Understanding the Burden of Respiratory Syncytial Virus in Older Adults in Latin America: An Expert Perspective on Knowledge Gaps.

Respiratory syncytial virus (RSV) is a significant global health concern and major cause of hospitalization, particularly among infants and older adults. The clinical impact of RSV is well characterized in infants; however, in many countries, the burden and risk of RSV in older populations are overlooked. In Latin America, there are limited data on RSV epidemiology and disease management in older adults. Therefore, the impact of RSV in this region needs to be addressed. Here, current insights on RSV infections in older populations in Latin America, including those with underlying health conditions, are discussed. We also outline the key challenges limiting our understanding of the burden of RSV in Latin America in a worldwide context and propose an expert consensus to improve our understanding of the burden of RSV in the region. By so doing, we aim to ultimately improve disease management and outcomes of those at risk and to alleviate the impact on healthcare systems.A graphical plain language summary is available with this article.

Postsurgical outcomes in a cohort of patients with hippocampal sclerosis: Initial experience in a referral epilepsy center in Peru.

Mesial temporal lobe epilepsy, one of the most common forms of epilepsy, is often linked with drug resistance. Surgical intervention is a reliable and safe treatment option, though research into postsurgical outcomes in our locality remains limited. We performed a retrospective observational study included 91 patients with mesial temporal lobe epilepsy and hippocampal sclerosis who had undergone anterior temporal lobectomy between 2012 and 2020 at a surgical epilepsy center located in Lima, Peru. Postoperative outcomes were analyzed using bivariate and multivariate analysis based on the Engel classification. We found that after 12 months of follow-up, 78.65% of the 91 patients achieved an Engel IA classification, while 9.09% attained Engel IB classification and 11.24% were designated as Engel II, with only 1.12% classified as Engel IVA. The median QOLIE31 score was 84 (IQR: 75-90), with 74.16% of the participants successfully reintegrating into academic or employment activities. After 24 months, only 68 patients completed the follow-up, with 69.12% achieving an Engel IA classification. Individuals with a secondary education or higher were more likely to achieve an Engel IA classification at 12 months (OR: 5.11; P = 0.005; CI: 1.63-16.01), after adjusting for sex and age. We concluded that most patients exhibited favorable outcomes after 1 year of follow-up. However, lower educational attainment was linked to worse postsurgical outcomes.

Safety and Non-Inferiority Evaluation of Two Immunization Schedules with an Inactivated SARS-CoV-2 Vaccine in Adults: A Randomized Clinical Trial.

Several vaccines have been developed to control the COVID-19 pandemic. CoronaVac®, an inactivated SARS-CoV-2 vaccine, has demonstrated safety and immunogenicity, preventing severe COVID-19 cases. We investigate the safety and non-inferiority of two immunization schedules of CoronaVac® in a non-inferiority trial in healthy adults. A total of 2302 healthy adults were enrolled at 8 centers in Chile and randomly assigned to two vaccination schedules, receiving two doses with either 14 or 28 days between each. The primary safety and efficacy endpoints were solicited adverse events (AEs) within 7 days of each dose, and comparing the number of cases of SARS-CoV-2 infection 14 days after the second dose between the schedules, respectively. The most frequent local AE was pain at the injection site, which was less frequent in participants aged ≥60 years. Other local AEs were reported in less than 5% of participants. The most frequent systemic AEs were headache, fatigue, and myalgia. Most AEs were mild and transient. There were no significant differences for local and systemic AEs between schedules. A total of 58 COVID-19 cases were confirmed, and all but 2 of them were mild. No differences were observed in the proportion of COVID-19 cases between schedules. CoronaVac® is safe, especially in ≥60-year-old participants. Both schedules protected against COVID-19 hospitalization.

Safety and Immunogenicity of an Inactivated Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine in a Subgroup of Healthy Adults in Chile.

