Using Incentives and Nudging to Improve Non-Targeted HIV Testing in Ecuador: A Randomized Trial.

Under-detection of HIV/AIDS still burdens many low- and middle-income countries (LMICs). Our randomized trial investigated the effects of financial incentives and a behavioral nudge to induce HIV testing and learning HIV status in Ecuador. In the control group, 12.2% of participants agreed to testing, and 5.3% learned results. A financial incentive paid at testing increased the fraction of participants tested by 50.1 percentage points (95% CI 38.8 to 61.4) and the fraction who learned their status by 8.9 percentage points (95% CI 5.3 to 12.5); the nudge had no effect. The HIV-positive rate was 1.2% in the control group, and incentives prompted a 4.7 percentage point (95% CI 0.5 to 8.9) higher proportion of HIV-positive detection. Incentives also induced earlier testing, suggesting reduced procrastination. This suggests that information with appropriately timed small financial incentives can improve HIV testing and detection of new cases in the general population in LMIC settings.

"Cancer is in style": lifestyle change and the perceived impact of globalization on Andean indigenous communities in Ecuador.

Introduction: There is a paucity of information on cancer among Indigenous populations in Latin America.Methods: Guided by tenets of community engaged research and syndemic theory, we conducted eight focus groups (n = 59) with Kichwa men and women in the province of Imbabura, Ecuador. Data were analyzed using applied thematic analysis techniques.Results: Cancer emerged as an important health problem and was reported as a growing concern. Kichwa participants in this study attributed the rise in cancer to (1) exposure to chemicals and pesticides, (2) urbanization and development, and (3) the rise of innutritious, westernized diets.Conclusion: Our findings suggest that the Kichwa are attuned to the global phenomena in which traditional diet has been replaced by western, processed foods and fast food, which result in higher levels of chronic diseases such as cancer. More research is needed to understand the cancer burden among Indigenous peoples in Latin America.

Physical Activity Experiences of South Asian Migrant Women in Western Australia: Implications for Intervention Development.

The benefits of physical activity are widely recognised; however, physical activity uptake remains low in South Asian populations. South Asian migrant women face health risks as they adapt to new cultures, and these risks are often intensified through their limited participation in physical activity as one of the behaviours that promote positive health outcomes. Three focus group discussions with sixteen South Asian migrant women aged between 33 and 64 years, with a median age of 48 years and who live in Western Australia, were conducted. Thematic analysis of the transcribed qualitative data was completed to explore and uncover South Asian women's experiences with physical activity, as well as their motivation, beliefs, attitudes, and knowledge about physical activity. Five major themes emerged after coding and analysing the data. The themes included the women's knowledge of physical activity, their general attitudes and beliefs surrounding physical activity, the advantages and disadvantages of participation in physical activity, their experiences with physical activity, and the barriers, challenges, and facilitators surrounding physical activity. Recommendations are proposed to increase physical activity among this group to improve overall health and wellbeing and implications for intervention development are discussed.

Financial Incentives, Not Behavioral Nudges, Led to Optimized HIV Testing among Pregnant Women in a High-Burden Urban Population in Ecuador.

Behavioral economic principles are increasingly being used in the fight against HIV, including improving voluntary testing in sub-Saharan Africa and South America. However, behavioral nudges have not been widely tested as a strategy to optimize HIV testing in pregnant women. Here, we assessed whether behavioral nudges or financial incentives were effective in optimizing HIV testing among pregnant women in a high-HIV burden setting. A randomized clinical trial was conducted between May 21 and Oct 5, 2018, to allocate pregnant women in Ecuador into three study arms: information only, soft commitment (i.e., a behavioral nudge), and financial incentives. All participants received an informational flyer, including the address of a testing location. Participants in the soft-commitment arm signed and kept a form on which they committed to get tested for HIV. Those in the financial incentive arm received a $10 incentive when tested for HIV. A stepwise logistic regression analysis estimated the effect of the study arms on HIV testing rate. Participants in the financial-incentive arm had higher odds of getting an HIV test (adjusted odds ratio 17.06, P < 0.001) as compared with information-only participants. Soft-commitment had the opposite effect (adjusted odds ratio 0.14, P = 0.014). Financial incentives might be useful in improving HIV testing among pregnant women, especially among those who might be at higher risk but who have not completed an HIV test.

