BMC Medical Ethics (Accessed 16 July 2016)

BMC Medical Ethics
(Accessed 16 July 2016)

Research article
HIV/AIDS clients, privacy and confidentiality; the case of two health centres in the Ashanti Region of Ghana
While most studies on HIV/AIDS often identify stigmatization and patients’ unwillingness to access health care as critical problems in the control of the pandemic, very few studies have focused on the possible…
Jonathan Mensah Dapaah and Kodjo A. Senah
BMC Medical Ethics 2016 17:41
Published on: 16 July 2016


Research article
Cluster randomized trial assessing the effects of rapid ethical assessment on informed consent comprehension in a low-resource setting
Adamu Addissie, Serebe Abay, Yeweyenhareg Feleke, Melanie Newport, Bobbie Farsides and Gail Davey
BMC Medical Ethics 2016 17:40
Published on: 12 July 2016
Maximizing comprehension is a major challenge for informed consent processes in low-literacy and resource-limited settings. Application of rapid qualitative assessments to improve the informed consent process is increasingly considered useful. This study assessed the effects of Rapid Ethical Assessment (REA) on comprehension, retention and quality of the informed consent process.
A cluster randomized trial was conducted among participants of HPV sero-prevalence study in two districts of Northern Ethiopia, in 2013. A total of 300 study participants, 150 in the intervention and 150 in the control group, were included in the study. For the intervention group, the informed consent process was designed with further revisions based on REA findings. Informed consent comprehension levels and quality of the consent process were measured using the Modular Informed Consent Comprehension Assessment (MICCA) and Quality of Informed Consent (QuIC) process assessment tools, respectively.
Study recruitment rates were 88.7 % and 80.7 % (p = 0.05), while study retention rates were 85.7 % and 70.3 % (p  < 0.005) for the intervention and control groups respectively. Overall, the mean informed consent comprehension scores for the intervention and control groups were 73.1 % and 45.2 %, respectively, with a mean difference in comprehension score of 27.9 % (95 % CI 24.0 % - 33.4 %; p <  0.001,). Mean scores for quality of informed consent for the intervention and control groups were 89.1 % and 78.5 %, respectively, with a mean difference of 10.5 % (95 % CI 6.8 -14.2 %; p < 0.001).
Levels of informed consent comprehension, quality of the consent process, study recruitment and retention rates were significantly improved in the intervention group. We recommend REA as a potential modality to improve informed consent comprehension and quality of informed consent process in low resource settings.

BMC Pregnancy and Childbirth (Accessed 16 July 2016)

BMC Pregnancy and Childbirth
(Accessed 16 July 2016)

Research article
Birth preparedness and place of birth in Tandahimba district, Tanzania: what women prepare for birth, where they go to deliver, and why
As making preparations for birth and health facility delivery are behaviours linked to positive maternal and newborn health outcomes, we aimed to describe what birth preparations were made, where women deliver…
Tara Tancred, Tanya Marchant, Claudia Hanson, Joanna Schellenberg and Fatuma Manzi
BMC Pregnancy and Childbirth 2016 16:165
Published on: 16 July 2016


Research article
Implementation of repeat HIV testing during pregnancy in Kenya: a qualitative study
Repeat HIV testing in late pregnancy has the potential to decrease rates of mother-to-child transmission of HIV by identifying mothers who seroconvert after having tested negative for HIV in early pregnancy.
Anna Joy Rogers, Elly Weke, Zachary Kwena, Elizabeth A. Bukusi, Patrick Oyaro, Craig R. Cohen and Janet M. Turan
BMC Pregnancy and Childbirth 2016 16:151
Published on: 11 July 2016

BMC Public Health (Accessed 16 July 2016)

BMC Public Health
(Accessed 16 July 2016)

Research article
The risk of falling into poverty after developing heart disease: a survival analysis
Those with a low income are known to have a higher risk of developing heart disease. However, the inverse relationship – falling into income poverty after developing heart disease has not been explored with lo…
Emily J. Callander and Deborah J. Schofield
BMC Public Health 2016 16:570
Published on: 15 July 2016


Research article
A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries
The reasons of deaths in developing countries are shifting from communicable diseases towards non-communicable diseases (NCDs). At the same time the number of health care interventions using mobile phones (mHe…
Victor Stephani, Daniel Opoku and Wilm Quentin
BMC Public Health 2016 16:572
Published on: 15 July 2016

Eurosurveillance – Volume 21, Issue 28, 14 July 2016 [Zika]

Volume 21, Issue 28, 14 July 2016

Surveillance report
Réunion Island prepared for possible Zika virus emergence, 2016
by S Larrieu, L Filleul, O Reilhes, M Jaffar-Bandjee, C Dumont, T Abossolo, H Thebault, E Brottet, F Pagès, P Vilain, I Leparc-Goffart, E Antok, D Vandroux, P Poubeau, M Moiton, P Von Theobald, F Chieze, A Gallay, H De Valk, F Bourdillon

Zika emergence in the French Territories of America and description of first confirmed cases of Zika virus infection on Martinique, November 2015 to February 2016
by E Daudens-Vaysse, M Ledrans, N Gay, V Ardillon, S Cassadou, F Najioullah, I Leparc-Goffart, D Rousset, C Herrmann, R Cesaire, M Maquart, O Flusin, S Matheus, P Huc-Anaïs, J Jaubert, A Criquet-Hayot, B Hoen, F Djossou, C Locatelli-Jouans, A Blateau, A McKenzie, M Melin, P Saint-Martin, F Dorléans, C Suivant, L Carvalho, M Petit-Sinturel, A Andrieu, H Noël, A Septfons, A Gallay, M Paty, L Filleul, A Cabié, the Zika Surveillance Working Group