BACKGROUND: The development of effective vaccines against coronavirus disease 2019 is a global priority. CoronaVac is an inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine with promising safety and immunogenicity profiles. This article reports safety and immunogenicity results obtained for healthy Chilean adults aged ≥18 years in a phase 3 clinical trial. METHODS: Volunteers randomly received 2 doses of CoronaVac or placebo, separated by 2 weeks. A total of 434 volunteers were enrolled, 397 aged 18-59 years and 37 aged ≥60 years. Solicited and unsolicited adverse reactions were registered from all volunteers. Blood samples were obtained from a subset of volunteers and analyzed for humoral and cellular measures of immunogenicity. RESULTS: The primary adverse reaction in the 434 volunteers was pain at the injection site, with a higher incidence in the vaccine than in the placebo arm. Adverse reactions observed were mostly mild and local. No severe adverse events were reported. The humoral evaluation was performed on 81 volunteers. Seroconversion rates for specific anti-S1-receptor binding domain (RBD) immunoglobulin G (IgG) were 82.22% and 84.44% in the 18-59 year age group and 62.69% and 70.37% in the ≥60 year age group, 2 and 4 weeks after the second dose, respectively. A significant increase in circulating neutralizing antibodies was detected 2 and 4 weeks after the second dose. The cellular evaluation was performed on 47 volunteers. We detected a significant induction of T-cell responses characterized by the secretion of interferon-γ (IFN-γ) upon stimulation with Mega Pools of peptides from SARS-CoV-2. CONCLUSIONS: Immunization with CoronaVac in a 0-14 schedule in Chilean adults aged ≥18 years is safe, induces anti-S1-RBD IgG with neutralizing capacity, activates T cells, and promotes the secretion of IFN-γ upon stimulation with SARS-CoV-2 antigens.

A simplified alternative diagnostic algorithm for SARS-CoV-2 suspected symptomatic patients and confirmed close contacts (asymptomatic): A consensus of Latin American experts.

INTRODUCTION: Latin America accounts for one-quarter of global COVID-19 cases and one-third of deaths. Inequalities in the region lead to barriers to the best use of diagnostic tests during the pandemic. There is a need for simplified guidelines that consider the region's limited health resources, international guidelines, medical literature, and local expertise. METHODS: Using a modified Delphi method, 9 experts from Latin American countries developed a simplified algorithm for COVID-19 diagnosis on the basis of their answers to 24 questions related to diagnostic settings, and discussion of the literature and their experiences. RESULTS: The algorithm considers 3 timeframes (≤7 days, 8-13 days, and ≥14 days) and presents diagnostic options for each. SARS-CoV-2 real- time reverse transcription-polymerase chain reaction is the test of choice from day 1 to 14 after symptom onset or close contact, although antigen testing may be used in specific circumstances, from day 5 to 7. Antibody assays may be used for confirmation, usually after day 14; however, if clinical suspicion is very high, but other tests are negative, these assays may be used as an adjunct to decision-making from day 8 to 13. CONCLUSION: The proposed algorithm aims to support COVID-19 diagnosis decision-making in Latin America.

Designing Calcium Phosphate Nanoparticles with the Co-Precipitation Technique to Improve Phosphorous Availability in Broiler Chicks.

Dicalcium phosphate (DP) is a mineral involved in the metabolism and development and is used as a dietary source of phosphorus (PT) for poultry. Our study objective is to design nano-dicalcium phosphate (NDP) by co-precipitation. The methodological procedure was divided into two phases: (1) NDP synthesis, and (2) bird performance, digestibility, and Ca-P in chick's tissues. The sizes of the NDP were 20-80 nm. NDP had the Ca: P ratio of 1:1.12. The birds were divided into control diet (available P (Pa) = 0.13%) and three supplementary P sources [Commercial (Calcium phosphate), analytical grade (DP) and nanoparticles (NDP)] with three Pa levels (0.24, 0.35, 0.46%). Supplementary P sources compared to the control treatment had the highest body weight gain (698.56 vs. 228; p < 0.05) and feed intake (FI) (965.18 vs. 345.82), respectively. The digestibility of PT (67%) improved with 0.35% NDP. The highest contents of PT -breast were with the levels of 0.35 and 0.46% NDP. The PT, ash, and diameters were higher (p < 0.05) with supplementary P compared to the control treatment. As conclusion, the use of 0.35% NDP was the ideal dose in the chicks for the digestibility, absorption values, and the amount of PT in the breast.

Interim report: Safety and immunogenicity of an inactivated vaccine against SARS-CoV-2 in healthy chilean adults in a phase 3 clinical trial.

