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Objective: We report the prevalence, characteristics and clinical outcomes of women with sexually transmitted infections (STIs) in pregnancy in the Western Sydney Local Health District (WSLHD) serving a large culturally and socio-economically diverse community in New South Wales (NSW), Australia, over the last 10 years., Methods: A retrospective cohort study of all pregnant women booked for antenatal care at three hospitals in WSLHD between September 2012 and August 2022 inclusive. Characteristics and birth outcomes associated with STIs diagnosed in pregnancy (chlamydia, gonorrhea, and syphilis) are reported using multivariable logistic regression adjusting for relevant confounders., Results: During 2012-2022, there were 102 905 births and 451 women (0.44%) with an STI diagnosis during pregnancy. The number of women with a history of chlamydia prior to their current pregnancy has increased over the last 10 years (P < 0.001). STIs in pregnancy were more common in younger women aged <20 years (adjusted odds ratio [aOR] 7.30, 95% confidence interval [CI] 5.04-10.57), 20-24 years (aOR 3.12, 95% CI 2.46-3.96), and >40 years (adj OR 1.67, 95% CI 1.07-2.59), in women with body mass index >30 (aOR 1.73, 95%CI 1.37-2.19), and those who smoked (aOR 2.24, 95% CI 1.71-2.94) and consumed alcohol (aOR 3.14, 95% CI 1.88-5.23) and illicit drugs (aOR 2.10, 95% CI 1.31-3.36). STIs in pregnancy were borderline associated with stillbirth (aOR 2.19 95% CI 0.90-5.36) but did not have a significant impact on preterm birth (aOR 1.21, 95% CI 0.87-1.68), admission to neonatal intensive care unit (NICU) (aOR 1.02, 95% CI 0.77-1.34), or having a small-for-gestational-age (SGA) baby (aOR 0.97, 95% CI 0.74-1.27)., Conclusions: Sociodemographic factors such as age, weight, smoking, and alcohol and drug use, were associated with the STI incidence in pregnancy. While the latter did not have an impact on preterm birth, NICU admission, and SGA in our cohort, there was a borderline association with stillbirth. Future research should identify barriers and facilitators to testing in a multicultural population and understanding the drivers of higher rates of STIs in certain population groups., (© 2024 International Federation of Gynecology and Obstetrics.)

Background: Infectious diseases including syphilis, HIV, and hepatitis B are major contributors to maternal and neonatal morbidity and mortality worldwide, especially in low- and middle-income countries (LMICs). The World Health Organization has prioritized elimination of vertical transmission of these three diseases., Objectives: To rapidly assess the impact of interventions designed to improve antenatal screening rates for syphilis, HIV, and hepatitis B in LMICs and to identify areas for future implementation research., Search Strategy: A comprehensive search was conducted across PubMed, Embase, and EconLit, targeting articles published between January 1, 2013, and June 27, 2023., Selection Criteria: We included quantitative interventional studies in English, involving pregnant adults (15 years or older) from LMICs. Exclusions were studies based in high-income countries, qualitative studies, or those investigating accuracy of diagnostic methods., Data Collection and Analysis: From an initial 5549 potential studies, 27 were finalized for review after various screening stages. Data extraction covered aspects such as study design, intervention details, and outcomes. Findings were qualitatively synthesized within a systems thinking framework., Main Results: The interventions assessed varied in terms of geographic locations, health care system levels, and modalities. The review highlighted the effectiveness of interventions such as community health interventions, service quality improvements, and financial incentives., Conclusions: The study underscores the potential of specific interventions in enhancing antenatal screening rates in LMICs. However, there is a discernible research gap concerning hepatitis B. The findings emphasize the importance of capacity building and health systems strengthening in public health interventions., (© 2024 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.)

Background: Gynecological cancers are one of the most important threats to women's health worldwide. The objective of this review is to synthesize and present the best available evidence on the experiences relating to sexual well-being among Muslim women with gynecological cancer., Methods: The databases searched included Web of Science, Scopus, SID, Google Scholar, ProQuest, MEDLINE, and CINAHL from the inception of the database until August 2021. The review was guided by the JBI methodology used for qualitative systematic reviews. Findings were collated using the meta-aggregation method through JBI SUMARI., Results: Eight studies involving Muslim women cancer survivors were included in the review. Meta-synthesis of the eight included studies generated 59 findings, which were organized into 14 categories and combined into four synthesized findings., Conclusions: Gynecological cancer and its treatment results in numerous challenges with sexual well-being among Muslim women cancer survivors. Providing information about sexual activity following gynecological cancer, better communication from health care professionals, and support from the husband is essential to overcome the struggle with intimacy and femininity experienced by the women, thus improving the sexual quality of life of Muslim gynecological cancer survivors., (© Samaneh Alinejad Mofrad et al., 2024; Published by Mary Ann Liebert, Inc.)

Introduction: Anemia remains a prevalent global health issue with varying severity. Intravenous iron supplementation, particularly with ferric carboxymaltose (FCM), has appeared as a possible therapeutic intervention for individuals with moderate to severe anemia. The study aimed to assess the efficacy and safety of ferric carboxymaltose (FCM) in reducing anemia., Methods: We searched electronic databases, registries, websites, e-libraries, reference lists of reviews, citations, etc. We included randomized control trials (RCTs), non-RCTs, and single-arm studies, while observational studies, case series, and case studies were excluded. Two reviewers independently screened the studies and extracted the data. We included studies of moderate-to-severely anemic Indians and excluded Indians with other comorbidities. We assessed the risk of bias and the overall quality of evidence (QoE) using GRADE GDT., Result: We identified 255 studies and included 14 studies (11 RCT, one non-RCT, and two single-arm studies) with 1,972 participants for qualitative analysis and 10 studies in the meta-analysis. All the included studies detailed the use of FCM for anemia. The primary outcomes assessed in the included studies were anemia, hemoglobin, and adverse events. The outcomes assessed ranged from 2 weeks to 12 weeks. The risk of bias varied across different studies with different outcomes. FCM is consistent with a fewer number of adverse events as compared to other interventions and provides "moderate" to "very low" QoE., Conclusion: A slow single infusion of 1 gram of FCM is well-tolerated, safe, and effective in treating iron deficiency anemia (IDA) and surpasses other interventions (Iron Sucrose Complex (ISC), Iron sucrose, and ferrous ascorbate) in elevating hemoglobin levels and replenishing iron stores., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=459363, CRD42023459363., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Khatib, Sinha, Gaidhane, Upadhyay, Waghmare, Anil, Saxena, Sawleshwarkar, Simkhada, Gaidhane and Quazi.)