Research Articles
The epidemiology and transmissibility of Zika virus in Girardot and San Andres island, Colombia, September 2015 to January 2016
by DP Rojas, NE Dean, Y Yang, E Kenah, J Quintero, S Tomasi, EL Ramirez, Y Kelly, C Castro, G Carrasquilla, ME Halloran, IM Longini

Globalization and Health [Accessed 16 July 2016]

Globalization and Health
[Accessed 16 July 2016]

Civil society: the catalyst for ensuring health in the age of sustainable development
Julia Smith, Kent Buse and Case Gordon
Published on: 16 July 2016
Sustainable Development Goal Three is rightly ambitious, but achieving it will require doing global health differently. Among other things, progressive civil society organisations will need to be recognised and supported as vital partners in achieving the necessary transformations. We argue, using illustrative examples, that a robust civil society can fulfill eight essential global health functions. These include producing compelling moral arguments for action, building coalitions beyond the health sector, introducing novel policy alternatives, enhancing the legitimacy of global health initiatives and institutions, strengthening systems for health, enhancing accountability systems, mitigating the commercial determinants of health and ensuring rights-based approaches. Given that civil society activism has catalyzed tremendous progress in global health, there is a need to invest in and support it as a global public good to ensure that the 2030 Agenda for Sustainable Development can be realised.


Breast cancer policy in Latin America: account of achievements and challenges in five countries
The recent increase of breast cancer mortality has put on alert to most countries in the region. However it has taken some time before breast cancer could be considered as a relevant problem.
Gustavo Nigenda, Maria Cecilia Gonzalez-Robledo, Luz Maria Gonzalez-Robledo and Rosa Maria Bejarano-Arias
Published on: 12 July 2016

Optimal control analysis of Ebola disease with control strategies of quarantine and vaccination

Infectious Diseases of Poverty
[Accessed 16 July 2016]

Research Article
Optimal control analysis of Ebola disease with control strategies of quarantine and vaccination
Muhammad Dure Ahmad, Muhammad Usman, Adnan Khan and Mudassar Imran
Published on: 13 July 2016
The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa. Some isolated cases were also observed in other regions of the world.
In this paper, we introduce a deterministic SEIR type model with additional hospitalization, quarantine and vaccination components in order to understand the disease dynamics. Optimal control strategies, both in the case of hospitalization (with and without quarantine) and vaccination are used to predict the possible future outcome in terms of resource utilization for disease control and the effectiveness of vaccination on sick populations. Further, with the help of uncertainty and sensitivity analysis we also have identified the most sensitive parameters which effectively contribute to change the disease dynamics. We have performed mathematical analysis with numerical simulations and optimal control strategies on Ebola virus models.
We used dynamical system tools with numerical simulations and optimal control strategies on our Ebola virus models. The original model, which allowed transmission of Ebola virus via human contact, was extended to include imperfect vaccination and quarantine. After the qualitative analysis of all three forms of Ebola model, numerical techniques, using MATLAB as a platform, were formulated and analyzed in detail. Our simulation results support the claims made in the qualitative section.
Our model incorporates an important component of individuals with high risk level with exposure to disease, such as front line health care workers, family members of EVD patients and Individuals involved in burial of deceased EVD patients, rather than the general population in the affected areas. Our analysis suggests that in order for R 0 (i.e., the basic reproduction number) to be less than one, which is the basic requirement for the disease elimination, the transmission rate of isolated individuals should be less than one-fourth of that for non-isolated ones. Our analysis also predicts, we need high levels of medication and hospitalization at the beginning of an epidemic. Further, optimal control analysis of the model suggests the control strategies that may be adopted by public health authorities in order to reduce the impact of epidemics like Ebola.

JAMA – July 12, 2016 [Special Focus – HIV, Vaccines, Prevention]

July 12, 2016, Vol 316, No. 2

Viewpoint | July 12, 2016
An HIV Vaccine -Mapping Uncharted Territory FREE
Anthony S. Fauci, MD1
JAMA. 2016;316(2):143-144. doi:10.1001/jama.2016.7538.
Scaling up access to antiretroviral therapy and proven approaches to HIV prevention potentially could control the HIV/AIDS pandemic and reduce it to a low level of endemicity. However, a safe and effective HIV vaccine would help reach this goal more quickly and in a more sustained way.

The scientific quest for an HIV vaccine spans nearly 3 decades and has taken multiple pathways, including attempts to induce antibody responses, T-cell responses, or combinations of both. These efforts have included human efficacy trials of monomeric HIV envelope glycoproteins, vectors containing inserts of HIV genes expressing envelope and other viral proteins, and prime-boost regimens that combine both approaches.1

So far, the only HIV vaccine efficacy trial to show promise was the RV144 trial conducted in Thailand. For immunogens, this study used a canarypox vector expressing HIV genes as a prime, followed by 2 booster injections of a recombinant HIV envelope glycoprotein.2 The trial resulted in a very modest vaccine efficacy of 31%. Neither broadly neutralizing antibodies nor cytolytic CD8+ T-cell responses were associated with protection against infection. Rather, IgG antibodies against the V1V2 region of the HIV envelope protein were associated with reduced infection.3 Efforts are now under way to improve on the results of RV144 in a southern African population by using multiple boosts, modified vectors, and adjuvants.