Background: The ongoing COVID-19 pandemic has had a significant impact worldwide, with an incommensurable social and economic burden. The rapid development of safe and protective vaccines against this disease is a global priority. CoronaVac is a vaccine prototype based on inactivated SARS-CoV-2, which has shown promising safety and immunogenicity profiles in pre-clinical studies and phase 1/2 trials in China. To this day, four phase 3 clinical trials are ongoing with CoronaVac in Brazil, Indonesia, Turkey, and Chile. This article reports the safety and immunogenicity results obtained in a subgroup of participants aged 18 years and older enrolled in the phase 3 Clinical Trial held in Chile. Methods: This is a multicenter phase 3 clinical trial. Healthcare workers aged 18 years and older were randomly assigned to receive two doses of CoronaVac or placebo separated by two weeks (0-14). We report preliminary safety results obtained for a subset of 434 participants, and antibody and cell-mediated immunity results obtained in a subset of participants assigned to the immunogenicity arm. The primary and secondary aims of the study include the evaluation of safety parameters and immunogenicity against SARS-CoV-2 after immunization, respectively. This trial is registered at clinicaltrials.gov ( NCT04651790 ). Findings: The recruitment of participants occurred between November 27 th , 2020, until January 9 th , 2021. 434 participants were enrolled, 397 were 18-59 years old, and 37 were ≥60 years old. Of these, 270 were immunized with CoronaVac, and the remaining 164 participants were inoculated with the corresponding placebo. The primary adverse reaction was pain at the injection site, with a higher incidence in the vaccine arm (55.6%) than in the placebo arm (40.0%). Moreover, the incidence of pain at the injection site in the 18-59 years old group was 58.4% as compared to 32.0% in the ≥60 years old group. The seroconversion rate for specific anti-S1-RBD IgG was 47.8% for the 18-59 years old group 14 days post immunization (p.i.) and 95.6% 28 and 42 days p.i. For the ≥60 years old group, the seroconversion rate was 18.1%, 100%, and 87.5% at 14, 28, and 42 days p.i., respectively. Importantly, we observed a 95.7% seroconversion rate in neutralizing antibodies for the 18-59 years old group 28 and 42 days p.i. The ≥60 years old group exhibited seroconversion rates of 90.0% and 100% at 28 and 42 days p.i. Interestingly, we did not observe a significant seroconversion rate of anti-N-SARS-CoV-2 IgG for the 18-59 years old group. For the participants ≥60 years old, a modest rate of seroconversion at 42 days p.i. was observed (37.5%). We observed a significant induction of a T cell response characterized by the secretion of IFN-γ upon stimulation with Mega Pools of peptides derived from SARS-CoV-2 proteins. No significant differences between the two age groups were observed for cell-mediated immunity. Interpretation: Immunization with CoronaVac in a 0-14 schedule in adults of 18 years and older in the Chilean population is safe and induces specific IgG production against the S1-RBD with neutralizing capacity, as well as the activation of T cells secreting IFN-γ, upon recognition of SARS-CoV-2 antigens. Funding: Ministry of Health of the Chilean Government; Confederation of Production and Commerce, Chile; Consortium of Universities for Vaccines and Therapies against COVID-19, Chile; Millennium Institute on Immunology and Immunotherapy.

Relation of the maximum temperature and relative humidity close to the insemination with the tropical milking criollo heifer's gestation in three seasons.

The high climatic variability of hot climates of the intertropical zone reduces cattle fertility. In dairy cows in temperates zones, the THI has been used to evaluate the temperature and relative humidity (RH) joint effect in reproduction, but its use is not recommended in all geographic zones; in hot climates, the maximum temperature (Tmax) can provide more convenient information than THI. The objective of this study was to determine the artificial insemination (AI) service seasons and their joint effect with the maximum temperature and relative humidity of the previous seven days, the service day, and posterior seven days to the AI in the tropical milking criollo (LT) heifer's gestation. Climatic data was used to define three seasons: hot-dry (HD), hot-humid (HH), and fresh-dry (FD), and 313 artificial insemination services from 176 heifers were analyzed over fourteen years. The seasons were determined by cluster analysis. Gestation at first service (GF) was analyzed with a logistic regression model and global gestation (GG) with a mixed linear generalized model. The Tmax of previous seven days insemination [Formula: see text] - 0.20 ± 0.09 (p ≤ 0.02) in HD (p ≤ 0.02) and RH of seven days posterior insemination [Formula: see text]= - 0.08 ± 0.04 (p ≤ 0.04) in HD (p ≤ 0.01) affected GF. No effect of the Tmax and RH on the service day was observed (p > 0.05). The highest GG probabilities were higher than 0.70 in HH and FD, making those seasons the most suitable for inseminating LT heifers.

Kappa-casein genotyping in tropical milking Criollo and its association to milk production and composition.