Developing Global Health Diplomacy-related Skills Using a COVID-19-like Epidemic Simulation as a Learning Strategy.

Public health and global health practitioners need to develop global health diplomacy (GHD) skills to efficiently work within complex global health scenarios, such as the current coronavirus disease (COVID-19) pandemic. Problem-based learning was used as a framework to create a scenario-based activity designed to develop GHD-related skills. The application and effectiveness of this scenario-based activity to develop GHD-related skills were assessed. A mixed-methods approach involving a self-administered survey and one focus group discussion was used. The survey collected baseline participant characteristics as well as understanding and improvements in GHD-related skills using a 5-point Likert scale. The focus group was audio-recorded and thematically analyzed using both inductive and deductive codes. Data integration was achieved by connecting and weaving. Method and investigator triangulation techniques were used. Participants self-reported significantly better postscenario-based activity responses when asked about their understanding of diplomacy, negotiation, communication, and how to address public health emergencies (P < 0.01, Wilcoxon signed rank test). Most participants either agreed or strongly agreed that their GHD-related skills improved with participation in the scenario-based activity (diplomacy = 55.6%; negotiation = 66.5%; communication = 72.2%; addressing public health emergencies = 72.1%). Overall, qualitative data were consistent with results obtained using quantitative methods. The scenario-based activity was effective for improving the self-reported understanding of GHD-related skills. The scenario-based activity was also effective for developing the selected GHD-related skills (as self-reported). This scenario-based activity is likely to reduce cognitive load and avoid participant overload, thereby facilitating learning. Further research is required to elucidate its long-term impact on skills development.

A tailored telehealth group tobacco cessation treatment program for people with HIV: Study protocol for a randomized controlled trial.

BACKGROUND: Smoking-related illnesses are the leading cause of death among people with HIV (PWH). Yet, there are few effective evidence-based interventions that help PWH quit smoking. The group-based program Positively Smoke Free is a biobehavioral cessation intervention for PWH with a growing evidence base. This study builds on prior work of Positively Smoke Free and addresses numerous weaknesses of prior trials for this population. We describe the Positively Quit Trial, a randomized controlled trial comparing a videoconferencing delivered Positively Smoke Free intervention to an attention-matched condition, assessing cessation over a 1-year period. METHODS: This attention-matched, randomized (1:1) controlled trial compares Positively Smoke Free Video-Groups to an updated version of Healthy Relationship Video-Groups. Participants are PWH, aged 18 years and older, who smoke at least one cigarette per day. All are offered nicotine replacement therapy patches and given brief advice to quit. Participants are enrolled in 12 group sessions focusing on either smoking cessation for PWH or broader topics regarding living healthy with HIV; in both conditions, Social Cognitive Theory is the guiding theoretical framework. Participants complete assessments at baseline, days 42, 90, 180, and 360; self-reported abstinence is verified with a video-observed cheek swab sent to a lab and tested for cotinine. PRIMARY OUTCOMES: Biochemically confirmed 7-day point prevalence smoking abstinence at day 360 is the primary outcome. Cost per quit, sustained abstinence at various timepoints, and biochemical confirmed abstinence at three and six months are secondary outcomes. Effects of smoking cessation on CD4 and virologic suppression are also explored.

Unravelling data for rapid evidence-based response to COVID-19: a summary of the unCoVer protocol.

INTRODUCTION: unCoVer-Unravelling data for rapid evidence-based response to COVID-19-is a Horizon 2020-funded network of 29 partners from 18 countries capable of collecting and using real-world data (RWD) derived from the response and provision of care to patients with COVID-19 by health systems across Europe and elsewhere. unCoVer aims to exploit the full potential of this information to rapidly address clinical and epidemiological research questions arising from the evolving pandemic. METHODS AND ANALYSIS: From the onset of the COVID-19 pandemic, partners are gathering RWD from electronic health records currently including information from over 22 000 hospitalised patients with COVID-19, and national surveillance and screening data, and registries with over 1 900 000 COVID-19 cases across Europe, with continuous updates. These heterogeneous datasets will be described, harmonised and integrated into a multi-user data repository operated through Opal-DataSHIELD, an interoperable open-source server application. Federated data analyses, without sharing or disclosing any individual-level data, will be performed with the objective to reveal patients' baseline characteristics, biomarkers, determinants of COVID-19 prognosis, safety and effectiveness of treatments, and potential strategies against COVID-19, as well as epidemiological patterns. These analyses will complement evidence from efficacy/safety clinical trials, where vulnerable, more complex/heterogeneous populations and those most at risk of severe COVID-19 are often excluded. ETHICS AND DISSEMINATION: After strict ethical considerations, databases will be available through a federated data analysis platform that allows processing of available COVID-19 RWD without disclosing identification information to analysts and limiting output to data aggregates. Dissemination of unCoVer's activities will be related to the access and use of dissimilar RWD, as well as the results generated by the pooled analyses. Dissemination will include training and educational activities, scientific publications and conference communications.