In addition to the follow-up of RV144, major HIV vaccine efforts have been launched in another direction: inducing broadly neutralizing antibodies (bNAbs) that can neutralize a wide range of HIV variants and hence afford protection against the rapidly mutating virus.1

Neutralizing antibodies have long been considered the “gold standard” of protection for vaccines against viruses because of the consistent observation that essentially all viral infections induce neutralizing antibodies, typically within days of infection. If the patient survives the infection, neutralizing antibodies usually clear the virus and provide lifelong protection against subsequent exposure to the same virus. Thus, the proof of concept for the development of a vaccine for most viruses is already provided by natural infection, and vaccines that optimally mimic natural infection have been the norm.

Not so for an HIV vaccine. The antigens presented by HIV to the immune system in natural infection do not elicit an adequate immune response to clear a virus that integrates,4 as evidenced by the lack of documented immune-mediated clearance of the virus by any known HIV-infected individual. HIV elicits high levels of broadly neutralizing antibodies in only a fraction of patients, usually only after a period of 2 or more years.1 With HIV, proving it is even possible for a vaccine to induce such antibodies is being explored by vaccinologists who are working in previously uncharted territory.

In their pursuit of bNAbs against HIV, scientists have used technologies that never before had been required (or even considered) in developing vaccines for other pathogens.1 These include x-ray crystallography and more recently cryoelectron microscopy to determine the native conformation of HIV envelope; novel cellular cloning technologies to isolate the rare B cells that recognize HIV envelope epitopes; high-throughput deep sequencing of B-cell genes and the unprecedented interrogation of the B-cell lineage to identify unmutated, germline B cells that might bind to known HIV envelope epitopes; and approaches to “steering” the B-cell lineage to make bNAbs.

The leading candidate for an HIV vaccine immunogen that elicits bNAbs is the viral envelope glycoprotein in forms that present native envelope epitopes. The HIV envelope is inherently unstable; in natural infection it preferentially presents to the immune system epitopes that elicit antibodies that are not broadly neutralizing, and that would be inadequate in the context of a vaccine. Investigators have determined that non-neutralizing antibodies bind to structures displayed on the unstable envelope, whereas several bNAbs bind readily to structural elements expressed on an experimentally stabilized envelope trimer.

A reasonable assumption, then, would be that the stable HIV envelope trimer may serve as a component of an immunogen to engage the relevant HIV-specific B-cell repertoire and induce it to produce bNAbs. Using the structural biological tools of x-ray crystallography and most recently the elegant technique of cryoelectron microscopy, investigators have successfully identified the near-native structure of the envelope trimer and stabilized it by insertion of various mutations.5 However, that was only the first step. The next step is to engage (if possible) the unmutated, naive B cells that give rise to bNAbs. These B cells are rare, occurring as infrequently as 1 in 2.5 million cells.

A major challenge encountered by scientists is that certain HIV envelope epitopes to which naturally occurring bNAbs bind do not bind to any identifiable germline B cell. Another potential obstacle was observed in an animal model: vaccination with a stable envelope trimer induced autologous neutralizing antibodies but not bNAbs.6 Thus, the process of generating bNAbs did not achieve its intended goal.
Subsequent efforts have been intensively directed at overcoming the inability to get past autologous neutralizing antibodies and proceed to production of bNAbs, notably with a new strategy that has been called “B-cell lineage design.” This concept was exemplified by a fortuitous experiment of nature. In an acute HIV infection study with extremely close follow-up of study participants, a patient who became infected was studied from the very earliest point after acute HIV infection.7 Scientists closely monitored the evolution of the antibody response and how the virus mutated to escape that evolving immune response. What unfolded was a back-and-forth of mutating virus escaping the immune response and the immune response evolving to keep up with the mutating virus. At the end of more than 2 years, the virus had coaxed along the immune response to produce antibodies that were broadly neutralizing for a wide variety of archived HIV isolates. However, the patient still had virus that was not neutralized by the resulting bNAb.7 Nonetheless, this observation fortified the concept of “B-cell lineage design” and the pursuit of sequential stimulation of the B-cell lineage with slightly different immunogens that mimic the evolving and mutating virus. Clearly, this strategy is quite different from the classic approach in vaccinology of priming and boosting with essentially the same antigen. The technically complex and intense interrogation and engagement of the B-cell limb of the immune response has provided some of the most elegant scientific studies performed in the context of vaccine development. However, it is unclear whether the application of this approach will be feasible in the context of a vaccine for millions of people.

Indeed, the field of HIV vaccinology is in uncharted territory. If efforts in developing an HIV vaccine based on the induction of bNAbs are successful, this achievement will represent the most elegant and complex scientific approach toward any vaccine in history. In contrast, if unsuccessful, this experience will be recorded as the most highly sophisticated and scientifically elegant proof that the development of such a vaccine is impossible. Hopefully, the former and not the latter will be true.

Marking Time in the Global HIV/AIDS Pandemic FREE
Gerald Friedland, MD
…The IAS conference returns to Durban in July 2016, and presents a unique opportunity to review the 15 years since the landmark 2000 meeting. It will document the current status of the global pandemic and consider and plan the future goals and strategies for the global struggle against HIV/AIDS.

Remarkably, a historic turn of events has been achieved during the past 15 years, representing perhaps one of the greatest scientific, medical, and public health realignment of resources between rich and poor. Resources and expertise have been shifted toward those poorer communities and populations in the world where the epidemic has reached full force. Research support has increased and has demonstrated the importance of new treatment and prevention tools and strategies of global benefit. Local governments and international agencies such as the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization; the Global Fund on AIDS, Tuberculosis, and Malaria; the US President’s Emergency Plan for AIDS Relief; other nations’ programs; nongovernmental organizations; academic institutions; private philanthropy; and other efforts have been assembled to meaningfully counteract the global pandemic, providing evidence-based prevention and treatment and attempting to reduce many of the issues of equity and health disparities at the pandemic’s core.