Background: Optimal breastfeeding (BF) practices are essential for child survival and proper growth and development. The purpose of this overview is to evaluate the effectiveness of different interventions for promoting and optimizing breastfeeding., Methods: We included systematic reviews (SRs) [including trials from Low-Income (LICs) and Low Middle-Income countries (LMICs)] that have evaluated the effect of various interventions for promoting and optimizing breastfeeding and excluded non-systematic reviews, and SRs based on observational studies. We searched various electronic databases. We followed the standard methodology as suggested by the Cochrane Handbook for Systematic Reviews of Interventions. Two sets of reviewers undertook screening followed by data extraction and assessment of the methodological quality of included SRs., Result: We identified and screened 1,002 Cochrane SRs and included six SRs in this overview. Included SRs reported only two of the primary outcomes, early initiation of breastfeeding (EIBF) and/or exclusive breastfeeding (EBF). None of the included SR reported continued BF up to 2 years of age. The results were evaluated using two major comparisons groups: BF intervention against routine care and one type of BF intervention vs. other types of BF intervention. Overall results from included SRs showed that there were improvements in the rates of EIBF and EBF among women who received BF intervention such as BF education sessions and support compared to those women who received only standard care. However, BF intervention via mobile devices showed no improvements. In Target Client Communication (TCC) via mobile devices intervention group, no significant improvements were reported in BF practices, and also the reported evidence was of very low certainty., Conclusion: Community Based Intervention Packages (CBIP) delivered to pregnant and reproductive-age women during their Antenatal care (ANC) and/or Postnatal care (PNC) periods by Ancillary Nurse-Midwives reported the highest improvement in EIBF compared to women who received standard care. However, insufficient evidence was reported to suggest that BF intervention showed improvements in EBF in both the comparison groups. This overview highlighted the gaps in primary research regarding the uncertainty about the settings such as LICs or LMICs, lack of evidence from LMICs, and also identified gaps in the availability of reliable up-to-date SRs on the effects of several BF interventions to promote and optimize practices., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42020174998, PROSPERO [CRD42020174998]., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Khatib, Gaidhane, Upadhyay, Telrandhe, Saxena, Simkhada, Sawleshwarkar and Quazi.)

Background: Japanese encephalitis virus (JEV) is a zoonotic mosquito-borne virus that causes a significant burden of disease across Asia, particularly in India, with high mortality in children. JEV circulates in wild ardeid birds and domestic pig reservoirs, both of which generate sufficiently high viraemias to infect vector mosquitoes, which can then subsequently infect humans. The landscapes of these hosts, particularly in the context of anthropogenic ecotones and resulting wildlife-livestock interfaces, are poorly understood and thus significant knowledge gaps in the epidemiology of JEV persist. This study sought to investigate the landscape epidemiology of JEV outbreaks in India over the period 2010-2020 to determine the influence of shared wetland and rain-fed agricultural landscapes and animal hosts on outbreak risk., Methods: Using surveillance data from India's National Centre for Disease Control Integrated Disease Surveillance Programme, JEV outbreaks were modelled as an inhomogeneous Poisson point process and externally validated against independently sourced data., Results: Outbreak risk was strongly associated with the habitat suitability of ardeid birds, both pig and chicken density, and the shared landscapes between fragmented rain-fed agriculture and both river and freshwater marsh wetlands., Conclusion: The results from this work provide the most complete understanding of the landscape epidemiology of JEV in India to date and suggest important One Health priorities for control and prevention across fragmented terrain comprising a wildlife-livestock interface that favours spillover to humans., (© The Author(s) 2022. Published by Oxford University Press on behalf of the International Epidemiological Association.)

Wild reservoirs of Japanese encephalitis virus are under-studied globally, which presents critical knowledge gaps for JEV epidemiology and infection ecology despite decades of received wisdom regarding this high-impact mosquito-borne virus. As a result, ardeid birds, generally understood to be the primary reservoirs for JEV, as well as other waterbirds occupying landscapes at high risk for spillover to humans, are frequently ignored by current surveillance mechanisms and infrastructure. This is particularly true in India, which experiences a high annual burden of human outbreaks. Incorporating wild reservoirs into surveillance of human and livestock populations is therefore essential but will first require a data-driven approach to target individual host species. The current study sought to identify preliminary waterbird target species for JEV surveillance development based on species' distributions in high-risk landscapes. Twenty-one target species were identified after adjusting species presence and abundance for the biotic constraints of sympatry. Furthermore, ardeid bird species richness demonstrated a strong non-linear association with the distribution of human JEV outbreaks, which suggested areas with the highest ardeid species richness corresponded to low JEV outbreak risk. No association was identified between JEV outbreaks and anatid or rallid richness. The lack of association between Anatidae and Rallidae family-level diversity and JEV outbreak risk notwithstanding, this study did identify several individual species among these two bird families in high-risk landscapes. The findings from this work provide the first data-driven evidence base to inform wildlife sampling for the monitoring of JEV circulation in outbreak hotspots in India and thus identify good preliminary targets for the development of One Health JEV surveillance., (© 2022 The Authors. Transboundary and Emerging Diseases published by Wiley-VCH GmbH.)