HIV/AIDS-related Knowledge and Behavior among School-attending Afro-Descendant Youths in Ecuador.

BACKGROUND OR OBJECTIVES: HIV/AIDS transmission in Ecuador is considered a concentrated epidemic; therefore, there are some studies on high risk groups but there is limited published data regarding the HIV/AIDS risk factors among adolescents of African descent. In this study, we sought to explore the determinants of HIV/AIDS-related knowledge and behavior among afro-descendant youths attending schools in the city of Esmeraldas, Ecuador. METHODS: A cross-sectional survey among school-attending youths was conducted in Esmeraldas, Ecuador in 2010. Our target population was afro-descendant youths attending the last two years of high school. Thirty public high schools enrolling students in junior and senior years were identified. Outcome data were analyzed in the form of three composite variables. A multivariate linear regression model was built for each outcome. RESULTS: A total of 213 school-attending afro-descendant youths aged 14 to 21 years old were enrolled in this study. Gender distribution was almost equal with a 1:1.17 male to female ratio. Overall, students in this population scored well in comprehensive knowledge of HIV with 88% having medium or higher knowledge. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Knowledge of HIV and its determinants was medium to high, but knowledge of sexually transmitted diseases was low among afro-descendant Ecuadorian adolescents in our study. Results of this study might be instrumental in facilitating decision-making processes related to the planning, implementation, and evaluation of HIV/AIDS prevention and control strategies in this specific population.

Biosafety at Home: How to Translate Biomedical Laboratory Safety Precautions for Everyday Use in the Context of COVID-19.

Population adoption of social distancing measures during the COVID-19 pandemic is at times deficient, increasing the risk of SARS-CoV-2 transmission. Healthcare workers and those living in areas of intense transmission may benefit from implementing biosafety measures in their daily lives. A mixed-methods approach, combining components of single negotiation text and the Delphi method, was used to create a COVID-19 biosafety-at-home protocol. A consensus building coordinator liaised with 12 experts to develop the protocol over 11 iterations. Experts had more than 200 years of combined experience in epidemiology, virology, infectious disease prevention, and public health. A flyer, created from the final protocol, was professionally designed and initially distributed via social media and institutional websites/emails in Ecuador beginning on May 2, 2020. Since then, it has been distributed in other countries, reaching ∼7,000 people. Translating research laboratory biosafety measures for the home/street environment might be challenging. The biosafety-at-home flyer addresses this challenge in a user-friendly format.

Syphilis and HIV/Syphilis Co-infection Among Men Who Have Sex With Men (MSM) in Ecuador.

There is a reemergence of syphilis in the Latin American and Caribbean region. There is also very little information about HIV/Syphilis co-infection and its determinants. The aim of this study is to investigate knowledge, attitudes, and practices regarding sexually transmitted infections (STIs), in particular syphilis infection and HIV/Syphilis co-infection, as well as to estimate the prevalence of syphilis among men who have sex with men (MSM) in a city with one of the highest HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 291 adult MSM. Questions included knowledge about STIs and their sexual practices. Blood samples were taken from participants to estimate the prevalence of syphilis and HIV/syphilis co-infection. In this population, the prevalence of HIV/syphilis co-infection was 4.8%, while the prevalence of syphilis as mono-infection was 6.5%. Participants who had syphilis mono-infection and HIV/syphilis co-infection were older. Men who had multiple partners and those who were forced to have sex had increased odds of syphilis and HIV/syphilis co-infection. A high prevalence of syphilis and self-reported STI was observed, which warrants targeted behavioral interventions. Co-infections are a cause for concern when treating a secondary infection in a person who is immunocompromised. These data suggest that specific knowledge, attitudes, and behaviors among MSM are associated with increased odds of STIs (including HIV/syphilis co-infections) in this region of Ecuador.

