Search

Background Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. Methods and findings We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996–31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle–Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20–64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%–16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000–46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000–9,432,000) LRI hospitalizations occur each year among adults. While adults, In this meta-analysis, Kathryn E. Lafond and colleagues estimate the global hospitalisation burden from influenza infections in adults., Author summary Why was this study done? Every year, millions of people become infected with influenza viruses, which infect the airways and cause symptoms that include a fever, tiredness and weakness, general aches and pains, sore throat, and cough. Most infected individuals recover quickly, but some develop more severe illness such as pneumonia, and may require hospitalization. Influenza vaccination can prevent infections and severe disease, but decisions on how to prioritize risk groups, particularly in limited-resource settings, require a robust evidence base, including global, regional, and local data. What did the researchers do and find? We conducted a systematic review to identify published articles on influenza-associated respiratory disease in hospitalized adults. We then aggregated the data from these articles with data collected by hospital-based influenza surveillance, to calculate a pooled estimate of the proportion of adults hospitalized with respiratory disease who are positive for influenza. Through this approach, we estimated that influenza was associated with 14% of acute respiratory hospitalizations among adults worldwide. This equates to over 5 million influenza-associated hospitalizations per year, with the highest rates among those 65 years and older. What do these findings mean? Estimating the disease burden of influenza allows researchers and policymakers to better understand its global impact across different target groups and allows comparisons with other causes of morbidity and mortality. As global populations age, the importance of vaccinating adults, particularly older adults, is likely to increase.

Background The psychological health of female sex workers (FSWs) has emerged as a major public health concern in many low- and middle-income countries (LMICs). Key risk factors include poverty, low education, violence, alcohol and drug use, human immunodeficiency virus (HIV), and stigma and discrimination. This systematic review and meta-analysis aimed to quantify the prevalence of mental health problems among FSWs in LMICs, and to examine associations with common risk factors. Method and findings The review protocol was registered with PROSPERO, number CRD42016049179. We searched 6 electronic databases for peer-reviewed, quantitative studies from inception to 26 April 2020. Study quality was assessed with the Centre for Evidence-Based Management (CEBM) Critical Appraisal Tool. Pooled prevalence estimates were calculated for depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal behaviour. Meta-analyses examined associations between these disorders and violence, alcohol/drug use, condom use, and HIV/sexually transmitted infection (STI). A total of 1,046 studies were identified, and 68 papers reporting on 56 unique studies were eligible for inclusion. These were geographically diverse (26 countries), representing all LMIC regions, and included 24,940 participants. All studies were cross-sectional and used a range of measurement tools; none reported a mental health intervention. Of the 56 studies, 14 scored as strong quality, 34 scored as moderate, and 8 scored as weak. The average age of participants was 28.9 years (age range: 11–64 years), with just under half (46%) having up to primary education or less. The pooled prevalence rates for mental disorders among FSWs in LMICs were as follows: depression 41.8% (95% CI 35.8%–48.0%), anxiety 21.0% (95% CI: 4.8%–58.4%), PTSD 19.7% (95% CI 3.2%–64.6%), psychological distress 40.8% (95% CI 20.7%–64.4%), recent suicide ideation 22.8% (95% CI 13.2%–36.5%), and recent suicide attempt 6.3% (95% CI 3.4%–11.4%). Meta-analyses found significant associations between violence experience and depression, violence experience and recent suicidal behaviour, alcohol use and recent suicidal behaviour, illicit drug use and depression, depression and inconsistent condom use with clients, and depression and HIV infection. Key study limitations include a paucity of longitudinal studies (necessary to assess causality), non-random sampling of participants by many studies, and the use of different measurement tools and cut-off scores to measure mental health problems and other common risk factors. Conclusions In this study, we found that mental health problems are highly prevalent among FSWs in LMICs and are strongly associated with common risk factors. Study findings support the concept of overlapping vulnerabilities and highlight the urgent need for interventions designed to improve the mental health and well-being of FSWs., Tara Beattie and co-workers assess the evidence on mental ill-health in female sex workers in low- and middle-income countries., Author summary Why was this study done? Understanding the prevalence of mental health problems, and key risk factors associated with poor mental health, is essential for building evidence-based prevention. To our knowledge, there has been no previous quantitative synthesis of the literature examining the prevalence of mental health problems among female sex workers (FSWs) in low- and middle-income countries (LMICs). This evidence is critical to inform evidence-based policymaking and intervention design and is timely given the growing interest in mental health globally. What did the researchers do and find? We undertook a quantitative systematic review to estimate the prevalence of mental health problems and to estimate the magnitude of associations between mental health problems and sex workers’ experience of violence, harmful alcohol and drug use, condom use, and human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). Meta-analyses across 31 studies with 18,524 FSWs in 17 LMICs suggest that mental health problems—including depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal thoughts and attempts—are highly prevalent among FSWs. Sex workers with a mental health problem were more likely to have experienced violence, to report harmful alcohol or drug use, to report inconsistent condom use with clients (but not regular partners), and to be HIV positive compared with sex workers who did not have a mental health problem (18 studies with 14,115 FSWs). What do these findings mean? The quantitative evidence clearly demonstrates that mental health problems are an important burden of disease experienced by many FSWs in LMICs, with levels substantially greater than those experienced by women in the general population. As no study described a mental health intervention, evidence-based mental health interventions for FSWs are urgently required to address the current treatment gap. The prevention and treatment of key risk factors such as violence and harmful alcohol and drug use would also help improve the mental health of FSWs. Longitudinal research is needed in order to unpack pathways of causation. Future studies should use validated tools and consistent cut-offs and timeframes to enable more rigorous comparisons between studies.