Caseins are abundant proteins in milk and found in four types (αS1, αS2, ß, and κ). There is substantial variation in the allelic and genotypic frequencies of the κ-casein gene in different cattle breeds, although the tropical milking Criollo (TMC) has not yet been investigated. The aim was to determine the allelic and genotypic frequencies in the κ-casein gene for two alleles (A and B) in TMC and further investigate its association to milk production and composition. A total of 180 TMC females were genotyped from blood samples. κ-Casein genotyping was performed using restriction fragment length polymorphism (RFLP) after polymerase chain reaction (PCR)-based amplification of genomic DNA. Allele frequencies were 0.39 for A-allele and 0.61 for B-allele (P < 0.05). Genotype frequencies were 0.09 (AA), 0.60 (AB), and 0.31 (BB) (P < 0.05). The κ-casein genotype in TMC cows did not affect milk yield or composition. In sum, the TMC has high frequencies of the B-allele and AB/BB genotypes, although there are no association of such genotypes and milk traits.

Comparison of four nonlinear growth models in Creole chickens of Mexico.

Animal growth is a complex and dynamic process that involves physiological and morphological changes from hatching to maturity. It is defined as the increase in body size per time unit. Mathematical functions, called growth models, have been used to explain growth patterns. The aim of this study was to compare the Gompertz-Laird, logistic, Richards, and Von Bertalanffy growth models to determine which best fits the data of the Creole chickens (CC). Three hundred forty-seven CC were individually weighed from hatching until 177 D of age. Birds were fed a starter diet (0-18 D of age; 19% crude protein (CP) and 3,000 kcal of ME/kg) and grower diet (19-177 D of age; 18% CP and 2,800 kcal of ME/kg). Data were analyzed using PROC NLIN to fit the nonlinear growth curve. The coefficient of determination (R2), Akaike information criteria (AIC), and Bayesian information criteria (BIC) were used to compare the goodness of fit of the models. The Von Bertalanffy (R2: 0.9382, 0.9415; AIC: 2,224.1, 2,424.8; BIC: 2,233.5, 2,434.3, for females and males, respectively) was the model that best explained growth of the birds. On the other hand, both the Gompertz-Laird and logistic models overestimated hatching BW and underestimated the final BW of CC. Females reached age of maximum growth faster than males. The asymptotic weight was higher in males (3,011 g) than in females (2,011 g). Body weight at inflection point was 892 g at 64 D of age for males and 596 g at 54 D for females. In conclusion, the best fit of the data was obtained with the Von Bertalanffy growth model; the information is intended to serve as the basis for utilizing CC.

Chilean Health Care Providers' Perceived Comfort in Performing Oral Rapid Testing for HIV: A Cross-Sectional Study.

OBJECTIVES: To understand key factors influencing Chilean health care providers' perceived comfort performing oral rapid HIV testing. DESIGN: One hundred and fifty health care providers completed a self-administered questionnaire that included a five-item scale measuring self-perceived comfort in conducting HIV pretest counseling, oral rapid testing, finger-prick testing, and delivering test results. RESULTS: Most participants (60%) envisioned good overall comfort performing oral rapid HIV testing (mean score of 16.21; range 0-20), including doing at least four of the five steps. They perceived least comfort delivering HIV-positive test results during posttest counseling. HIV stigmatizing attitudes reduced self-perceived comfort. CONCLUSIONS: Providing training to counter HIV stigmatization while increasing comfort in performing oral rapid testing would help facilitate its successful implementation.

Soybean meal substitution by dehulled lupine (Lupinus angustifolius) with enzymes in broiler diets.

OBJECTIVE: Evaluate the effects of i) dehulling of lupine seed on chemical composition and apparent metabolizable energy (AME) and ii) soybean meal substitution by dehulled lupine seed in broiler diets with enzymes on productive performance, size of digestive organs and welfare-related variables. METHODS: Experiment 1, chemical composition and AME were determined in whole and dehulled lupine seed. Experiment 2, two hundred eighty-eight one-day-old male Ross 308 broilers were used. The experimental diets were maize-soybean meal (MS), MS with enzymes (MSE) and maize-dehulled lupine seed with enzymes (MLE). Diets were assigned to the experimental units under a completely randomized design (eight replicates per diet). The body weight (BW) gain, feed intake, feed conversion, digestive organ weights, gait score, latency to lie down and valgus/varus angulation were evaluated. RESULTS: The dehulling process increased protein (25.0% to 31.1%), AME (5.9 to 8.8 MJ/kg) and amino acid contents. The BW gain of broilers fed the MLE diet was similar (p>0.05) to that of those fed the MS diet, but lower than that of those fed the MSE diet. Feed intake of broilers fed the MLE diet was higher (p<0.05) than that of those fed the MS diet and similar (p>0.05) to those fed the MSE diet. Feed conversion of broilers fed the MLE diet was 8.0% and 8.7% higher (p<0.05) than that of those fed the MS and MSE diets, respectively. Broilers fed the MLE diet had the highest (p<0.05) relative proventriculus and gizzard weights, but had poor welfare-related variables. CONCLUSION: It is possible to substitute soybean meal by dehulled lupine seed with enzymes in broiler diets, obtaining similar BW gains in broilers fed the MLE and MS diets; however, a higher feed intake is required. Additionally, the MLE diet reduced welfare-related variables.

