Is the Differentiated Service Delivery Model Suited to the Needs of People Living with HIV in Rwanda?

The primary goal of antiretroviral treatment is to improve the health of individuals with HIV, and a secondary goal is to prevent further transmission. In 2016, Rwanda adopted the World Health Organization's "treat-all" approach in combination with the differentiated service delivery (DSD) model. The model's goal was to shorten the time from HIV diagnosis to treatment initiation, regardless of the CD4 T-cell count. This study sought to identify perceptions, enablers, and challenges associated with DSD model adoption among PLHIV.This study included selected health centers in Kigali city, Rwanda, between August and September 2022. The patients included were those exposed to the new HIV care model (DSD) model and those exposed to the previous model who transitioned to the current model. Interviews and focus group discussions were also held to obtain views and opinions on the DSD model. The data were collected via questionnaires and audio-recorded focus group discussions and were subsequently analyzed.The study identified several themes, including participants' initial emotions about a new HIV diagnosis, disclosure, experiences with transitioning to the DSD model, the effect of peer education, and barriers to and facilitators of the DSD model. Participants appreciated reduced clinic visits under the DSD model but faced transition and peer educator mobility challenges.The DSD model reduces waiting times, educates patients, and aligns with national goals. Identified barriers call for training and improved peer educator retention. Recommendations include enhancing the DSD model and future research to evaluate its long-term impact and cost-effectiveness.

Effects of Multi-Month Dispensing on Clinical Outcomes: Retrospective Cohort Analysis Conducted in Kenya.

Multi-month dispensing (MMD) has been widely adopted by national HIV programs as a key strategy for improving the quality of HIV care and treatment services while meeting the unique needs of diverse client populations. We assessed the clinical outcomes of clients receiving MMD in Kenya by conducting a retrospective cohort study using routine programmatic data in 32 government health facilities in Kenya. We included clients who were eligible for multi-month antiretroviral therapy (ART) dispensing for ≥ 3 months (≥ 3MMD) according to national guidelines. The primary exposure was enrollment into ≥ 3MMD. The outcomes were lost to follow-up (LTFU) and viral rebound. Multilevel modified-Poisson regression models with robust standard errors were used to compare clinical outcomes between clients enrolled in ≥ 3MMD and those receiving ART dispensing for less than 3 months (< 3MMD). A total of 3,501 clients eligible for ≥ 3MMD were included in the analysis, of whom 65% were enrolled in ≥ 3MMD at entry into the cohort. There was no difference in LTFU of ≥ 180 days between the two types of care (aRR 1.1, 95% CI 0.7-1.6), while ≥ 3MMD was protective for viral rebound (aRR 0.1 95% CI 0.0-0.2). As more diverse client-focused service delivery models are being implemented, robust evaluations are essential to guide the implementation, monitor progress, and assess acceptability and effectiveness to deliver optimal people-centered care.

A simple model for the total number of SARS-CoV-2 infections on a national level.

This study aimed to identify an appropriate simple mathematical model to fit the number of coronavirus disease 2019 (COVID-19) cases at the national level for the early portion of the pandemic, before significant public health interventions could be enacted. The total number of cases for the COVID-19 epidemic over time in 28 countries was analysed and fit to several simple rate models. The resulting model parameters were used to extrapolate projections for more recent data. While the Gompertz growth model (mean R2 = 0.998) best fit the current data, uncertainties in the eventual case limit introduced significant model errors. However, the quadratic rate model (mean R2 = 0.992) fit the current data best for 25 (89%) countries as determined by R2 values of the remaining models. Projection to the future using the simple quadratic model accurately forecast the number of future total number of cases 50% of the time up to 10 days in advance. Extrapolation to the future with the simple exponential model significantly overpredicted the total number of future cases. These results demonstrate that accurate future predictions of the case load in a given country can be made using this very simple model.

Comparative antimicrobial activity of two new mutacins.