Background: Preventive public health has been suggested as methods for reducing the transmission of COVID-19. Safety and efficacy of one such public health measure: WASH intervention for COVID-19 has not been systematically reviewed. We undertook a rapid review to assess the effect of WASH intervention in reducing the incidence of COVID-19., Methods: We conducted searches in PubMed, MEDLINE, and EMBASE. We undertook screening of studies in two stages and extracted data and assessed the quality of evidence for the primary outcome using GRADE recommendations., Main Results: We included a total of 13 studies with three studies on COVID-19 and 10 on SARS. The study found that hand washing, sterilization of hands, gargling, cleaning/shower after attending patients of COVID-19, or SARS was protective. Evidence also found that frequent washes can prevent SARS transmission among HCWs. However; one study reported that due to enhanced infection-prevention measures, front-line HCWs are more prone to hand-skin damage. The certainty of the evidence for our primary outcome as per GRADE was very low. We did not find any studies that assessed the effect of WASH on hospitalizations, and mortality due to COVID-19. Also; we did not find any study that compared WASH interventions with any other public health measures., Conclusions: Current evidence of WASH interventions for COVID-19 is limited as it is largely based on indirect evidence from SARS. Findings from the included studies consistently show that WASH is important in reducing the number of cases during a pandemic. Timely implementation of WASH along with other public health interventions can be vital to ensure the desired success. Further good-quality studies providing direct evidence of the efficacy of WASH on COVID-19 are needed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Khatib, Sinha, Mishra, Quazi, Gaidhane, Saxena, Gaidhane, Bhardwaj, Sawleshwarkar and Zahiruddin.)

Introduction: Differentiation between relapse and reinfection in cases with tuberculosis (TB) recurrence has important implications for public health, especially in patients with human immunodeficiency virus (HIV) co-infection. We compared Mycobacterial Interspersed Repeat Unit (MIRU) typing and spoligotyping with whole genome sequencing (WGS) to differentiate between relapse and reinfection in patients (HIV-positive and HIV-negative) with TB recurrence. We also assessed the value of WGS to track acquired drug resistance in those with relapse after successful treatment., Method: Forty-one paired M. tuberculosis isolates collected from 20 HIV-positive and 21 HIV-negative patients were subjected to WGS in addition to spoligotyping and MIRU typing. Phylogenetic and Single Nucleotide Substitution (SNP) clustering analyses were performed to determine whether recurrences were due to relapse or re-infection., Results: Comparison of M. tuberculosis genomes indicated that 95% of TB recurrences in the HIV-negative cohort were due to relapse, while the majority of TB recurrences (75%) in the HIV-positive cohort was due to reinfection (P = 0.0001). New drug resistance mutations were acquired in 5/24 cases (20.8%) that experienced relapse., Conclusions: WGS provided increased resolution, but differentiation between relapse and reinfection was broadly consistent with MIRU and spoligotyping. The high contribution of reinfection among HIV infected patients experiencing TB recurrence warrants further study to explore risk factors for TB exposure., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Kyasanur forest disease virus (KFDV) is a rapidly expanding tick-borne zoonotic virus with natural foci in the forested region of the Western Ghats of South India. The Western Ghats is one of the world's most important biodiversity hotspots and, like many such areas of high biodiversity, is under significant pressure from anthropogenic landscape change. The current study sought to quantify mammalian species richness using ensemble models of the distributions of a sample of species extant in the Western Ghats and to explore its association with KFDV outbreaks, as well as the modifying effects of deforestation on this association. Species richness was quantified as a composite of individual species' distributions, as derived from ensembles of boosted regression tree, random forest, and generalised additive models. Species richness was further adjusted for the potential biotic constraints of sympatric species. Both species richness and forest loss demonstrated strong positive associations with KFDV outbreaks, however forest loss substantially modified the association between species richness and outbreaks. High species richness was associated with increased KFDV risk but only in areas of low forest loss. In contrast, lower species richness was associated with increased KFDV risk in areas of greater forest loss. This relationship persisted when species richness was adjusted for biotic constraints at the taluk-level. In addition, the taluk-level species abundances of three monkey species ( Macaca radiata , Semnopithecus hypoleucus , and Semnopithecus priam ) were also associated with outbreaks. These results suggest that increased monitoring of wildlife in areas of significant habitat fragmentation may add considerably to critical knowledge gaps in KFDV epidemiology and infection ecology and should be incorporated into novel One Health surveillance development for the region. In addition, the inclusion of some primate species as sentinels of KFDV circulation into general wildlife surveillance architecture may add further value., Competing Interests: none., (© 2021 The Authors.)