Genetic variability of Tropical Milking Criollo cattle of Mexico estimated from genealogy information / Variabilidad genética de la raza bovina criolla Lechero Tropical de México estimada a partir de información genealógica / Variabilidade genética da raça bovina crioula Leiteiro Tropical do México estimada a partir de informação genealógica

Abstract Background: Genetic variability of populations is essential for their genetic conservation and improvement, and genealogy analysis is a useful tool to estimate it. Objective: To determine genetic variability and inbreeding levels in Tropical Milking Criollo (LT). Methods: This study analyzed the genealogy of LT using the ENDOG software. Registration certificates of 3,427 LT animals born between 1945 and 2013, and from 608 born between 1950 and 2013 were used. Two populations were defined: the first one with all registered animals (PLT), and the second with nucleus animals (PCP). Results: Estimates for PLT and PCP were: founders 890, 114; ancestors 855, 102; effective founders 111, 43; effective ancestors 72, 26, and effective population size 68.1 and 64.6, respectively. Inbreeding coefficients were 4.32 and 3.48% for the highest genetic integrity index; and the average relatedness (AR) coefficients were 1.19 and 5.55 for PLT and PCP, respectively. Genealogy depth was shallow in both populations, with full equivalent generations of 2.00 and 3.53. Global generation intervals were about seven years. Conclusions: The LT population is not endangered and its genetic improvement program should continue.

Resumen Antecedentes: la variabilidad genética de las poblaciones es esencial para su conservación y mejora genética, y el análisis de genealogía es útil para estimarla. Objetivo: determinar la variabilidad genética y los niveles de consanguinidad en la raza criolla Lechero Tropical (LT). Métodos: el estudio analizó la genealogía de la raza criolla LT con el programa ENDOG v4.8. Se utilizaron 3.427 registros de animales LT nacidos entre 1945 y 2013, y de 608 nacidos entre 1950 y 2013. Se definieron dos poblaciones, una que incluye todos los animales registrados (PLT) y otra solamente con los animales provenientes del núcleo genético (PCP). Resultados: en la PLT y PCP se estimaron animales fundadores 890, 114; ancestros 855, 102; número efectivo de fundadores 111, 43; número efectivo de ancestros 72, 26, y tamaño efectivo de población 68,1, 64,6, respectivamente. Para la categoría más alta de índice de integridad genética, los coeficientes de consanguinidad fueron 4,32 y 3,48%; y el coeficiente medio de relación global (AR) fue 1,19 y 5,55 para PLT y PCP, respectivamente. La profundidad de la genealogía en ambas poblaciones fue superficial con generaciones completas equivalentes de 2,00 y 3,53. Los intervalos generacionales globales fueron cercanos a siete años. Conclusiones: la población LT no se encuentra en riesgo de extinción y puede continuar con su programa de mejora genética.

Resumo Antecedentes: a variabilidade genética das populações é essencial para sua conservação e melhora genética e a análise da genealogia é útil para estimá-la. Objetivo: determinar a variabilidade genética e os níveis de consanguinidade na raça crioula Leiteiro Tropical (LT). Métodos: o estudo analisou a genealogia da raça crioula LT com o programa ENDOG v4.8. Foram utilizaram 3.427 registros de animais LT nascidos de 1945 a 2013, e de 608 nascidos entre 1950 e 2013. Foram definidas duas populações, uma que inclui todos os animais registrados (PLT) e outra somente com os animais provenientes do núcleo genético (PCP). Resultados: na PLT e PCP foram estimados animais fundadores 890, 114; ascendentes 855, 102; número efetivo de fundadores 111, 43; número efetivo de ascendentes 72, 26 e tamanho efetivo da população 68,1, 64.6, respectivamente. Para a categoria mais alta de índice de integridade genética os coeficientes de consanguinidade foram 4,32 e 3,48%; o coeficiente médio da relação global (AR) foi 1,19 e 5,55 para PLT e PCP, respectivamente. A profundidade da genealogia em ambas populações foi superficial com gerações completas equivalentes de 2,00 e 3,53. Os intervalos geracionais globais foram próximos a sete anos. Conclusões: a população LT não se encontra em risco de extinção e pode continuar com seu programa de melhoria genética.