OBJECTIVES: To compare the in vitro activity of mutacins D-123.1 and F-59.1 against different bacteria including antibiotic-resistant strains, in order to evaluate their application potential. DESIGN AND METHODS: The antibacterial activity spectrum of purified F-59.1 and the MIC and MBC of F-59.1 and D-123.1 against target bacteria were determined. RESULTS: Most bacteria were inhibited by the purified mutacins. Mutacin F-59.1 shows a relatively wide activity spectrum. Mutacin D-123.1 has low Minimum Inhibitory Concentrations [MICs] (0.25-4 microg/ml) against human pathogens while F-59.1 has higher MICs (3.2-12.8 microg/ml) mainly against food-borne pathogens. CONCLUSION: The effectiveness of mutacins D-123.1 and F-59.1 against human and food-borne pathogens is demonstrated. Mutacin D-123.1 shows potential as a new antibiotic while F-59.1 shows promising application in food products.

A quantitative risk assessment of West Nile virus introduction into Barbados / Una evaluación del riesgo cuantitativo de la introducción del virus del Nilo Occidental en Barbados

OBJECTIVE: To present a quantitative risk assessment of West Nile (WNV) virus introduction into Barbados, West Indies. DESIGN AND METHODS: Three possible modes were considered: a) WNV infected mosquitoes via air transport, by city of departure, b) WNV infected mosquitoes via marine transport and c) viraemic migratory, birds. We estimated the number of WNV infected migratory birds as the product of the proportion of migratory birds infected and the number of migratory birds entering Barbados in three taxonomic groups. We further estimated the number of days these birds would be infectious as: [formula: see text]. We then estimated the number (#) of infectious mosquito-days for mosquitoes entering Barbados via air transport as: # infected mosquitoes = (total flights per week/city) x (duration of WNV season) x (number of Culex mosquitoes aboard each flight) x (Culex mosquito WNV infection prevalence) x (vector competence index) x (days infectious). The number of infected mosquitoes entering Barbados via marine transport was estimated using a similar expression as for air transport, except that the number of airplanes and mosquitoes/airplane were substituted with the # of sea containers during a 22-week mosquito season and # of mosquitoes/container. RESULTS: Migratory birds (approximately 69-101 infected birds/year) were associated with the highest introductory risk followed by mode (a) (approximately 2 infected mosquitoes/year) and mode (b) (0. 004 infected mosquitoes/year). CONCLUSIONS: Migratory birds and mosquitoes via air are imminent threats for virus introduction. Impending co-circulation of West Nile virus and four strains of dengue virus may present new challenges for public health.

OBJETIVO: Presentar una valoración del riesgo cuantitativa de la introducción del Virus del Nilo Occidental (VNO) en Barbados, West Indies. MÉTODOS E DISEÑO: Se consideraron tres posibles modos: a) mosquitos infectados con el VNO vía transporte aéreo, por ciudad de salida, b) mosquitos infectados con el VNO vía transporte marítimo, y c) aves migratorias virémicas. Calculamos el número de aves migratorias infectadas con el VNO como el producto de la proporción de aves migratorias infectadas por el número de aves migratorias que entran a Barbados en tres grupos taxonómicos. Luego calculamos el número de días en que estas aves serían infecciosas, de la forma siguiente:[fórmula: ver en el texto].Calculamos entonces el número de días-mosquito infeccioso para los mosquitos que entran en Barbados mediante transporte aéreo, como sigue: # mosquitos infectados = (vuelos totales por semana/ciudad) x (duración de la estación del VNO) x (número de mosquitos Culex a bordo de cada vuelo) x (prevalencia de infección con VNO por mosquito Culex) x (índice de competencia del vector) x (días infecciosos). El número de mosquitos infectados que entraron a Barbados por vía del transporte marítimo fue calculado usando una fórmula similar a la usada en relación con el transporte aéreo, excepto que el número de aeroplanos y mosquitos/ aeroplanos fueron sustituidos con el # de contenedores marítimos durante una temporada de mosquitos de 22 semanas y el # de mosquitos/contenedor RESULTADOS: Las aves migratorias ~ (69-101 aves infectadas/años) estuvieron asociadas con el riesgo de introducción más alto seguido del modo (a) (~2 mosquitos infectados/año), y finalmente el modo (b) (0.004 mosquitos infectados/año). CONCLUSIONES: Las aves migratorias y los mosquitos por vía aérea representan una amenaza inminente de introducción de virus. La co-circulación inminente del Virus del Nilo Occidental y cuatro cepas de virus de dengue pueden presentar nuevos desafíos a la salud pública.