Background: In TB, therapeutic drug monitoring (TDM) is recommended for linezolid; however, implementation is challenging in endemic settings. Non-invasive saliva sampling using a mobile assay would increase the feasibility of TDM., Objectives: To validate a linezolid saliva assay using a mobile UV spectrophotometer., Methods: The saliva assay was developed using NanoPhotometer NP80® and linezolid concentrations were quantified using second-order derivative spectroscopy. Sample preparation involved liquid-liquid extraction of saliva, using saturated sodium chloride and ethyl acetate at 1:1:3 (v/v/v). The assay was validated for accuracy, precision, selectivity, specificity, carry-over, matrix effect, stability and filters. Acceptance criteria were bias and coefficient of variation (CV) <15% for quality control (QC) samples and <20% for the lower limit of quantification (LLOQ)., Results: Linezolid concentrations correlated with the amplitude between 250 and 270 nm on the second-order derivative spectra. The linezolid calibration curve was linear over the range of 3.0 to 25 mg/L (R2 = 0.99) and the LLOQ was 3.0 mg/L. Accuracy and precision were demonstrated with bias of -7.5% to 2.7% and CV ≤5.6%. The assay met the criteria for selectivity, matrix effect, carry-over, stability (tested up to 3 days) and use of filters (0.22 μM Millex®-GV and Millex®-GP). Specificity was tested with potential co-medications. Interferences from pyrazinamide, levofloxacin, moxifloxacin, rifampicin, abacavir, acetaminophen and trimethoprim were noted; however, with minimal clinical implications on linezolid dosing., Conclusions: We validated a UV spectrophotometric assay using non-invasive saliva sampling for linezolid. The next step is to demonstrate clinical feasibility and value to facilitate programmatic implementation of TDM., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Since the recent introduction of several viable vaccines for SARS-CoV-2, vaccination uptake has become the key factor that will determine our success in containing the COVID-19 pandemic. We argue that game theory and social network models should be used to guide decisions pertaining to vaccination programmes for the best possible results. In the months following the introduction of vaccines, their availability and the human resources needed to run the vaccination programmes have been scarce in many countries. Vaccine hesitancy is also being encountered from some sections of the general public. We emphasize that decision-making under uncertainty and imperfect information, and with only conditionally optimal outcomes, is a unique forte of established game-theoretic modelling. Therefore, we can use this approach to obtain the best framework for modelling and simulating vaccination prioritization and uptake that will be readily available to inform important policy decisions for the optimal control of the COVID-19 pandemic., (© 2021 The Authors.)

Global health discipline is of increasing interest for educators and students in public health across the world. Public health education is recently gaining momentum in India, but global health is still at an embryonic stage. Value of students as stakeholders in curriculum development is increasingly recognized but literature about perspectives of public health students regarding global health education is limited. This study aimed to explore Indian public health students' perspectives about global health education and to provide platform for the development of global health education framework for future public health professionals. This study involved a series of focus groups with students and sought to understand perceptions about global health and global health education framework. We recruited public health students at three institutes across India for focus group discussions. Focus groups questions covered current understanding of global health, opinions regarding global health education for public health curriculum and the relevance of global health competency domains for future employment. Recordings were transcribed verbatim and the transcripts were read along with field notes and then analyzed thematically. A total of 36 students participated in four focus groups. There was a general recognition that global health is transnational and that a global outlook is now essential. But there were concerns regarding local and global priorities in public health. Global health was regarded as being wider than public health by some, but others viewed public health being the umbrella term with global health as a specialization. Global health competencies were viewed as a "step up" from the public health competencies but core public health competencies were considered essential. International experiences and use of technology were key themes for delivery of global health education. Employability and career progression for global health graduates were of concern for many participants. This study provides insight into the student perspectives regarding global health education for public health programs in India. Clear direction in terms of curriculum and its utility for career growth and employability as a global health professional needs to be established for global health education in India and other similar settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Sawleshwarkar, Zodpey and Negin.)

The health and economic impacts of infectious disease pandemics are catastrophic as most recently manifested by coronavirus disease 2019 (COVID-19). The emerging infections that lead to substantive epidemics or pandemics are typically zoonoses that cross species boundaries at vulnerable points of animal-human interface. The sharing of space between wildlife and humans, and their domesticated animals, has dramatically increased in recent decades and is a key driver of pathogen spillover. Increasing animal-human interface has also occurred in concert with both increasing globalisation and failing health systems, resulting in a trifecta with dire implications for human and animal health. Nevertheless, to date we lack a geographical description of this trifecta that can be applied strategically to pandemic prevention. This investigation provides the first geographical quantification of the intersection of animal-human interfaces, poor human health system performance and global connectivity via the network of air travel. In so doing, this work provides a systematic, data-driven approach to classifying spillover hazard based on the distribution of animal-human interfaces while simultaneously identifying globally connected cities that are adjacent to these interfaces and which may facilitate global pathogen dissemination. We present this geography of high-impact spillover as a tool for developing targeted surveillance systems and improved health infrastructure in vulnerable areas that may present conduits for future pandemics., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:, (© 2020 The Authors.)

Background: Global health education has attracted significant attention in recent years from academic institutions in developed countries. In India however, a recent analysis found that delivery of global health education is fragmented and called for academic institutions to work towards closing the developing country/developed country dichotomy. Our study explored the understanding of global health in the Indian setting and opportunities for development of a global health education framework in Indian public health institutions., Methods: The study involved semi-structured interviews with staff of Indian public health institutes and other key stakeholders in global health in India. The interview questions covered participants' interpretation of global health and their opinion about global health education in India. Thematic analysis was conducted. A theoretical framework developed by Smith and Shiffman to explain political priority for global health initiatives was adapted to guide our analysis to explore development of global health education in Indian public health institutions., Results: A total of 17 semi-structured interviews were completed which involved 12 faculty members from five public health institutes and five stakeholders from national and multilateral organisations. Global health was viewed as the application of public health in real-world setting and at a broader, deeper and transnational scale. The understanding of global health was informed by participants' exposure to work experiences and interaction with overseas faculty. Most common view about the relationship between global health and public health was that public health has become more global and both are interconnected. Integration of global health education into public health curriculum was supported but there were concerns given public health was still a new discipline in India. Most participants felt that global health competencies are complementary to public health competencies and build on core public health skills. Employability, faculty exposure to global health and 'sensitisation' of all stakeholders were key barriers to offering global health education programs., Conclusion: Global health as a concept and educational practice is embryonic in India but there is considerable potential to grow in order to ensure that education meets the needs of future practitioners of global health in the context of sustainable development.