[Practical clues for a fecal microbiota transplantation by colonoscopy for recurrent Clostridium difficile infection. Experience in a University center]. / Claves prácticas para un trasplante de microbiota fecal por colonoscopía en infección por Clostridium difficile recurrente. Experiencia en un centro universitario.

Fecal microbiota transplantation (FMT) is a highly effective therapy in recurrent Clostridium difficile. The best route to administrate the fecal matter has not been established yet. However, the lower gastrointestinal route by colonoscopy is effective and safe, presenting a higher acceptance by patients. In addition, this route allows an evaluation of colonic mucosa seeking for differential diagnostics. We present a case series of FMT performed in our institution by colonoscopy, highlighting outcomes and practical aspects for its implementation.

Claves prácticas para un trasplante de microbiota fecal por colonoscopía en infección por Clostridium difficile recurrente. Experiencia en un centro universitario / Practical clues for a fecal microbiota transplantation by colonoscopy for recurrent Clostridium difficile infection. Experience in a University center

Resumen El trasplante de microbiota fecal (TMF) constituye una terapia altamente eficaz en la infección por Clostridium difficile (ICD) recurrente. La mejor vía de administración del material fecal aún no ha sido establecida; sin embargo, la vía baja a través de colonoscopía resulta eficaz, segura y de mayor aceptación por los pacientes, permitiendo además el examen de la mucosa del colon en busca de diagnósticos diferenciales. Presentamos una serie de casos de TMF realizados en nuestra institución a través de colonoscopía, destacando los resultados y aspectos prácticos para su implementación.

Fecal microbiota transplantation (FMT) is a highly effective therapy in recurrent Clostridium difficile. The best route to administrate the fecal matter has not been established yet. However, the lower gastrointestinal route by colonoscopy is effective and safe, presenting a higher acceptance by patients. In addition, this route allows an evaluation of colonic mucosa seeking for differential diagnostics. We present a case series of FMT performed in our institution by colonoscopy, highlighting outcomes and practical aspects for its implementation.

Predictors of readiness for oral rapid HIV testing by Chilean health care providers / Factores predictivos de la disposición de los prestadores de atención de salud de Chile a realizar la prueba oral rápida de detección del VIH

Objective. This study identified the personal characteristics that affect Chilean health care providers’ readiness to adopt HIV Oral Rapid Testing (ORT) in Chile as a new clinical evidence- based practice (EBP). Methods. Using a cross-sectional research design, the study sampled 150 nurses, midwives, and physicians employed at four clinics within the Pontifícia Universidad Católica de Chile Health Network in Santiago. Participants completed a self-administered survey asking about their demographic background, EBP attitudes and experience, personal beliefs related to HIV, the importance of HIV testing, and perceived self-comfort in performing a rapid HIV test. Results. Of the participants, 90% believed that incorporating ORT would make a positive difference in their practice and said that they would be willing to adopt the technology for that reason. Nonetheless, the providers reported a mean “readiness to implement ORT” score of 15.1 out of a possible value of 20, suggesting only moderate self-perceived readiness to adopt the EBP. Education, beliefs about evidence-based practice, perceived comfort in performing ORT, and perceived importance of HIV testing explained 43.6% of the variance in readiness to adopt ORT. Conclusion. The findings of this first ORT pre-implementation study in Chile can help guide policy makers and HIV stakeholders to prepare for and increase primary health care providers’ readiness to successfully adopt this evidence-based technology. Successful adoption of ORT could increase Chile’s capacity to reach HIV-vulnerable Chileans for testing and referral to care if infected, thus helping the country to reduce further transmission of the virus and its medical complications.