A quantitative risk assessment of West Nile virus introduction into Barbados.

OBJECTIVE: To present a quantitative risk assessment of West Nile (WNV) virus introduction into Barbados, West Indies. DESIGN AND METHODS: Three possible modes were considered: a) WNV infected mosquitoes via air transport, by city of departure, b) WNV infected mosquitoes via marine transport and c) viraemic migratory, birds. We estimated the number of WNV infected migratory birds as the product of the proportion of migratory birds infected and the number of migratory birds entering Barbados in three taxonomic groups. We further estimated the number of days these birds would be infectious as: [formula: see text]. We then estimated the number (#) of infectious mosquito-days for mosquitoes entering Barbados via air transport as: # infected mosquitoes = (total flights per week/city) x (duration of WNV season) x (number of Culex mosquitoes aboard each flight) x (Culex mosquito WNV infection prevalence) x (vector competence index) x (days infectious). The number of infected mosquitoes entering Barbados via marine transport was estimated using a similar expression as for air transport, except that the number of airplanes and mosquitoes/airplane were substituted with the # of sea containers during a 22-week mosquito season and # of mosquitoes/container. RESULTS: Migratory birds (approximately 69-101 infected birds/year) were associated with the highest introductory risk followed by mode (a) (approximately 2 infected mosquitoes/year) and mode (b) (0. 004 infected mosquitoes/year). CONCLUSIONS: Migratory birds and mosquitoes via air are imminent threats for virus introduction. Impending co-circulation of West Nile virus and four strains of dengue virus may present new challenges for public health.

Comparison of the activity spectra against pathogens of bacterial strains producing a mutacin or a lantibiotic.

The increase of drug resistance among bacterial pathogens is currently a major threat in hospital settings. New and more efficient antibiotic compounds have to be developed to fight infectious diseases. In the present work, a deferred antagonism test was used to determine the activity of different bacterial strains producing either a mutacin or a lantibiotic against bacterial pathogens. The mutacins A, B, C, D, I, K, L, M, and nisins A and Z were active against all enterococci tested. Mutacins A and B, and nisins A and Z inhibited all the staphylococci tested. Except for the strains producing mutacins P, Q, and X, all the other producing strains inhibited the streptococci tested. Mutacins A, B, I, J, T, nisins A and Z, and epidermin inhibited the two antibiotic-resistant strains of Neisseria gonorrhoeae tested. Mutacins A, B, C, D, and nisins A and Z inhibited Campylobacter jejuni and Helicobacter pylori. Thus, the wide activity spectra of nisin A and Z are confirmed. These results also indicate that many of the mutacins, especially those of groups A, B, C, D, I, J, K, L, M, and T, could be candidates for further development as useful antibiotics.

MICs of mutacin B-Ny266, nisin A, vancomycin, and oxacillin against bacterial pathogens.

Peptide antibiotics, particularly lantibiotics, are good candidates for replacing antibiotics to which bacteria have become resistant. In order to compare two such lantibiotics with two antibiotics, the MICs of nisin A, mutacin B-Ny266, vancomycin, and oxacillin against various bacterial pathogens were determined. The results indicate that nisin A and mutacin B-Ny266 are as active as vancomycin and oxacillin against most of the strains tested. Furthermore, mutacin B-Ny266 remains active against strains that are resistant to nisin A, oxacillin, or vancomycin. The wide spectrum of activity of mutacin B-Ny266, its low MICs against bacterial pathogens, and its activity against bacteria resistant to other inhibitors support the development of this substance for therapeutic use.

Oral microbial ecology and the role of salivary immunoglobulin A.