Background Transmitted human immunodeficiency virus type 1 (HIV-1) drug resistance (TDR) is an important contributor to antiretroviral treatment failure, and is associated with HIV-1 transmission among men who have sex with men (MSM), non-MSM clusters and individuals diagnosed with concurrent sexually transmissible infections (STI). Western Sydney has a culturally diverse population, with a high proportion of non-Australian-born individuals. This study describes the prevalence of TDR and non-B HIV-1 subtypes in a clinic-based population., Methods: A clinic database was examined for all newly diagnosed treatment-naïve HIV-1 patients and information on their HIV-1 resistance and subtype, demographics including country of birth and diagnosis of a bacterial sexually transmissible infection was collected., Results: Data were available from 74/79 individuals (62 cis-male, 16 cis-female and 1 transgender woman). Of the 74 genotypes, the prevalence of non-B subtypes and TDR was 43/74 (58%; 95%CI = 46.9-69.3) and 14/74 (19%; 95%CI = 10.0 to 27.8). It was also found that 30/79 (38%) had a concurrent bacterial STI. TDR was associated with subtype B infection (OR 3.53; 95%CI = 1.41-8.82; P = 0.007) and being born in Australia (OR 12.0; 95%CI = 2.45-58.86; P = 0.002)., Conclusion: The relative prevalence of non-B HIV-1 subtypes and TDR is higher in Western Sydney than in the rest of Australia. TDR is associated with subtype B HIV-1 and being Australian born, suggesting ongoing local transmission. This highlights the diversity of the HIV epidemic locally and the need for interventions to prevent ongoing HIV transmission.

Introduction: Disclosure of HIV status to sexual partners can help HIV prevention efforts and enable HIV positive people to receive social support, as well as increasing access and adherence to treatment. This study was conducted to determine the rate, processes, outcomes, and correlates of HIV status disclosure to sexual partners among HIV positive individuals., Method: A cross-sectional study was conducted between September and November 2015 at two HIV outpatient clinics in Addis Ababa, Ethiopia. Data were collected using an interviewer- administered semi-structured questionnaire. Logistic analysis was used to determine the independent correlates of serostatus disclosure., Results: Of 742 participants, (371 men and 371 women), 727 (98%) were on antiretroviral therapy and 676 (91.1%) had at least one sexual partner since their HIV diagnosis, of whom 558 (82.5%) had disclosed their HIV status to their most recent sexual partner. Of those who reported having disclosed their status to their most recent sexual partner, 82 (14.7%) had at least one unprotected sexual encounter with the partner, after HIV diagnosis but prior to disclosure. The most commonly reported initial outcome of disclosure was gaining emotional and/or financial support. Some (11.3%) also reported that their disclosure immediately initiated their partner for HIV testing. Negative outcomes to disclosure, such as stigma and discrimination, were more common among females (26.2%) compared to males (12.7%). In the multiple regression analysis, disclosure was associated with greater condom use, greater social support, knowing the partner's HIV status, having a good relationship with the partner, and cohabiting with the partner., Conclusion: HIV disclosure was common amongst participants, although sometimes delayed, with possible consequences for onward transmission. Fear of negative outcomes, such as verbal abuse and physical violence, were major barriers to disclosure. Efforts to support disclosure have the potential to contribute to HIV control and prevention by encouraging safer sexual practice, initiating partners for HIV testing, and enhancing support for people living with HIV., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Rates of new HIV-1 diagnoses are increasing in Australia, with evidence of an increasing proportion of non-B HIV-1 subtypes reflecting a growing impact of migration and travel. The present study aims to define HIV-1 subtype diversity patterns and investigate possible HIV-1 transmission networks within Australia., Methods: The Australian Molecular Epidemiology Network (AMEN) HIV collaborating sites in Western Australia, South Australia, Victoria, Queensland and western Sydney (New South Wales), provided baseline HIV-1 partial pol sequence, age and gender information for 4,873 patients who had genotypes performed during 2005-2012. HIV-1 phylogenetic analyses utilised MEGA V6, with a stringent classification of transmission pairs or clusters (bootstrap ≥98%, genetic distance ≤1.5% from at least one other sequence in the cluster)., Results: HIV-1 subtype B represented 74.5% of the 4,873 sequences (WA 59%, SA 68.4%, w-Syd 73.8%, Vic 75.6%, Qld 82.1%), with similar proportion of transmission pairs and clusters found in the B and non-B cohorts (23% vs 24.5% of sequences, p = 0.3). Significantly more subtype B clusters were comprised of ≥3 sequences compared with non-B clusters (45.0% vs 24.0%, p = 0.021) and significantly more subtype B pairs and clusters were male-only (88% compared to 53% CRF01&#95;AE and 17% subtype C clusters). Factors associated with being in a cluster of any size included; being sequenced in a more recent time period (p<0.001), being younger (p<0.001), being male (p = 0.023) and having a B subtype (p = 0.02). Being in a larger cluster (>3) was associated with being sequenced in a more recent time period (p = 0.05) and being male (p = 0.008)., Conclusion: This nationwide HIV-1 study of 4,873 patient sequences highlights the increased diversity of HIV-1 subtypes within the Australian epidemic, as well as differences in transmission networks associated with these HIV-1 subtypes. These findings provide epidemiological insights not readily available using standard surveillance methods and can inform the development of effective public health strategies in the current paradigm of HIV prevention in Australia.

During the last decade, the literature about global health has grown exponentially. Academic institutions are also exploring the scope of their public health educational programs to meet the demand for a global health professional. This has become more relevant in the context of the sustainable development goals. There have been attempts to describe global health competencies for specific professional groups. The focus of these competencies has been variable with a variety of different themes being described ranging from globalization and health care, analysis and program management, as well as equity and capacity strengthening. This review aims to describe global health competencies and attempts to distill common competency domains to assist in curriculum development and integration in postgraduate public health education programs. A literature search was conducted using relevant keywords with a focus on public health education. This resulted in identification of 13 articles that described global health competencies. All these articles were published between 2005 and 2015 with six from the USA, two each from Canada and Australia, and one each from UK, Europe, and Americas. A range of methods used to describe competency domains included literature review, interviews with experts and employers, surveys of staff and students, and description or review of an academic program. Eleven competency domains were distilled from the selected articles. These competency domains primarily referred to three main aspects, one that focuses on burden of disease and the determinants of health. A second set focuses on core public health skills including policy development, analysis, and program management. Another set of competency domains could be classified as "soft skills" and includes collaboration, partnering, communication, professionalism, capacity building, and political awareness. This review presents the landscape of defined global health competencies for postgraduate public health education. The discussion about use of "global health," "international health," and "global public health" will continue, and academic institutions need to explore ways to integrate these competencies in postgraduate public health programs. This is critical in the post-MDG era that we prepare global public health workforce for the challenges of improving health of the "global" population in the context of sustainable development goals.

Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the world. Persistent oncogenic HPV infection has been a leading threat to global health and can lead to serious complications such as cervical cancer. Prevention interventions including vaccination and screening have been proven effective in reducing the risk of HPV-related diseases. In recent decades, computational epidemiology has been serving as a very useful tool to study HPV transmission dynamics and evaluation of prevention strategies. In this paper, we conduct a comprehensive literature review on state-of-the-art computational epidemic models for HPV disease dynamics, transmission dynamics, as well as prevention efforts. Selecting 45 most-relevant papers from an initial pool of 10,497 papers identified through keyword search, we classify them based on models used and prevention strategies employed, summarize current research trends, identify gaps in the present literature, and identify future research directions. In particular, we describe current consensus regarding optimal prevention strategies which favour prioritizing teenage girls for vaccination. We also note that optimal prevention strategies depend on the resources available in each country, with hybrid vaccination and screening being the most fruitful for developed countries, and screening-only approaches being most cost effective for low and middle income countries. We also highlight that in future, the use of computational and operations research tools such as game theory and linear programming, coupled with the large scale use of census and geographic information systems data, will greatly aid in the modelling, analysis and prevention of HPV.

The mechanism by which immunity to Herpes Simplex Virus (HSV) is initiated is not completely defined. HSV initially infects mucosal epidermis prior to entering nerve endings. In mice, epidermal Langerhans cells (LCs) are the first dendritic cells (DCs) to encounter HSV, but it is CD103(+) dermal DCs that carry viral antigen to lymph nodes for antigen presentation, suggesting DC cross-talk in skin. In this study, we compared topically HSV-1 infected human foreskin explants with biopsies of initial human genital herpes lesions to show LCs are initially infected then emigrate into the dermis. Here, LCs bearing markers of maturation and apoptosis formed large cell clusters with BDCA3(+) dermal DCs (thought to be equivalent to murine CD103(+) dermal DCs) and DC-SIGN(+) DCs/macrophages. HSV-expressing LC fragments were observed inside the dermal DCs/macrophages and the BDCA3(+) dermal DCs had up-regulated a damaged cell uptake receptor CLEC9A. No other infected epidermal cells interacted with dermal DCs. Correspondingly, LCs isolated from human skin and infected with HSV-1 in vitro also underwent apoptosis and were taken up by similarly isolated BDCA3(+) dermal DCs and DC-SIGN(+) cells. Thus, we conclude a viral antigen relay takes place where HSV infected LCs undergo apoptosis and are taken up by dermal DCs for subsequent antigen presentation. This provides a rationale for targeting these cells with mucosal or perhaps intradermal HSV immunization.

We report a retrospective cross-sectional study from Western Sydney that assessed the sexual health characteristics of Indian-born patients attending sexual health services compared with Australian-born controls. The sexual health needs of Indian-born patients differed significantly from controls with those born in India reporting more sexual dysfunction and controls having more sexually transmitted infections (STI). These issues should be considered when delivering services to people from culturally and linguistically diverse backgrounds., (© 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.)

Objective: To determine the characteristics of general practitioners (GPs) who test and patients who are tested for HIV in Australia., Design and Setting: A secondary analysis of data from the Bettering the Evaluation and Care of Health programme; a cross-sectional, national survey of GP activity., Methods: We identified GP, patient and encounter characteristics that were associated with HIV testing between April 2000 and March 2010. We looked at testing rates for patients with different characteristics, whether they had attended for screening and GP 'risk factor' identification. Multiple logistic regression was used to measure the independent effect of each GP, patient and encounter characteristic on testing for HIV., Results: Data were available for 984,200 encounters from 9842 GPs. 1796 (18.2%) of GPs performed at least one HIV test. On logistic regression, independent predictors of HIV testing included the management of a 'risk factor' (OR 19.4, 95% CI 17.4 to 21.6), screening (OR 10.6, 95% CI 9.4 to 12.1), younger GP age, practice in a metropolitan area (OR 1.4, 95% CI 1.2 to 1.6), patient age, gender (male > female OR 3.0, 95% CI 2.7 to 3.3), being new to that practice (OR 2.1, 95% CI 1.8 to 2.3) and being Indigenous (OR 1.7, 95% CI 1.3 to 2.4)., Conclusion: The most significant independent predictors of testing were identification of a risk factor and attendance for screening. Unless barriers to testing are addressed it is unlikely that altering guidelines alone will improve testing rates and reduce transmission.

Background: In the absence of guidelines for sexual health medicine (SHM) curriculum for medical schools in Australia and New Zealand, little is known about the current curriculum. We therefore, sought to quantitatively and qualitatively measure the existing SHM teaching at medical schools in the region., Methods: SHM specialists and Deans (or their nominated delegates) were requested to complete a questionnaire with respect to the SHM teaching in their associated medical schools., Results: Forty-two specialists completed the questionnaire. Wide variations were found in the time spent on various topics in SHM. 'Training to teach' was found to be a major unmet need of SHM specialists. Four (16.7%) of 24 medical schools completed the questionnaire. The total time allocated to SHM in these medical schools varied from 13.6 to 39.0 h, with a median of 31.1 h. At least 70% of key SHM topics were covered in all curricula., Conclusion: SHM teaching varied markedly in terms of subject matter, allocated time and teaching modalities. National guidelines for the teaching of SHM to medical students could facilitate the development of more consistent standards within the medical workforce. Training in teaching and learning methods to specialists may improve dissemination of sexual health skills to the wider medical workforce.