Risk Factors Associated With HIV Among Men Who Have Sex With Men (MSM) in Ecuador.

The Joint United Nations Program on HIV/AIDS estimates that between 0.3% and 0.7% of adults aged 15 to 49 years were living with HIV in Ecuador in 2013. However, very little is known about the HIV prevalence rate among men who have sex with men (MSM) in that country. A cross-sectional survey was conducted to investigate the knowledge, attitudes, and practices regarding HIV/AIDS as well as to estimate the prevalence of HIV among MSM in one of the cities with high HIV prevalence rates in Ecuador. In this study, questionnaires were administered to 307 adult MSM. An HIV prevalence of 10% was observed. Knowledge about HIV was high; 91% of participants could identify how HIV is transmitted. Although consistent condom use for anal sex was relatively high (89%) among participants who reported having pay-for-service clients, only 64% reported using a condom during oral sex with a client. Participants who had multiple male sexual partners (i.e., their stable male partners plus other partner[s]) had 3.7 times higher odds of testing positive for HIV compared with those who did not. They also had reduced odds of condom use. Participants who were forced to have anal receptive sex had 3 times higher odds of testing positive for HIV. Despite the finding that participants exhibited high knowledge about HIV/AIDS, a high prevalence rate of HIV was observed, which warrants targeted behavioral interventions. These data are consistent with MSM being one of the highest at-risk population groups for HIV in this region of Ecuador.

Post-earthquake Zika virus surge: Disaster and public health threat amid climatic conduciveness.

A recent major earthquake (M7.8), coupled with appropriate climatic conditions, led to significant destruction in Ecuador. Temperature variations, which may be induced by anthropogenic climate change, are often associated with changes in rainfall, humidity and pressure. Temperature and humidity are associated with ecological modifications that may favour mosquito breeding. We hypothesized that the disruptive ecological changes triggered by the earthquake, in the context of appropriate climatic conditions, led to an upsurge in Zika virus (ZIKV) infections. Here we show that, after controlling for climatic and socioeconomic conditions, earthquake severity was associated with incident ZIKV cases. Pre-earthquake mean maximum monthly temperature and post-earthquake mean monthly pressure were negatively associated with ZIKV incidence rates. These results demonstrate the dynamics of post-disaster vector-borne disease transmission, in the context of conducive/favourable climatic conditions, which are relevant in a climate change-affected world where disasters may occur in largely populated areas.

Effects of chronic ascariasis and trichuriasis on cytokine production and gene expression in human blood: a cross-sectional study.

BACKGROUND: Chronic soil-transmitted helminth (STH) infections are associated with effects on systemic immune responses that could be caused by alterations in immune homeostasis. To investigate this, we measured the impact in children of STH infections on cytokine responses and gene expression in unstimulated blood. METHODOLOGY/PRINCIPAL FINDINGS: Sixty children were classified as having chronic, light, or no STH infections. Peripheral blood mononuclear cells were cultured in medium for 5 days to measure cytokine accumulation. RNA was isolated from peripheral blood and gene expression analysed using microarrays. Different infection groups were compared for the purpose of analysis: STH infection (combined chronic and light vs. uninfected groups) and chronic STH infection (chronic vs. combined light and uninfected groups). The chronic STH infection effect was associated with elevated production of GM-CSF (P=0.007), IL-2 (P=0.03), IL-5 (P=0.01), and IL-10 (P=0.01). Data reduction suggested that chronic infections were primarily associated with an immune phenotype characterized by elevated IL-5 and IL-10, typical of a modified Th2-like response. Chronic STH infections were associated with the up-regulation of genes associated with immune homeostasis (IDO, P=0.03; CCL23, P=0.008, HRK, P=0.005), down-regulation of microRNA hsa-let-7d (P=0.01) and differential regulation of several genes associated with granulocyte-mediated inflammation (IL-8, down-regulated, P=0.0002; RNASE2, up-regulated, P=0.009; RNASE3, up-regulated, p=0.03). CONCLUSIONS/SIGNIFICANCE: Chronic STH infections were associated with a cytokine response indicative of a modified Th2 response. There was evidence that STH infections were associated with a pattern of gene expression suggestive of the induction of homeostatic mechanisms, the differential expression of several inflammatory genes and the down-regulation of microRNA has-let-7d. Effects on immune homeostasis and the development of a modified Th2 immune response during chronic STH infections could explain the systemic immunologic effects that have been associated with these infections such as impaired immune responses to vaccines and the suppression of inflammatory diseases.