In the oral cavity, indigenous bacteria are often associated with two major oral diseases, caries and periodontal diseases. These diseases seem to appear following an imbalance in the oral resident microbiota, leading to the emergence of potentially pathogenic bacteria. To define the process involved in caries and periodontal diseases, it is necessary to understand the ecology of the oral cavity and to identify the factors responsible for the transition of the oral microbiota from a commensal to a pathogenic relationship with the host. The regulatory forces influencing the oral ecosystem can be divided into three major categories: host related, microbe related, and external factors. Among host factors, secretory immunoglobulin A (SIgA) constitutes the main specific immune defense mechanism in saliva and may play an important role in the homeostasis of the oral microbiota. Naturally occurring SIgA antibodies that are reactive against a variety of indigenous bacteria are detectable in saliva. These antibodies may control the oral microbiota by reducing the adherence of bacteria to the oral mucosa and teeth. It is thought that protection against bacterial etiologic agents of caries and periodontal diseases could be conferred by the induction of SIgA antibodies via the stimulation of the mucosal immune system. However, elucidation of the role of the SIgA immune system in controlling the oral indigenous microbiota is a prerequisite for the development of effective vaccines against these diseases. The role of SIgA antibodies in the acquisition and the regulation of the indigenous microbiota is still controversial. Our review discusses the importance of SIgA among the multiple factors that control the oral microbiota. It describes the oral ecosystems, the principal factors that may control the oral microbiota, a basic knowledge of the secretory immune system, the biological functions of SIgA, and, finally, experiments related to the role of SIgA in oral microbial ecology.

Purification and structure of mutacin B-Ny266: a new lantibiotic produced by Streptococcus mutans.

Mutacins are bactericidal substances of proteinaceous nature produced by Streptococcus mutans. Lantibiotics are antibacterial substances containing post-translationally modified amino acids such as lanthionine. Mutacin B-Ny266 was purified from the cell pellet of S. mutans strain Ny266 by ethanol extraction at pH 2.0 followed by reversed-phase chromatography (Sep-Pak cartridge) and by HPLC on a C18 column. The mean purification factor was 3240 +/- 81 and the mean yield was 1.0 +/- 0.1%. Molecular mass of mutacin B-Ny266 as determined by mass spectroscopy is 2270.29 +/- 0.21 Da. The amino acid sequence of the purified active fraction was obtained by Edman degradation after treatment with alkaline ethanethiol. Twenty-one amino acids were detected in this analysis. Mutacin B-Ny266 belongs to the type A lantibiotics. The proposed sequence is: F-K-A-W-U-F-A-Abu-P-G-A-A-K-O-G-A-F-N-U-Y-A. The molecule differs from that of epidermin/staphylococcin 1580 and gallidermin at positions 1, 2, 4, 5 and 6.

Comparison of the indigenous oral microbiota and immunoglobulin responses of athymic (nu/nu) and euthymic (nu/+) mice.

The role of the immune system in the homeostasis of indigenous oral bacterial populations is poorly understood. In this study, we compared the evolution of the indigenous oral microbiota of specific pathogen-free athymic nude (nu/nu) BALB/c mice with that of their corresponding phenotypically normal (nu/-) littermates. We also evaluated corresponding salivary and serum antibody activities (IgA and IgG) against the predominant indigenous oral bacteria. The bacterial species recovered from the two mouse strains were Lactobacillus murinus, Enterococcus faecalis, Streptococcus oralis and Staphylococcus epidermidis. From 27 days of age, nu/+ and nu/nu mice had significantly different proportions of oral bacterial populations. When the microbiota stabilized (at 40 days of age), the total cultivable microbiota of nu/+ mice was dominated by L. murinus (65-85%), while that of nu/nu mice was dominated by E. faecalis (40-60%). The precise factors that alter the oral resident microbiota in nu/nu mice are unknown. We found that total salivary IgA levels were significantly lower in nu/nu mice, but no association were observed between the level of salivary IgA antibody against indigenous bacteria and the proportion of these indigenous bacteria in the oral microbiota. The change in the microbiota of nude mice may have been caused by other factors such as defects in other immune functions or cold stress.

Species selectivity of new siderophore-drug conjugates that use specific iron uptake for entry into bacteria.