New HIV infections have declined by 35% since 2000 and the number of people accessing ART globally has doubled every 3 to 4 years, increasing exponentially from an estimated 690 000 in 2000 (the vast majority in the developed world) to 3 million in 2007 and to 17 million people at the end of 2015.3 Of these, 10.3 million (61%) were in sub-Saharan Africa. Global coverage of ART increased from less than 5% in 2000 to 46% at the end of 2015.4 South Africa has the largest HIV epidemic in the world, with an estimated 6.3 million people living with HIV in 2013, but now has initiated ART for nearly 3.4 million people living with HIV/AIDS, more than any other country in the world.4 Studies have demonstrated a restoration of life expectancy on a population level, similar to what had been seen in the United States after the introduction of ART5 and population-based declines in HIV transmission were shown as ART was rolled out.

The past 15 years also have seen a large increase in effective HIV prevention tools, including condoms, harm reduction, male circumcision, and vaginal microbicides as well as structural (ie, policies, laws, institutional, and administrative approaches) and community-based approaches. The availability and use of ART remains the most potent tool, both as treatment and prevention of new infections in maternal to child transmission, HIV discordant partners,6 and, most recently, as preexposure prophylaxis.7 All of these strategies, including those that address fundamental human rights, must be used in combination to provide the greatest benefit. With these effective tools and strategies, is the world now on the cusp of another epochal change in the pandemic?

The power of combining treatment and prevention has resulted in the formulation by UNAIDS of the 90-90-90 strategy to be accomplished by 2020.8 This is defined as 90% of all people living with HIV will know their HIV status, 90% of these will receive sustained ART, and 90% of these will have viral suppression. Further extending this to 2030 with a strategy of 95-95-95 is estimated to avert an additional 17.6 million HIV infections and 10.8 million AIDS-related deaths between 2016 and 2030,8 and carries the expectation that the pandemic will be eliminated (ie, the global prevalence of HIV will be reduced to a negligible amount and no longer represent a global public health threat).

However, enormous challenges remain in reaching these goals. They include the difficulties of engaging key populations with the treatment and prevention benefits, the fragility and weakness of the health care systems needed for their delivery, the fact that neither a vaccine nor cure is expected within this time frame and ART remains a lifelong therapy with challenges of linkage to care, medication adherence, and loss to follow-up all impinging on sustained viral suppression. Continued stigma and intractable human rights challenges, comorbidities, such as tuberculosis (the leading cause of mortality in people living with HIV/AIDS), and increasingly drug-resistant tuberculosis, all pose major hurdles.

In addition, it is unclear whether the costs to local and international communities will be bearable, estimated as increasing from the current $19 billion per year to $36 billion per year, and whether political will can be sustained over time.9 A central question at the 2016 IAS conference will be if, with the now-available powerful prevention and treatment tools, these goals and strategies are realistic and attainable or, at best, only aspirational.

The accomplishments of the past 15 years were similarly deemed unrealistic and aspirational, and perhaps such a triumph of global success will be repeated and the HIV/AIDS pandemic not only can be reversed, but contained. The 2016 IAS meeting in Durban will again provide a view of the present and a glimpse into the future of the still disastrous and volatile HIV/AIDS pandemic.

Condomless Sex With Virologically Suppressed HIV-Infected Individuals: How Safe Is It? FREE
Eric S. Daar, MD; Katya Corado, MD

Antiretrovirals for HIV Treatment and Prevention: The Challenges of Success FREE
Kenneth H. Mayer, MD; Douglas S. Krakower, MD

Visions for an AIDS-Free Generation: Red Ribbons of Hope FREE
Preeti N. Malani, MD, MSJ


Original Investigations
Effect of Patient Navigation With or Without Financial Incentives on Viral Suppression Among Hospitalized Patients With HIV Infection and Substance Use: A Randomized Clinical Trial FREE
Lisa R. Metsch, PhD; Daniel J. Feaster, PhD; Lauren Gooden, PhD; Tim Matheson, PhD; Maxine Stitzer, PhD; Moupali Das, MD; Mamta K. Jain, MD; Allan E. Rodriguez, MD; Wendy S. Armstrong, MD; Gregory M. Lucas, MD, PhD; Ank E. Nijhawan, MD; Mari-Lynn Drainoni, PhD; Patricia Herrera, MD; Pamela Vergara-Rodriguez, MD; Jeffrey M. Jacobson, MD; Michael J. Mugavero, MD; Meg Sullivan, MD; Eric S. Daar, MD; Deborah K. McMahon, MD; David C. Ferris, MD; Robert Lindblad, MD; Paul VanVeldhuisen, PhD; Neal Oden, PhD; Pedro C. Castellón, MPH; Susan Tross, PhD; Louise F. Haynes, MSW; Antoine Douaihy, MD; James L. Sorensen, PhD; David S. Metzger, PhD; Raul N. Mandler, MD; Grant N. Colfax, MD; Carlos del Rio, MD
Includes: Supplemental Content