Virus del Ébola: reflexiones sobre la reciente epidemia / Ebola virus: reflections on the recent epidemic

En resumen, con el antecedente de la reciente epidemia por el virus del Ébola, las autoridades gubernamentales y sanitarias deberán mantenerse con ojos vigilantes, no sólo en los puestos de entrada al país, sino también en las salas de emergencias de todos los hospitales y las unidades de servicios de salud (públicas y privadas). De igual manera, se deben establecer protocolos de diagnostico oportuno, transferencia de pacientes, aislamiento y tratamiento de sostén intensivo; así como es fundamental capacitar suficiente personal sanitario para hacer frente a este tipo de procesos infecciosos. Para ello se deben equipar unidades especiales en las principales ciudades del país. Los ciudadanos, a su vez, en situaciones de este tipo, deben mantener la calma y ser constantemente informados a través de canales oficiales, incluso a fin de reportar cualquier caso sospechoso de manera inmediata. Estas recomendaciones tienen sentido, no solamente por enfermedades que pueden llegar importadas desde el extranjero, sino también ante la eventualidad de brotes que podrían aparecer en el país causados por otros microorganismos.

In summary, with the antecedent of the recent virus epidemic of Ebola, government and health authorities should remain vigilant, not only at the entry points to the country, but also in the emergency rooms of all hospitals and health service units (public and private). Similarly, protocols must be established for timely diagnosis, patient transfer, isolation and intensive support treatment; A) Yes how is it essential to train Sufficient health personnel to deal with this type of infectious processes. For this they must equip special units in Main cities of the country. The citizens, in turn, in situations of this type, they must keep the calm down and be constantly informed through official channels, even in order to report any suspect case immediately. These recommendations They make sense, not just for diseases that may come imported from abroad, but also before the eventuality outbreaks that could appear in the country caused by other microorganisms.

Los diseños de investigación / The designs of investigation

La investigación científica es una herramienta fundamental para el desarrollo del conocimiento en varios campos de la actividad médica y de salud pública. Su importancia, al igual que la necesidad de transmitir sus avances en propuestas pragmáticas, ha sido resaltada en varios trabajos previos [1 - 3]. Por lo tanto, es crucial que los profesionales en ciencias de la salud tengan un entendimiento general pero completo, sobre los diferentes métodos disponibles para llevar a cabo tan encomiable actividad.

Scientific research is a fundamental tool for knowledge development in various fields of activity Medical and public health. its importance, as well as the need to convey its progress in pragmatic proposals, it has been highlighted in several works previous [1 - 3]. Therefore, it is crucial that science professionals of health have a general but complete understanding about the different methods available to carry out so commendable activity.

Fiebre por dengue asociada acolecistitis alitiásica / Dengue fever related acalculous acolecistitis

Contexto: El dengue representa un importante problema de salud pública en países con climas tropicales ysubtropicales. En su forma clásica se manifiesta con fiebre, mialgias, artralgias, dolor retroauricular y malestar general; no obstante, cuadros atípicos de síndrome febril pueden complicar el diagnóstico.Presentación del caso: Reportamos el caso de una mujer en edad fértil que se presentó con un cuadro febril de48 horas de evolución acompañado de dolor abdominal, malestar general y evidencia ecosonográfica decolecistitis alitiásica. Al décimo día de evolución se encontraron anticuerpos de tipo IgG e IgM anti-Dengue; por locual, se concluyó el diagnóstico de Fiebre de Dengue acompañada de colecistitis alitiásica.Conclusión: Es importante tener presente el diagnóstico de dengue en pacientes febriles que han viajadorecientemente a regiones tropicales y subtropicales o que residan en ellas, incluso en quienes su cuadro clínicono concuerde con la descripción clásica de la enfermedad.