Siderophores selectively bind ferric iron and are involved in receptor-specific iron transport into bacteria. Several types of siderophores were synthesized, and growth-promoting or inhibitory activities when they were conjugated to carbacephalosporin, erythromycylamine, or nalidixic acid were investigated. Overall, 11 types of siderophores and 21 drug conjugates were tested against seven different bacterial species: Escherichia coli, Bordetella bronchiseptica, Pasteurella multocida, Pasteurella haemolytica, Streptococcus suis, Staphylococcus aureus, and Staphylococcus epidermidis. In some species, the inhibitory activities of the drug conjugates were associated with the ability of the bacteria to use the siderophore portion of the molecules for growth promotion in disc diffusion tests (0.04 mumol of conjugate or siderophore per disc). E. coli used catechol-based siderophore portions as well as hydroxamate-based tri-delta-OH-N-OH-delta-N-acetyl-L-ornithine ferric iron ligands for growth under iron-restricted conditions achieved by supplemental ethylenediamine di (O-hydroxyphenylacetic acid) (100 micrograms/ml) and was sensitive to carbacephalosporin conjugated to these siderophore types (up to a 34-mm-diameter inhibition zone). B. bronchiseptica used desferrioxamine B and an isocyanurate-based or trihydroxamate in addition to catechol-based siderophore portions for promotion but was not inhibited by beta-lactam conjugates partly because of the presence of beta-lactamase. P. multocida and P. haemolytica did not use any of the synthetic siderophores for growth promotion, and the inhibitory activities of some conjugates seemed partly linked to their ability to withhold iron from these bacteria, since individual siderophore portions showed some antibacterial effects. Individual siderophores did not promote S. suis growth in restrictive conditions, but the type of ferric iron ligands attached to beta-lactams affected inhibitory activities. The antibacterial activities of the intracellular-acting agents erythromycylamine and nalidixic acid were reduced or lost, even against S. aureus and S. epidermidis, when the agents were conjugated to siderophores. Conjugate-resistant E. coli mutants showed the absence of some iron-regulated outer membrane proteins in gel electrophoresis profiles and in specific phage or colicin sensitivity tests, implying that the drugs used outer membrane receptors of ferric complexes to get into cells.

No apparent influence of immunoglobulins on indigenous oral and intestinal microbiota of mice.

The role of secretory immunoglobulin A (sIgA) in the control of the indigenous microbiota is not well understood. In this study, we compared the oral and intestinal microbiota of transgenic B-cell-deficient (microMT) mice with their heterozygous (microMT/+) normal littermates. The levels of salivary IgA and serum IgA and IgG were normal in microMT/+ mice, while no immunoglobulins were detected in microMT/microMT mice. The acquisition and proportions of the different species of the oral and intestinal indigenous bacterial populations were not significantly different between the two groups of mice. Our results thus suggest that secretory IgA does not play a major role in the regulation of the indigenous microbiota of mice.

Comparison of the proportions of oral bacterial species in BALB/c mice from different suppliers.

In order to assess the influence of the origin of mice on their oral bacteria, the proportions of bacterial species found in the oral cavity of BALB/c mice from 5 suppliers were determined. The results indicated that mice from different origins harboured different oral bacterial populations upon arrival at our animal facilities and the differences persisted for at least one week after arrival. Except in one case, the oral bacteria did not differ from one shipment to another from each supplier and remained similar after one week at our animal facilities. The results thus indicate that the composition of the oral bacterial population is influenced by the origin of the mice.

Pneumocystis carinii infection in transgenic B cell-deficient mice.

Pneumocystis carinii is an important cause of pneumonia in immunocompromised hosts. Both cellular and humoral immunity seem important in resistance to this pathogen, but the specific role of each component is poorly understood. An outbreak of P. carinii pneumonia in transgenic B cell-deficient mice (muMT) was studied. Over 4 months, >50% of 41 muMT/muMT mice maintained in a sterile environment died of pneumonia. Some mice had concurrent infection with Pasteurella pneumotropica. Homozygous muMT/muMT mice had no detectable serum immunoglobulins, while their heterozygous muMT/+ counterparts had normal levels of IgM, IgG, and IgA and did not develop pneumonia. The infection was controlled by treating the mice with trimethoprim-sulfamethoxazole, and the pathogen was eliminated by cesarean rederivation. These observations suggest an important role for B cells in the host defense against P. carinii.

Effects of a Bacterial Hay Preservative (Pediococcus pentosaceus) on Hay under Experimental Storage Conditions.