Sexual Activity Without Condoms and Risk of HIV Transmission in Serodifferent Couples When the HIV-Positive Partner Is Using Suppressive Antiretroviral Therapy FREE
Alison J. Rodger, MD; Valentina Cambiano, PhD; Tina Bruun, RN; Pietro Vernazza, MD; Simon Collins; Jan van Lunzen, PhD; Giulio Maria Corbelli; Vicente Estrada, MD; Anna Maria Geretti, MD; Apostolos Beloukas, PhD; David Asboe, FRCP; Pompeyo Viciana, MD; Félix Gutiérrez, MD; Bonaventura Clotet, PhD; Christian Pradier, MD; Jan Gerstoft, MD; Rainer Weber, MD; Katarina Westling, MD; Gilles Wandeler, MD; Jan M. Prins, PhD; Armin Rieger, MD; Marcel Stoeckle, MD; Tim Kümmerle, PhD; Teresa Bini, MD; Adriana Ammassari, MD; Richard Gilson, MD; Ivanka Krznaric, PhD; Matti Ristola, PhD; Robert Zangerle, MD; Pia Handberg, RN; Antonio Antela, PhD; Sris Allan, FRCP; Andrew N. Phillips, PhD; Jens Lundgren, MD; for the PARTNER Study Group
Includes: CME, Supplemental Content
Editorial: Condomless Sex With Virologically Suppressed HIV-Infected Individuals;
Eric S. Daar, MD; Katya Corado, MD

Association of Medical Male Circumcision and Antiretroviral Therapy Scale-up With Community HIV Incidence in Rakai, Uganda FREE
Xiangrong Kong, PhD; Godfrey Kigozi, MB, ChB, PhD; Joseph Ssekasanvu, MS; Fred Nalugoda, PhD; Gertrude Nakigozi, MD, MPH; Anthony Ndyanabo, MSc; Tom Lutalo, MS; Steven J. Reynolds, MD, MPH; Robert Ssekubugu, MHS; Joseph Kagaayi, MB, ChB, PhD; Eva Bugos, BS; Larry W. Chang, MD, MPH; Pilgrim Nanlesta, PhD; Grabowski Mary, PhD; Amanda Berman, MSPH, MPhil; Thomas C. Quinn, MD; David Serwadda, MB, ChB, MMed, MPH; Maria J. Wawer, MD, MSH; Ronald H. Gray, MD, MSc
Includes: CME, Supplemental Content


Special Communication
Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society–USA Panel FREE
Huldrych F. Günthard, MD; Michael S. Saag, MD; Constance A. Benson, MD; Carlos del Rio, MD; Joseph J. Eron, MD; Joel E. Gallant, MD, MPH; Jennifer F. Hoy, MBBS, FRACP; Michael J. Mugavero, MD, MHSc; Paul E. Sax, MD; Melanie A. Thompson, MD; Rajesh T. Gandhi, MD; Raphael J. Landovitz, MD; Davey M. Smith, MD; Donna M. Jacobsen, BS; Paul A. Volberding, MD
Includes: CME, Supplemental Content
Editorial: Antiretrovirals for HIV Treatment and Prevention; Kenneth H. Mayer, MD; Douglas S. Krakower, MD


From the JAMA Network
Reaching High-Risk Patients for HIV Preexposure Prophylaxis FREE
James Riddell IV, MD; Jonathan A. Cohn, MD, MS

The Role of Food Banks in Addressing Food Insecurity: A Systematic Review

Journal of Community Health
Volume 41, Issue 4, August 2016

Original Paper
The Role of Food Banks in Addressing Food Insecurity: A Systematic Review
August 2016, Volume 41, Issue 4, pp 732-740
Chantelle Bazerghi, Fiona H. McKay, Matthew Dunn
Food banks play a major role in the food aid sector by distributing donated and purchased groceries directly to food insecure families. The public health implications of food insecurity are significant, particularly as food insecurity has a higher prevalence among certain population groups. This review consolidates current knowledge about the function and efficacy of food banks to address food insecurity. A systematic review was conducted. Thirty-five publications were reviewed, of which 14 examined food security status, 13 analysed nutritional quality of food provided, and 24 considered clients’ needs in relation to food bank use. This review found that while food banks have an important role to play in providing immediate solutions to severe food deprivation, they are limited in their capacity to improve overall food security outcomes due to the limited provision of nutrient-dense foods in insufficient amounts, especially from dairy, vegetables and fruits. Food banks have the potential to improve food security outcomes when operational resources are adequate, provisions of perishable food groups are available, and client needs are identified and addressed.

Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends

The Lancet
Jul 16, 2016 Volume 388 Number 10041 p211-306

Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends
Gilda Sedgh, Jonathan Bearak, Susheela Singh, Akinrinola Bankole, Anna Popinchalk, Bela Ganatra, Clémentine Rossier, Caitlin Gerdts, Özge Tunçalp, Brooke Ronald Johnson Jr, Heidi Bart Johnston, Leontine Alkema
Information about the incidence of induced abortion is needed to motivate and inform efforts to help women avoid unintended pregnancies and to monitor progress toward that end. We estimate subregional, regional, and global levels and trends in abortion incidence for 1990 to 2014, and abortion rates in subgroups of women. We use the results to estimate the proportion of pregnancies that end in abortion and examine whether abortion rates vary in countries grouped by the legal status of abortion.
We requested abortion data from government agencies and compiled data from international sources and nationally representative studies. With data for 1069 country-years, we estimated incidence using a Bayesian hierarchical time series model whereby the overall abortion rate is a function of the modelled rates in subgroups of women of reproductive age defined by their marital status and contraceptive need and use, and the sizes of these subgroups.
We estimated that 35 abortions (90% uncertainty interval [UI] 33 to 44) occurred annually per 1000 women aged 15–44 years worldwide in 2010–14, which was 5 points less than 40 (39–48) in 1990–94 (90% UI for decline −11 to 0). Because of population growth, the annual number of abortions worldwide increased by 5·9 million (90% UI −1·3 to 15·4), from 50·4 million in 1990–94 (48·6 to 59·9) to 56·3 million (52·4 to 70·0) in 2010–14. In the developed world, the abortion rate declined 19 points (−26 to −14), from 46 (41 to 59) to 27 (24 to 37). In the developing world, we found a non-significant 2 point decline (90% UI −9 to 4) in the rate from 39 (37 to 47) to 37 (34 to 46). Some 25% (90% UI 23 to 29) of pregnancies ended in abortion in 2010–14. Globally, 73% (90% UI 59 to 82) of abortions were obtained by married women in 2010–14 compared with 27% (18 to 41) obtained by unmarried women. We did not observe an association between the abortion rates for 2010–14 and the grounds under which abortion is legally allowed.
Abortion rates have declined significantly since 1990 in the developed world but not in the developing world. Ensuring access to sexual and reproductive health care could help millions of women avoid unintended pregnancies and ensure access to safe abortion.
UK Government, Dutch Ministry of Foreign Affairs, Norwegian Agency for Development Cooperation, The David and Lucile Packard Foundation, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

Coping Strategies for Landslide and Flood Disasters: A Qualitative Study of Mt. Elgon Region, Uganda

PLOS Currents: Disasters
[Accessed 16 July 2016]

Research Article
Coping Strategies for Landslide and Flood Disasters: A Qualitative Study of Mt. Elgon Region, Uganda
July 11, 2016
Introduction: The occurrence of landslides and floods in East Africa has increased over the past decades with enormous Public Health implications and massive alterations in the lives of those affected. In Uganda, the Elgon region is reported to have the highest occurrence of landslides and floods making this area vulnerable. This study aimed at understanding both coping strategies and the underlying causes of vulnerability to landslides and floods in the Mt. Elgon region.
Methods: We conducted a qualitative study in three districts of Bududa, Manafwa and Butalejja in the Mt. Elgon region in eastern Uganda. Six Focus Group Discussions (FGDs) and eight Key Informant Interviews (KIIs) were conducted. We used trained research assistants (moderator and note taker) to collect data. All discussions were audio taped, and were transcribed verbatim before analysis. We explored both coping strategies and underlying causes of vulnerability. Data were analysed using latent content analysis; through identifying codes from which basis categories were generated and grouped into themes.
Results: The positive coping strategies used to deal with landslides and floods included adoption of good farming methods, support from government and other partners, livelihood diversification and using indigenous knowledge in weather forecasting and preparedness. Relocation was identified as unsustainable because people often returned back to high risk areas. The key underlying causes of vulnerability were; poverty, population pressure making people move to high risk areas, unsatisfactory knowledge on disaster preparedness and, cultural beliefs affecting people’s ability to cope.
Conclusion: This study revealed that deep rooted links to poverty, culture and unsatisfactory knowledge on disaster preparedness were responsible for failure to overcome the effects to landslides and floods in disaster prone communities of Uganda. However, good farming practices and support from the government and implementation partners were shown to be effective in enabling the community to lessen the negative effects disasters. This calls for high impact innovative interventions focused in addressing these underlying causes as well as involvement of all stakeholders in scaling the effective coping strategies in order to build resilience in this community and other similarly affected areas.

PLoS Neglected Tropical Diseases [Accessed 16 July 2016]

PLoS Neglected Tropical Diseases
[Accessed 16 July 2016]

The Vaccination of 35,000 Dogs in 20 Working Days Using Combined Static Point and Door-to-Door Methods in Blantyre, Malawi
Andrew D Gibson, Ian G Handel, Kate Shervell, Tarryn Roux, Dagmar Mayer, Stanford Muyila, Golden B Maruwo, Edwin M. S Nkhulungo, Rachel A Foster, Patrick Chikungwa, Bernard Chimera, Barend M.deC Bronsvoort, Richard J Mellanby, Luke Gamble
Research Article | published 14 Jul 2016 | PLOS Neglected Tropical Diseases


Community Willingness to Participate in a Dengue Study in Aceh Province, Indonesia

PLoS One
[Accessed 16 July 2016]

Research Article
Community Willingness to Participate in a Dengue Study in Aceh Province, Indonesia
Harapan Harapan, Samsul Anwar, Aslam Bustaman, Arsil Radiansyah, Pradiba Angraini, Riny Fasli, Salwiyadi Salwiyadi, Reza Akbar Bastian, Ade Oktiviyari, Imaduddin Akmal, Muhammad Iqbalamin, Jamalul Adil, Fenni Henrizal, Darmayanti Darmayanti, Rovy Pratama, Jonny Karunia Fajar, Abdul Malik Setiawan, Allison Imrie, Ulrich Kuch, David Alexander Groneberg, R. Tedjo Sasmono, Meghnath Dhimal, Ruth Müller
Research Article | published 12 Jul 2016 | PLOS ONE
Dengue virus infection is the most rapidly spreading vector-borne disease in the world. Essential research on dengue virus transmission and its prevention requires community participation. Therefore, it is crucial to understand the factors that are associated with the willingness of communities in high prevalence areas to participate in dengue research. The aim of this study was to explore factors associated with the willingness of healthy community members in Aceh province, Indonesia, to participate in dengue research that would require phlebotomy.
Methodology/Principal Findings
A community-based cross-sectional study was carried out in nine regencies and municipalities of Aceh from November 2014 to March 2015. Interviews using a set of validated questionnaires were conducted to collect data on demography, history of dengue infection, socioeconomic status, and knowledge, attitude and practice regarding dengue fever. Two-step logistic regression and Spearman’s rank correlation (rs) analysis were used to assess the influence of independent variables on dependent variables. Among 535 participants, less than 20% had a good willingness to participate in the dengue study. The factors associated with good willingness to participate were being female, working as a civil servant, private employee or entrepreneur, having a high socioeconomic status and good knowledge, attitude and practice regarding dengue. Good knowledge and attitude regarding dengue were positive independent predictors of willingness to participate (OR: 2.30 [95% CI: 1.36–3.90] and 3.73 [95% CI: 2.24–6.21], respectively).
The willingness to participate in dengue research is very low among community members in Aceh, and the two most important associated factors are knowledge and attitude regarding dengue. To increase participation rate, efforts to improve the knowledge and attitude of community members regarding dengue fever and dengue-related research is required before such studies are launched.