Human resource capacity building is a key strategy in the design, delivery, sustainability and scale up HIV treatment and prevention programmes. The review aims to present human resource capacity building initiatives undertaken by the National AIDS Control Organisation (NACO) and to discuss the available opportunities in India.There was minimal emphasis on human resource capacity building in National AIDS control programme (NACP)-I. The focus of capacity building in NACP-II was on strengthening the capacity of partners implementing various HIV/AIDS interventions. NACP-III (2007-2012) focussed on capacity building as a priority agenda. Other than short-term training programmes, NACP-III is strengthening the capacity of partners through the State Training and Resource Centre, Technical Support Unit, District AIDS Prevention Control Unit, Fellowship Programme and Network of Indian Institutions for HIV/AIDS Research.Various opportunities to enhance and consolidate capacity building responses in HIV/AIDS in India may include mainstreaming of capacity building, appropriate management of knowledge and resources, effective delivery of training, measuring and documenting impact,accreditation of programmes and institutes,use of information technology, identifying and implementing innovations and working for sustainability.Growing demand for capacity-building in HIV/AIDS needs substantial efforts to ensure that these are implemented effectively and efficiently. NACO had made significant strides in these regards, but at the same time there are arduous challenges like measuring impact, quality, documentation, operational research, and sustainability. NACO is formulating Phase-IV of NACP. This review will provide feedback to the NACO for strengthening its strategic document for human resource capacity building.

Objectives: We aimed to ascertain how frequently Australian general practitioners (GPs) test patients for chlamydia and to determine GP, patient and encounter characteristics where tests occurred., Methods: We identified all GP, patient and encounter characteristics associated with higher testing rates, April 2000 to March 2007, using the Bettering the Evaluation and Care of Health data. Multiple logistic regression was used to measure the effect of each GP, patient and encounter characteristic., Results: Data were available for 689 000 encounters from 6890 GPs, of which 2236 were test encounters. Testing rates increased significantly between 2000 and 2007 (P < 0.0001). The rate of testing was higher for female patients (4.2 per 1000, 95% confidence interval (CI): 3.8-4.5) than males (2.0; 95% CI: 1.8-2.2). Predictors of higher chlamydia testing were: female GP (adjusted odds ratio (AOR): 1.84; 95% CI: 1.60-2.1); GP age (<35 v. 55+, 2.17; 95% CI: 1.65-2.85); practice in a major city (1.34; 95% CI: 1.18-1.52); large practice (5+ GP practice v. solo, 1.69; 95% CI: 1.27-2.25); graduated in Australia (1.22; 95% CI: 1.04-1.44); patient sex and younger age, being new to the practice (1.65; 95% CI: 0.47-1.86), Indigenous (3.46; 95% CI: 2.64-4.54), late in the study (twice as likely in 2006-07 than in 2000-01) and 'opportunity to test' (AOR: 32.25; 95% CI: 27.25-38.16)., Conclusions: Chlamydia testing rates have increased in general practice in Australia, with higher rates in females. Initiatives to overcome barriers to testing (especially for male patients and older male GPs) need to be established and evaluated.

Background: Sex workers (SWs) are globally recognised to be at high risk for the acquisition and transmission of sexually transmissible infections (STIs). There is a paucity of published data concerning SWs from the western suburbs of Sydney, with the last published study conducted in 1988. Therefore, we conducted a study to determine the demographics, sexual practices and health care needs of SWs attending Sexual Health Clinics (SHCs) in the region., Methods: Self-identified SWs presenting to SHCs in western Sydney between April 2007 and March 2008 were identified using clinic databases. A case note review was then undertaken., Results: One hundred and eighty-five female SWs were included in the analysis. Ninety-eight (54.5%) were born overseas (predominantly China) and 82 (45.6%) were born in Australia. One hundred and seventeen (68%) were English speaking backgrounds (ESB), while 55 (32%) were from non-English speaking backgrounds (NESB). Seventy-two (38.9%) were symptomatic on attendance, with vaginal discharge the most common symptom. Chlamydia was the most commonly reported STI in the previous 12 months with 28 cases (15.1%). SWs from NESB were significantly more likely to be older, symptomatic, have a hepatitis B diagnosis in the previous year and work more shifts per week, compared with SWs from ESB. SWs born overseas were more likely to be symptomatic than Australian born SWs who, in turn, were more likely to have a hepatitis C diagnosis in the previous year., Conclusion: SWs from NESB would potentially benefit from evidenced-based, culturally and linguistically appropriate interventions and targeted health promotion.

The present review assesses the protection that condoms offer against sexually transmissible infections (STI) and the impact that social, political and religious opinion in the USA has had in the past 8 years on promoting condoms for safer sex. Condoms offer protection against most STI. However, the degree of protection depends on correct and consistent use, the type of sexual activity and the biological characteristics of different infections. Cross-sectional and case-control studies and other observational data provide the majority of evidence for STI prevention. Condoms provide a high level of protection against those infections that are transmitted mainly via infected secretions, including HIV, gonorrhoea, chlamydia and trichomoniasis. Protection against those infections transmitted via skin and mucous membrane contact, including Herpes simplex virus infection and human papilloma virus, appears to be less. The Bush administration, driven by conservative political, social and religious elements in the USA, has mounted a concerted campaign to undermine the role of the condom in health-promotion activities in the USA and overseas by undervaluing and misrepresenting scientific data, and through a sustained and well-funded promotion of abstinence-only education. However, this has lead to considerable controversy and disillusionment with abstinence-only education, both at home and abroad, and there is now incontrovertible evidence that abstinence-only programs are ineffectual.

