Infectious Diseases
- Eliminating Mother-to-Child Transmission of HIV by 2030: 5 Strategies to Ensure Continued Progress
To keep up momentum in preventing mother-to-child transmission we propose: (1) advocating for greater political and financial commitment; (2) targeting high-risk populations such as adolescent girls and young women; (3) implementing novel service delivery models such as community treatment groups; (4) performing regular viral load monitoring during pregnancy and postpartum to ensure suppression before delivery and during breastfeeding; and (5) harnessing technology in monitoring and evaluation and HIV diagnostics.
- From Research to Policy: The WHO Experience With Developing Guidelines on the Potential Risk of HIV Acquisition and Progestogen-Only Contraception Use
To develop guidance for women at high risk of HIV, WHO carefully considered the risks of maternal morbidity and mortality from unintended pregnancy against possible increased risk of HIV acquisition with injectable use. Among the many challenges: (1) balancing timeliness of changing the guidance against the potential impact of it; (2) engaging a range of stakeholders; (3) translating complex research and policy messages to clients; (4) needing additional research; and (5) monitoring and evaluating successes and challenges with implementing new guidelines.
- Re-Evaluating the Possible Increased Risk of HIV Acquisition With Progestin-Only Injectables Versus Maternal Mortality and Life Expectancy in Africa: A Decision Analysis
Our model suggests that removing progestin-only injectables in Africa would have a net negative effect on maternal health, life expectancy, and mortality under a variety of scenarios.
- High Background Congenital Microcephaly in Rural Guatemala: Implications for Neonatal Congenital Zika Virus Infection Screening
A variety of microcephaly case definitions detect high background prevalence in rural Guatemala, which complicates congenital Zika screening efforts. In addition, gestational age is needed for most screening tools but is usually unknown in low-resource settings. Fenton growth curves, originally designed for use in preterm infants, offer a standardized approach to adjust for unknown gestational age and may improve screening efforts.
- Overcoming Operational Challenges to Ebola Case Investigation in Sierra Leone
Deficiencies in transportation and communication, low frontline staff morale, and mistrust among communities, among other operational challenges, greatly limited Ebola case investigation in Sierra Leone. Recommendations for future outbreaks: (1) timely compensation for frontline staff, (2) context-appropriate transportation and communication resources, (3) systematic data collection, storage, and retrieval systems, (4) sound linkages between frontline staff and communities, (5) daily meetings between frontline staff and epidemiologists, (6) clear and appropriate operational chain of command, and (7) political and funding support to operational agencies.
- Infant Feeding Policy and Programming During the 2014–2015 Ebola Virus Disease Outbreak in Sierra Leone
Policies on breastfeeding and possible mother-to-child transmission of Ebola Virus Disease (EVD) during the outbreak evolved depending on public health priorities and the evidence available at that particular time. To improve responses to future outbreaks, research on vertical transmission of EVD should be prioritized; infant and young child feeding experts should be integrated into the outbreak response; and a digital repository of national policies and associated messages should be created.
- Long-Acting HIV Treatment and Prevention: Closer to the Threshold
Substantial progress has been made toward viable, practical long-acting approaches to deliver HIV treatment and prevention through: (1) continued improvements in long-acting antiretrovirals (ARVs); (2) better innovative delivery systems; and (3) collaboration of willing partners to advance new ARVs. More progress on those 3 fronts is still needed to arrive at the goal of optimized HIV treatment and prevention for all who would benefit—and of finally controlling the HIV epidemic.
- Design Improvements for Personal Protective Equipment Used in Ebola and Other Epidemic Outbreaks
We redesigned the personal protective equipment ensemble widely used during the 2014 Ebola outbreak into a relatively simpler and more versatile coverall and hood, to improve protection and usability for frontline workers treating patients in infectious disease outbreaks around the world.
- CDC's Male Circumcision Recommendations Represent a Key Public Health Measure
Frisch and Earp, opponents of male circumcision, have criticized draft recommendations from the CDC that advocate counseling men and parents of newborn boys in the United States about the benefits and risks of male circumcision. We provide a rebuttal to Frisch and Earp's criticisms and contend that the recommendations are entirely appropriate and merit consideration for policy development.
- Referral Systems to Integrate Health and Economic Strengthening Services for People with HIV: A Qualitative Assessment in Malawi
Two types of referral systems were implemented in this low-resource context: (1) a simple paper-based system connecting clinical HIV and nutrition support to village savings and loans services, and (2) a complex mHealth-based system with more than 20 types of health, economic strengthening, livelihoods, and food security services. Clients reported the referrals improved their health and nutrition and ability to save money in both models but more with the simple model. Providers had difficulty using the mobile app under the mHealth system, even after repeated trainings, considerable ongoing technical assistance, and multiple rounds of revisions to the interface.