Equity and length of lifespan are not the same

PNAS – Proceedings of the National Academy of Sciences of the United States of America
(Accessed 16 July 2016)

Social Sciences – Social Sciences – Biological Sciences – Medical Sciences:
Equity and length of lifespan are not the same
Benjamin Seligman, Gabi Greenberg, and Shripad Tuljapurkar
PNAS 2016 ; published ahead of print July 11, 2016, doi:10.1073/pnas.1601112113
We find that the causes of death that have led to greater equality among lifespans are different from the causes that have led to longer average lifespan, also called life expectancy. Control of leading causes of death, such as heart disease, increased life expectancy, whereas medical interventions on infant mortality led to greater equality. Action to promote health equity will require further mitigation of the killers of young people rather than solely focusing on the most common causes of death.
Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy; in particular, they affect mortality at younger ages. We also find that, for two leading causes of death [cancers and cardiovascular disease (CVD)], there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.

Reproductive Health [Accessed 16 July 2016]

Reproductive Health
[Accessed 16 July 2016]

Study protocol
Zika virus infection in pregnant women in Honduras: study protocol
Although there is increasing evidence for a relationship between symptomatic Zika virus (ZIKV) maternal infection, and microcephaly, a firm causal relation has yet to be established by epidemiologic studies.
Pierre Buekens, Jackeline Alger, Fernando Althabe, Eduardo Bergel, Amanda M. Berrueta, Carolina Bustillo, Maria-Luisa Cafferata, Emily Harville, Karla Rosales, Dawn M. Wesson and Concepcion Zuniga
Reproductive Health 2016 13:82
Published on: 16 July 2016


Male involvement in reproductive, maternal and child health: a qualitative study of policymaker and practitioner perspectives in the Pacific
The importance of involving men in reproductive, maternal and child health programs is increasingly recognised globally. In the Pacific region, most maternal and child health services do not actively engage ex…
Jessica Davis, Joseph Vyankandondera, Stanley Luchters, David Simon and Wendy Holmes
Reproductive Health 2016 13:81
Published on: 16 July 2016

The Lebanese–Syrian crisis: impact of influx of Syrian refugees to an already weak state

Risk Management and Healthcare Policy
Volume 9, 2016
[Accessed 16 July 2016]

Original Research
The Lebanese–Syrian crisis: impact of influx of Syrian refugees to an already weak state
Cherri Z, Arcos González P, Castro Delgado R
Risk Management and Healthcare Policy 2016, 9:165-172
Published Date: 14 July 2016
Background: Lebanon, a small Middle Eastern country facing constant political and national unity challenges with a population of approximately 300,000 Palestinian and Iraqi refugees, has welcomed more than 1.2 million Office of the United Nations Commissioner for Refugees (UNHCR)-registered Syrian refugees since 2012. The Government of Lebanon considers individuals who crossed Lebanese–Syrian borders since 2011 as “displaced”, emphasizing its long-standing position that Lebanon is not a state for refugees, refusing to establish camps, and adopting a policy paper to reduce their numbers in October 2014. Humanitarian response to the Syrian influx to Lebanon has been constantly assembling with the UNHCR as the main acting body and the Lebanon Crisis Response Plan as the latest plan for 2016.
Methods: Review of secondary data from gray literature and reports focusing on the influx of Syrian refugees to Lebanon by visiting databases covering humanitarian response in complex emergencies. Limitations include obtaining majority of the data from gray literature and changing statistics due to the instability of the situation.
Results: The influx of Syrian refugees to Lebanon, an already weak and vulnerable state, has negatively impacted life in Lebanon on different levels including increasing demographics, regressing economy, exhausting social services, complicating politics, and decreasing security as well as worsened the life of displaced Syrians themselves.
Conclusion: Displaced Syrians and Lebanese people share aggravating hardships of a mutual and precarious crisis resulting from the Syrian influx to Lebanon. Although a lot of response has been initiated, both populations still lack much of their basic needs due to lack of funding and nonsustainable program initiatives. The two major recommendations for future interventions are to ensure continuous and effective monitoring and sustainability in order to alleviate current and future suffering in Lebanon.