Objetivo. En este estudio se determinaron las características personales que influyen sobre la disposición de los prestadores de atención de salud a adoptar la prueba oral rápida de detección del VIH en Chile como una nueva práctica clínica basada en la evidencia. Métodos. Con un diseño de investigación transversal, en el estudio se realizó un muestreo de 150 enfermeros, parteras y médicos que trabajaban en cuatro centros de la Red de Salud de la Pontifícia Universidad Católica de Chile, en Santiago. Los participantes llenaron una encuesta autoadministrada en la que se preguntaba sus características demográficas, actitudes y experiencia en relación con la práctica clínica basada en la evidencia, creencias personales respecto del VIH, importancia de las pruebas de detección del VIH y sensación de comodidad respecto de realizar una prueba oral rápida de detección del VIH. Resultados. El 90% de los participantes afirmó que creía que la incorporación de la prueba oral rápida significaría un cambio positivo en su práctica y que estaría dispuesto a adoptar la nueva tecnología por ese motivo. No obstante, de acuerdo con las respuestas, la "disposición a utilizar la prueba oral rápida" obtuvo una media de puntuación de 15,1 de un posible valor de 20, lo que sugiere solo una disposición autopercibida moderada a adoptar esta práctica basada en la evidencia. La educación, las creencias acerca de la práctica basada en la evidencia, la sensación de comodidad al realizar la prueba oral rápida y la percepción de la importancia de las pruebas de detección del VIH explican el 43,6% de la varianza de la disposición a adoptar la prueba oral rápida. Conclusiones. Los resultados de este estudio previo a la introducción de la prueba oral rápida de detección del VIH en Chile pueden ser útiles para orientar a los responsables de las políticas y a las partes interesadas en cuanto a la preparación de los prestadores de atención primaria de la salud para que aumente su disposición a adoptar con éxito esta tecnología basada en la evidencia. La adopción satisfactoria de la prueba oral rápida podría aumentar la capacidad de Chile para llegar a los chilenos vulnerables a la infección por el VIH para que se realicen la prueba y sean derivados para recibir atención si tienen un resultado positivo y, de este modo, podría contribuir a detener la transmisión del virus y reducir las complicaciones médicas.

Predictors of readiness for oral rapid HIV testing by Chilean health care providers / Factores predictivos de la disposición de los prestadores de atención de salud de Chile a realizar la prueba oral rápida de detección del VIH

ABSTRACT Objective This study identified the personal characteristics that affect Chilean health care providers’ readiness to adopt HIV Oral Rapid Testing (ORT) in Chile as a new clinical evidence-based practice (EBP). Methods Using a cross-sectional research design, the study sampled 150 nurses, midwives, and physicians employed at four clinics within the Pontifícia Universidad Católica de Chile Health Network in Santiago. Participants completed a self-administered survey asking about their demographic background, EBP attitudes and experience, personal beliefs related to HIV, the importance of HIV testing, and perceived self-comfort in performing a rapid HIV test. Results Of the participants, 90% believed that incorporating ORT would make a positive difference in their practice and said that they would be willing to adopt the technology for that reason. Nonetheless, the providers reported a mean “readiness to implement ORT” score of 15.1 out of a possible value of 20, suggesting only moderate self-perceived readiness to adopt the EBP. Education, beliefs about evidence-based practice, perceived comfort in performing ORT, and perceived importance of HIV testing explained 43.6% of the variance in readiness to adopt ORT. Conclusion The findings of this first ORT pre-implementation study in Chile can help guide policy makers and HIV stakeholders to prepare for and increase primary health care providers’ readiness to successfully adopt this evidence-based technology. Successful adoption of ORT could increase Chile’s capacity to reach HIV-vulnerable Chileans for testing and referral to care if infected, thus helping the country to reduce further transmission of the virus and its medical complications.