IntroductionHigh rates of pre-treatment loss to care among persons diagnosed with HIV persist. Linkage to care can be improved through active digitally-based surveillance. Currently, record-keeping for HIV diagnoses in South Africa is paper-based. Aggregated testing data are reported routinely, and only discordant findings result in a specimen being tested at a laboratory and digitised. The Western Cape Province in South Africa has a Provincial Health Data Centre (PHDC) where person-level routine electronic data are consolidated in a single database, leveraging the existence of a unique patient identifier. To facilitate improved HIV surveillance, a pre-carbonated point-of-care test (PoCT) form was piloted, where one copy was routed to a central point and digitised for PHDC inclusion.MethodsWe evaluated the utility of the intervention using cross-sectional and retrospective cohort analyses, as well as comparisons with aggregate data. Data were linked to the Patient Master Index of the PHDC using unique identifiers. Prior evidences of HIV within the PHDC were used to differentiate newly diagnosed patients and those retesting, as well as linkage to care and treatment.ResultsFrom May 2017 to June 2018, 11337 digitised point-of-care HIV testing records were linked to the PHDC. Overall, 96% of records in the aggregate dataset were digitised, with 97% linked to the PHDC. Of those tested, 79% were female (median age 27 years). Linkage demonstrated that 51.3% (95% CI 48.4-54.1%) of patients testing HIV-positive were retesting. Of those newly diagnosed, 81% (95% CI 77.9-84.3%) were linked to HIV care and 25% (95% CI 21.6-28.7%) were initiated on antiretroviral therapy immediately.ConclusionDigitisation of PoCT results provides individuated HIV testing data to assist in linkage to care and in differentiating newly diagnosed patients from positive patients retesting. Actionable and accurate data can improve the measurement of performance towards the UNAIDS 90-90-90 targets.

Recent studies suggest that a large proportion of new HIV-1 infections in mature epidemics occurs within discordant couples, making discordancy a major contributor to the spread of HIV/AIDS in Africa. This paper aims at assessing changes over a five-year period (2009-2015) on the (risk) factors associated with HIV serodiscordance among couples in Mozambique, using cross-sectional data from the INSIDA and IMASIDA surveys. The pooled data of both surveys were analyzed using a joint model for three parameters characterizing in a particular way disagreement and sero(con/dis)corance between the HIV statuses of couples, as introduced by Aerts et al.: the probability that the female partner is HIV positive, given that both partners differ in their HIV status, the probability that only one partner is HIV positive, given that at least one of the two partners is positive ("positive" serodiscordance), and the probability that both partners are negative given that at most one of the two partners is positive ("negative" seroconcordance). The results reveal similar significant factors and estimates as in Aerts et al. (HIV prevalence, union number for woman, STI for man, condom use by woman and wealth index), but the additional significant factors "condom use by man" (no use had a negative effect on the positive serodiscordance) and "union number for man" (for couples where the man has been married or co-habiting with a woman before had a decreased negative seroconcordance) were identified. The only factor that had a different effect over time (IMASIDA as compared to INSIDA) was the effect of "HIV prevalence of province" on the negative seroconcordance. The negative effect of a higher HIV prevalence was less pronounced in 2015 for negative seroconcordance. This study was financially supported by the Flemish Interuniversity Council (VLIR-UOS) in collaboration with Eduardo Mondlane University (UEM) through the DESAFIO Program, in Mozambique to AJCJ. Juga, AJC (corresponding author), Eduardo Mondlane Univ, Fac Sci, Dept Math & Informat, Maputo, Mozambique; Hasselt Univ, Data Sci Inst, I BioStat, Diepenbeek, Belgium. adelino.juga@gmail.com