Science – 15 July 2016

15 July 2016 Vol 353, Issue 6296
Special Issue – Natural Hazards

Human influence on tropical cyclone intensity
By Adam H. Sobel, Suzana J. Camargo, Timothy M. Hall, Chia-Ying Lee, Michael K. Tippett, Allison A. Wing
Science15 Jul 2016 : 242-246

Global trends in satellite-based emergency mapping
By Stefan Voigt, Fabio Giulio-Tonolo, Josh Lyons, Jan Kučera, Brenda Jones, Tobias Schneiderhan, Gabriel Platzeck, Kazuya Kaku, Manzul Kumar Hazarika, Lorant Czaran, Suju Li, Wendi Pedersen, Godstime Kadiri James, Catherine Proy, Denis Macharia Muthike, Jerome Bequignon, Debarati Guha-Sapir
Science15 Jul 2016 : 247-252


Policy Forum
Crisis informatics—New data for extraordinary times
By Leysia Palen, Kenneth M. Anderson
Science15 Jul 2016 : 224-225
Focus on behaviors, not on fetishizing social media tools

Butterfly communities under threat
By Jeremy A. Thomas
Science15 Jul 2016 : 216-218
Butterfly populations are declining worldwide as a result of habitat loss and degradation

How much biodiversity loss is too much?
By Tom H. Oliver
Science15 Jul 2016 : 220-221
Widespread biodiversity losses are observed but safe-limit thresholds remain uncertain

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
Week ending 9 July 2016

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice

pdf version: The Sentinel_ week ending 9 July 2016

Contents [click on link below to move to associated content]
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals

:: Journal Watch

:: Journal Watch
The Sentinel will track key peer-reviewed journals which address a broad range of interests in human rights, humanitarian response, health and development. It is not intended to be exhaustive. We will add to those monitored below as we encounter relevant content and upon recommendation from readers. We selectively provide full text of abstracts and other content but note that successful access to some of the articles and other content may require subscription or other access arrangement unique to the publisher. Please suggest additional journals you feel warrant coverage.

Annals of Internal Medicine – 5 July 2016

Annals of Internal Medicine
5 July 2016, Vol. 165. No. 1

Original Research
Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States
Cora L. Bernard, MS; Margaret L. Brandeau, PhD; Keith Humphreys, PhD; Eran Bendavid, MD, MS; Mark Holodniy, MD; Christopher Weyant, MS; Douglas K. Owens, MD, MS; and Jeremy D. Goldhaber-Fiebert, PhD
Background: The total population health benefits and costs of HIV preexposure prophylaxis (PrEP) for people who inject drugs (PWID) in the United States are unclear.
Objective: To evaluate the cost-effectiveness and optimal delivery conditions of PrEP for PWID.
Design: Empirically calibrated dynamic compartmental model.
Data Sources: Published literature and expert opinion.
Target Population: Adult U.S. PWID.
Time Horizon: 20 years and lifetime.
Intervention: PrEP alone, PrEP with frequent screening (PrEP+screen), and PrEP+screen with enhanced provision of antiretroviral therapy (ART) for individuals who become infected (PrEP+screen+ART). All scenarios are considered at 25% coverage.
Outcome Measures: Infections averted, deaths averted, change in HIV prevalence, discounted costs (in 2015 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
Results of Base-Case Analysis: PrEP+screen+ART dominates other strategies, averting 26 700 infections and reducing HIV prevalence among PWID by 14% compared with the status quo. Achieving these benefits costs $253 000 per QALY gained. At current drug prices, total expenditures for PrEP+screen+ART could be as high as $44 billion over 20 years.
Results of Sensitivity Analysis: Cost-effectiveness of the intervention is linear in the annual cost of PrEP and is dependent on PrEP drug adherence, individual transmission risks, and community HIV prevalence.
Limitation: Data on risk stratification and achievable PrEP efficacy levels for U.S. PWID are limited.
Conclusion: PrEP with frequent screening and prompt treatment for those who become infected can reduce HIV burden among PWID and provide health benefits for the entire U.S. population, but, at current drug prices, it remains an expensive intervention both in absolute terms and in cost per QALY gained.
Primary Funding Source: National Institute on Drug Abuse.


Addressing Infection Prevention and Control in the First U.S. Community Hospital to Care for Patients With Ebola Virus Disease: Context for National Recommendations and Future Strategies
Kristin J. Cummings, MD, MPH; Mary J. Choi, MD, MPH; Eric J. Esswein, MSPH, CIH; Marie A. de Perio, MD; Joshua M. Harney, MS, CIH; Wendy M. Chung, MD, MS; David L. Lakey, MD; Allison M. Liddell, MD; and Pierre E. Rollin, MD
Health care personnel (HCP) caring for patients with Ebola virus disease (EVD) are at increased risk for infection with the virus. In 2014, a Texas hospital became the first U.S. community hospital to care for a patient with EVD; 2 nurses were infected while providing care. This article describes infection control measures developed to strengthen the hospital’s capacity to safely diagnose and treat patients with EVD. After admission of the first patient with EVD, a multidisciplinary team from the Centers for Disease Control and Prevention (CDC) joined the hospital’s infection preventionists to implement a system of occupational safety and health controls for direct patient care, handling of clinical specimens, and managing regulated medical waste. Existing engineering and administrative controls were strengthened. The personal protective equipment (PPE) ensemble was standardized, HCP were trained on donning and doffing PPE, and a system of trained observers supervising PPE donning and doffing was implemented. Caring for patients with EVD placed substantial demands on a community hospital. The experiences of the authors and others informed national policies for the care of patients with EVD and protection of HCP, including new guidance for PPE, a rapid system for deploying CDC staff to assist hospitals (“Ebola Response Team”), and a framework for a tiered approach to hospital preparedness. The designation of regional Ebola treatment centers and the establishment of the National Ebola Training and Education Center address the need for HCP to be prepared to safely care for patients with EVD and other high-consequence emerging infectious diseases.