RESUMEN Objetivo En este estudio se determinaron las características personales que influyen sobre la disposición de los prestadores de atención de salud a adoptar la prueba oral rápida de detección del VIH en Chile como una nueva práctica clínica basada en la evidencia. Métodos Con un diseño de investigación transversal, en el estudio se realizó un muestreo de 150 enfermeros, parteras y médicos que trabajaban en cuatro centros de la Red de Salud de la Pontifícia Universidad Católica de Chile, en Santiago. Los participantes llenaron una encuesta autoadministrada en la que se preguntaba sus características demográficas, actitudes y experiencia en relación con la práctica clínica basada en la evidencia, creencias personales respecto del VIH, importancia de las pruebas de detección del VIH y sensación de comodidad respecto de realizar una prueba oral rápida de detección del VIH. Resultados El 90% de los participantes afirmó que creía que la incorporación de la prueba oral rápida significaría un cambio positivo en su práctica y que estaría dispuesto a adoptar la nueva tecnología por ese motivo. No obstante, de acuerdo con las respuestas, la "disposición a utilizar la prueba oral rápida" obtuvo una media de puntuación de 15,1 de un posible valor de 20, lo que sugiere solo una disposición autopercibida moderada a adoptar esta práctica basada en la evidencia. La educación, las creencias acerca de la práctica basada en la evidencia, la sensación de comodidad al realizar la prueba oral rápida y la percepción de la importancia de las pruebas de detección del VIH explican el 43,6% de la varianza de la disposición a adoptar la prueba oral rápida. Conclusiones Los resultados de este estudio previo a la introducción de la prueba oral rápida de detección del VIH en Chile pueden ser útiles para orientar a los responsables de las políticas y a las partes interesadas en cuanto a la preparación de los prestadores de atención primaria de la salud para que aumente su disposición a adoptar con éxito esta tecnología basada en la evidencia. La adopción satisfactoria de la prueba oral rápida podría aumentar la capacidad de Chile para llegar a los chilenos vulnerables a la infección por el VIH para que se realicen la prueba y sean derivados para recibir atención si tienen un resultado positivo y, de este modo, podría contribuir a detener la transmisión del virus y reducir las complicaciones médicas.

Predictors of readiness for oral rapid HIV testing by Chilean health care providers.

OBJECTIVE: This study identified the personal characteristics that affect Chilean health care providers' readiness to adopt HIV Oral Rapid Testing (ORT) in Chile as a new clinical evidence-based practice (EBP). METHODS: Using a cross-sectional research design, the study sampled 150 nurses, midwives, and physicians employed at four clinics within the Pontifícia Universidad Católica de Chile Health Network in Santiago. Participants completed a self-administered survey asking about their demographic background, EBP attitudes and experience, personal beliefs related to HIV, the importance of HIV testing, and perceived self-comfort in performing a rapid HIV test. RESULTS: Of the participants, 90% believed that incorporating ORT would make a positive difference in their practice and said that they would be willing to adopt the technology for that reason. Nonetheless, the providers reported a mean "readiness to implement ORT" score of 15.1 out of a possible value of 20, suggesting only moderate self-perceived readiness to adopt the EBP. Education, beliefs about evidence-based practice, perceived comfort in performing ORT, and perceived importance of HIV testing explained 43.6% of the variance in readiness to adopt ORT. CONCLUSION: The findings of this first ORT pre-implementation study in Chile can help guide policy makers and HIV stakeholders to prepare for and increase primary health care providers' readiness to successfully adopt this evidence-based technology. Successful adoption of ORT could increase Chile's capacity to reach HIV-vulnerable Chileans for testing and referral to care if infected, thus helping the country to reduce further transmission of the virus and its medical complications.

HIV-1 tropism: a comparison between RNA and proviral DNA in routine clinical samples from Chilean patients.

BACKGROUND: HIV in Chile has a notification rate of 0.01%. Coreceptor antagonists are a family of antiretroviral drugs that are used with the prior knowledge of patients HIV-1 tropism. Viral RNA-based tropism detection requires a plasma viral load ≥1000 copies/mL, while proviral DNA-based detection can be performed regardless of plasma viral load. This test is useful in patients with low or undetectable viral loads and would benefit with a proper therapy. The aim of this study was to determine the correlation between HIV RNA and proviral genotypic DNA tropism tests. FINDINGS: Forty three Chilean patients were examined using population-based V3 sequencing, and a geno2pheno false-positive rate (FPR) cutoff values of 5, 5.75, 10 and 20%. With cutoff 5.75% a concordance of 88.4% in tropism prediction was found after a simultaneous comparison between HIV tropism assessment by RNA and DNA. In total, five discrepancies (11.6%) were found, 3 patients were RNA-R5/DNA-X4 and two were RNA-X4/DNA-R5. Proviral DNA enabled the prediction of tropism in patients with a low or undetectable viral load. For cutoff 5 and 5.75% genotypic testing using proviral DNA showed a similar sensitivity for X4 as RNA. We found that the highest sensitivity for detecting the X4 strain occurred with proviral DNA and cutoff of 10 and 20%. Viral loads were higher among X4 strain carriers than among R5 strain carriers (p < 0.05). CONCLUSIONS: A high degree of concordance was found between tropism testing with RNA and testing with proviral DNA. Our results suggest that proviral DNA-based genotypic tropism testing is a useful option for patients with low or undetectable viral load who require a different therapy.