The abundant growth of molds and thermophilic actinomycetes in stored hay decreases its quality and can be hazardous for the producer who inhales these contaminants when the moldy hay is fed in closed barns. These microbes are responsible for a respiratory disease called farmer's lung. Products, including bacterial cultures that can be inoculated in hay, are available to prevent hay deterioration by molds and bacteria. The aim of this study was to verify the effectiveness of Pediococcus pentosaceus (a bacterial inoculant) in preventing hay deterioration at different humidity levels in a laboratory experiment. Mixtures of grasses (mostly alfalfa, timothy, and clover) placed in plastic bags were treated with the commercially available product (live culture of P. pentosaceus) at 500,000 and 5,000,000 CFU/g of hay and humidified at different levels (20, 25, 30, and 35%). Control batches of hay (untreated) were prepared at the same humidity levels. The growth of inoculated bacteria in hay, pH level, and hay deterioration were evaluated. Under these experimental conditions, the growth of P. pentosaceus was abundant only when it was inoculated in very moist hay (35% moisture), resulting in bacterium levels of 6.3 x 10(sup8) CFU/g after 30 days. This abundant growth did not prevent the pH from increasing (final pH of about 9.0), nor did it prevent molding. At lower humidity levels (20, 25, and 30%), the bacterial inoculant used did not grow and did not prevent hay deterioration.

Inverse correlation between the proportion of salivary bacteria inhibiting Streptococcus mutans and the percentage of untreated carious teeth.

To evaluate the role of inhibitory substances produced by bacteria in the oral cavity, we estimated, by a deferred test on Todd-Hewitt agar enriched with hemin and vitamin K, the proportion of bacteria that inhibited or stimulated the growth of Streptococcus mutans and Porphyromonas gingivalis, from the saliva of 109 patients (54 males and 55 females) attending our dental clinics. The patients, aged from 8 to 75 years old (mean: 31 +/- 18 years), were randomly selected whatever the reason for their visit. The results, evaluated with the Spearman rank test, indicated that there was no statistically significant (P > 0.05) correlation between the proportion of salivary bacteria inhibiting or stimulating P. gingivalis with the Community Periodontal Index of Treatment Needs (CPITN), the number of carious, missing and filled teeth, or with the decayed, missing and filled teeth index (DMFT). Also, no statistically significant correlation was observed between the proportion of salivary bacteria stimulating the growth of S. mutans and the above mentioned health indexes. However, a statistically significant (P < 0.005) negative correlation was found between the percentage of cultivated bacteria that inhibit S. mutans and the percentage of untreated carious teeth as well as with the CPITN. The results thus indicate a possible role for inhibitory substances produced by bacteria in the maintenance of oral health.

Comparative Analysis of the 16S to 23S Ribosomal Intergenic Spacer Sequences of Bacillus thuringiensis Strains and Subspecies and of Closely Related Species.

Volume 61, no. 4, p. 1624, column 2, lines 38-41: The sentence should read "For example, at position 21, the G nucleotide (Fig. 1) was present in all the ISR B. thuringiensis subspecies except for B. thuringiensis subsp. tenebrionis (Te4), which contained an A." Page 1624, column 2, line 45: "Position 62" should read "position 11." Page 1624, column 2, line 47: "Position 90" should read "position 39." Page 1624, column 2, line 49: "Position 83" should read "position 32." Page 1625, column 1, line 3: "Position 83" should read "position 32." Page 1626, column 1, line 1: "Positions 62, 90, and 165, and one deletion at position 83" should read "positions 11, 39, and 114, and one deletion at position 32." [This corrects the article on p. 1623 in vol. 61.].

Colonization of the oral cavity of mice by an unidentified streptococcus.

While studying the oral bacterial biota of mice, we observed an unidentified streptococcus (TG) that eventually became the dominant species of the oral cavities of all other mice in our animal facility. We found that the strain is indigenous to Jackson Laboratory mice but is absent in animals from Charles River Laboratories. TG was also transmitted from artificially contaminated BALB/c mice to the oral cavities of 4 other mouse strains. Streptococcus sp. TG stimulated the secretory and systemic immune systems of artificially contaminated Charles River BALB/c mice but did not provoke clinical symptoms. The increase in antibody level to TG did not prevent its colonization and persistence in these mice. In mice from Jackson Laboratory, the secretory and systemic immune response to TG was significantly lower. In vitro, Streptococcus sp. TG inhibited murine oral lactobacilli and staphylococci, probably due to the production of hydrogen peroxide.