namibia, Tanzania, Zambia, and Zimbabwe. METHODS: We conducted an analysis of data from the cross-sectional Population-based HIV Impact Assessment (PHIA) surveys from 2015 to 2017. PHIAs are nationally representative surveys measuring HIV outcomes. HIV rapid test data (with PCR confirmatory testing for children aged <18 months) were used to measure HIV prevalence among children in each country (Eswatini, Lesotho, Malawi, Namibia, Tanzania, Zambia, and Zimbabwe). Mothers or guardians reported previous HIV testing of children and previous results. Detection of antiretroviral medications was done using dried blood spots. Children who tested positive in the PHIA with previous negative or unknown HIV test results and without detectable antiretroviral medication blood concentrations were considered previously undiagnosed; all other children who tested positive were considered previously diagnosed. Survey weights with jackknife variance were used to generate national estimates of HIV prevalence and undiagnosed HIV in children aged 1-14 years. We also report the prevalence (weighted proportions) of antiretroviral therapy coverage and viral load suppression (<400 copies per mL). FINDINGS: Between 2015 and 2017, 42 248 children aged 1-14 years were included in the surveys, of whom 594 were living with HIV. Across the seven countries, the estimated weighted HIV prevalence was 0·9% (probability band 0·7-1·1) and we estimated that there were 425 000 (probability band 365 000-485 000) children living with HIV. Among all children living with HIV, 61·0% (n=259 000 [probability band 216 000-303 000]) were previously diagnosed and 39·0% (n=166 000 [128 000-204 000]) had not been previously diagnosed with HIV. Among previously diagnosed children living with HIV, 88·4% had detectable antiretroviral medication blood concentrations and 48·3% had viral load suppression. Among all children living with HIV (regardless of previous diagnosis status), 54·7% had detectable antiretroviral medication blood concentrations and 32·6% had viral load suppression. INTERPRETATION: Our findings show the uneven coverage of paediatric HIV testing across these seven countries and underscore the urgent need to address gaps in diagnosis and treatment for all children living with HIV. FUNDING: None.

COVID-19 Testing Among US Children, Parental Preferences for Testing Venues, and Acceptability of School-Based Testing.

OBJECTIVES: Testing remains critical for identifying pediatric cases of COVID-19 and as a public health intervention to contain infections. We surveyed US parents to measure the proportion of children tested for COVID-19 since the start of the pandemic, preferred testing venues for children, and acceptability of school-based COVID-19 testing. METHODS: We conducted an online survey of 2074 US parents of children aged ≤12 years in March 2021. We applied survey weights to generate national estimates, and we used Rao-Scott adjusted Pearson χ2 tests to compare incidence by selected sociodemographic characteristics. We used Poisson regression models with robust SEs to estimate adjusted risk ratios (aRRs) of pediatric testing. RESULTS: Among US parents, 35.9% reported their youngest child had ever been tested for COVID-19. Parents who were female versus male (aRR = 0.69; 95% CI, 0.60-0.79), Asian versus non-Hispanic White (aRR = 0.58; 95% CI, 0.39-0.87), and from the Midwest versus the Northeast (aRR = 0.76; 95% CI, 0.63-0.91) were less likely to report testing of a child. Children who had health insurance versus no health insurance (aRR = 1.38; 95% CI, 1.05-1.81), were attending in-person school/daycare versus not attending (aRR = 1.67; 95% CI, 1.43-1.95), and were from households with annual household income ≥$100 000 versus income <$50 000-$99 999 (aRR = 1.19; 95% CI, 1.02-1.40) were more likely to have tested for COVID-19. Half of parents (52.7%) reported the pediatrician's office as the most preferred testing venue, and 50.6% said they would allow their youngest child to be tested for COVID-19 at school/daycare if required. CONCLUSIONS: Greater efforts are needed to ensure access to COVID-19 testing for US children, including those without health insurance.

Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini.

Tuberculosis (TB) primarily affects women during their reproductive years and contributes to maternal mortality and poor pregnancy outcomes. For pregnant women living with HIV (WLHIV), TB is the leading cause of non-obstetric maternal mortality, and pregnant WLHIV with TB are at increased risk of transmitting both TB and HIV to their infants. TB diagnosis among pregnant women, particularly WLHIV, remains challenging, and TB preventive treatment (TPT) coverage among pregnant WLHIV is limited. This project aimed to strengthen integrated TB and reproductive, maternal, neonatal and child health (RMNCH) services in Eswatini to improve screening and treatment for TB disease, TPT uptake and completion among women receiving RMNCH services. The project was conducted from April-December 2017 at four health facilities in Eswatini and introduced enhanced monitoring tools and on-site technical support in RMNCH services. We present data on TB case finding among women, and TPT coverage and completion among eligible WLHIV. A questionnaire (S1 Appendix) measured healthcare provider perspectives on the project after three months of project implementation, including feasibility of scaling-up integrated TB and RMNCH services. A total of 5,724 women (HIV-negative or WLHIV) were screened for active TB disease while attending RMNCH services; 53 (0.9%) were identified with presumptive TB, of whom 37 (70%) were evaluated for TB disease and 6 (0.1% of those screened) were diagnosed with TB. Among 1,950 WLHIV who screened negative for TB, 848 (43%) initiated TPT and 462 (54%) completed. Forty-three healthcare providers completed the questionnaire, and overall were highly supportive of integrated TB and RMNCH services. Integration of TB/HIV services in RMNCH settings was feasible and ensured high TB screening coverage among women of reproductive age, however, symptom screening identified few TB cases, and further studies should explore various screening algorithms and diagnostics that optimize case finding in this population. Interventions should focus on working with healthcare providers and patients to improve TPT initiation and completion rates.