Background: The use of highly active antiretroviral therapy (HAART) has profoundly altered the life expectancy of individuals infected with HIV. Metabolic abnormalities associated with antiretrovirals and cumulative exposure to combination antiretroviral therapy, including dyslipidaemia and insulin resistance, have been linked to an increased risk of myocardial infarction., Methods: Longitudinal data from a large prospectively collected clinical database were analysed. All patients who commenced first antiretroviral therapy (ART) [two nucleoside reverse transcriptase inhibitors (NRTIs)+one nonnucleoside reverse transcriptase inhibitor (NNRTI) or one active protease inhibitor (PI)] since 1996 were identified. Patients with elevated cholesterol levels [>5.5 mmol/L (215 mg/dL)] prior to therapy initiation were excluded. Quantitative data were categorized into quartiles and presented stratified by individuals developing abnormal levels of cholesterol during first-line HAART. Event time was defined as time from commencing first-line ART to either development of cholesterol level >6.5 mmol/L (254 mg/dL) or switch of first-line therapy. The Kaplan-Meier product limit survival method was used to estimate time to abnormal cholesterol level, and the chi2 test was used for comparisons between drug classes. Cox's proportional hazards regression analysis was used to identify factors predicting a likelihood of raised cholesterol level., Results: A total of 1664 patients were included in the study: 57.1% on two NRTIs+one NNRTI, 38.4% on two NRTIs+one PI, and 4.4% on two NRTIs+a boosted PI regimen. Regimens containing stavudine or PIs were associated with a significantly higher event risk and earlier time to event. No differences between efavirenz and nevirapine or between didanosine and lamivudine were observed. In 28 patients exposed to the combination of tenofovir+lamivudine+efavirenz, there were no episodes of elevated cholesterol level., Conclusion: Dyslipidaemia has emerged as an important issue in HIV-infected individuals receiving antiretroviral therapy. This study demonstrates that age at start of therapy, baseline cholesterol level, stavudine use and PI use are all associated with increased risk of hypercholesterolemia on initial therapy. Both NRTI and NNRTI/PI choice influence risk of hypercholesterolaemia.

Background: The CD4 count is a dominant prognostic and predictive factor in HIV infection. This study assessed the utility of the total lymphocyte count (TLC) in place of the CD4 count to predict the development of AIDS defining opportunistic infections (ADOI)., Methods: The Chelsea and Westminster cohort was used to identify those people with a first episode of an ADOI. Corresponding CD4 and TLCs were recorded before diagnosis or at the time of first prescribing prophylaxis; patients without an AIDS defining opportunistic infection were defined as being at "risk" and receiver operating characteristic (ROC) curves were used to display the results of sensitivity and the false positive error rate of total lymphocyte and CD4 count groups., Results: A significant linear correlation was seen between the log(10) CD4 count and log(10) TLC (Pearson's correlation coefficient = 0.70, p<0.001). The finer cut off value for TLC where false positive error rate is minimum and sensitivity maximum was 1500-2000 cells/mm(3). Patients with TLC 1000-1500 cells/mm(3) were estimated to be at 40% increased risk of developing an ADOI. The cut off value for CD4 counts measured 200 cells/mm(3) above which the risk developing an ADOI decreased. Patients with a CD4 count of 150-200 cells/mm(3) were at a 34% increased risk of developing an ADOI. The area under the ROC curve for TLC was 10% lower than that for CD4 count., Conclusions: The TLC is minimally less reliable than the CD4 count as a predictor of ADOIs. In the absence of expensive equipment for CD4 measurement, the TLC is a useful test.

Objective: To compare the immunological response to highly active antiretroviral therapy (HAART) in treatment-naive patients with a baseline CD4 count of <200 cells/mm(3)., Design and Methods: We identified treatment-naive human immunodeficiency virus (HIV-1)-infected individuals who had commenced HAART since 1996 and who had a starting CD4 count of <200 cells/mm(3). Immunological success was defined as achieving a CD4 count of >200 cells/mm(3) and treatments were compared using univariate and multivariate Cox's proportional hazards models in order to establish whether protease inhibitor (PI)-based regimens were significantly different to regimens based on non-nucleoside reverse transcriptase inhibitors (NNRTIs). Both regimens utilize a nucleoside analogue (NA) backbone., Results: A total of 599 patients were identified. When the variables were entered into a multivariate analysis, no significant differences between HAART regimens were found. We showed that compared with efavirenz regimens a two NA plus one PI regimen was not significantly less likely to achieve immunological success (adjusted HR: 0.65, 95% CI 0.41-1.03, P=0.07). Two NA and boosted PI (adjusted HR: 1.33, 95% CI 0.81 to 2.16) or two NA and nevirapine (adjusted HR: 0.93, 95% CI 0.67-1.29) regimens were also not significantly different from efavirenz-based regimens, based on the endpoint of immunological success., Conclusion: PI-, boosted PI- and NNRTI-based HAART regimens are not significantly different in achieving increased CD4 counts in individuals who commence therapy with a low CD4 count.

In this multicenter, open, non-comparative study, the efficacy and irritation potential of 4% benzoyl peroxide cream in hydrophase base (Brevoxyl) was evaluated for the treatment of acne vulgaris. All evaluable patients (n=567) received treatment with 4% benzoyl peroxide cream in hydrophase base for six weeks. The investigators evaluated the patients at baseline and at 1,2,4 &6 weeks. Patients also rated their improvement and adverse effects. Doctor's assessment showed that at the end of 6'h week 85.6% had good to very good effect of the treatment. The profile of side effects observed by doctors revealed that 53.8% of total patients did not have any irritation whereas only 11.6% had moderate to severe irritation. 53.8% of patients did not report any irritation: 41.4% had some irritation whereas only 4.8% patients reported troublesome irritation. A satisfactory response was reported as ear;y as two weeks and most of the patients had a very satisfactory response after six weeks and were willing to continue the treatment. This supports the theory that the hydrophase formulation in 'Brevoxyl helped to enhance efficacy and decrease the irritation associated with use of benzoyl peroxide.