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Of all HIV patients, 10.3% are HIV-2 infected (18% in the original cohort), 7.3% are HIV 1/2 dually infected (11% in the original cohort) and 74.2% are HIV-1 infected (69% in the original cohort). Performance of Bio-Rad HIV-1/2 Confirmatory Assay in HIV-1, HIV-2 and HIV-1/2 dually reactive patients: comparison with INNO-LIA and immunocomb discriminatory assays. Mortality of HIV-1, HIV-2 and HIV-1/HIV-2 dually infected patients in a clinic-based cohort in The Gambia. Key Features The Bissau HIV Cohort was established in 2007 as a single-centre cohort in the capital city Bissau in Guinea-Bissau, to gain insight into the effect of introducing antiretroviral treatment in a treatment-naïve population concomitantly infected with retroviruses [human immunodeficiency virus 1 (HIV-1), human immunodeficiency virus 2 (HIV-2) and human t-lympotropic virus 1 (HTLV-1)] and tuberculosis. [Extracted from the article]

Problem The introduction of antiretroviral therapy (ART) for HIV infection in sub-Saharan Africa has improved the quality of life of millions of people and reduced mortality. However, substantial problems with the infrastructure for ART delivery remain. Approach Clinicians and researchers at an HIV clinic in Guinea-Bissau identified problems with the delivery of ART by establishing a clinical database and by collaborating with international researchers. Local setting The Bissau HIV cohort study group was established in 2007 as a collaboration between local HIV physicians and international HIV researchers. Patients were recruited from the HIV clinic at the country's main hospital in the capital Bissau. Relevant changes Between 2005 and 2013, 5514 HIV-positive patients were treated at the clinic. Working together, local health-care workers and international researchers identified the main problems affecting ART delivery: inadequate drug supply; loss of patients to follow-up; and inadequate laboratory services. Solutions to these problems were devised. The collaborations encouraged local physicians to start their own research projects to find possible solutions to problems at the clinic. Lessons learnt The HIV clinic in Bissau faced numerous obstacles in delivering ART at a sufficiently high quality and patients' lives were put in jeopardy. The effectiveness of ART could be enhanced by delivering it as part of an International research collaboration since such collaborations can help identify problems, find solutions and increase the capacity of the health-care system. Probleme L'introduction de la therapie antiretrovirale (TAR) pourtraiter la contamination par le VIH en Afrique subsaharienne a ameliore la qualite de vie de millions de personnes et redult la mortalite. Cependant, l'infrastructure de distribution de la TAR reste tres problematique. Approche Les cliniciens et les chercheurs d'une clinique de Guinee Bissau ont identifie des problemes avec la distribution de la IAK en creant une base de donnees clinique et en collaborant avec des chercheurs internatlonaux. Environnement local Le groupe d'etude de la cohorte VIH de Bissau a ete cree en 2007 comme une collaboration entre des medecins locaux traitant le VIH et des chercheurs internationaux etudlant le VIH. Les patients ont ete recrutesa la clinique VIH situee dans l'hopital principal du pays a Bissau, la capitale. Changements significatifs Entre 2005 et 2013, 5514 patients seropositifs ont ete traites a la clinique. En travaillant ensemble, les personnels de sante locaux et les chercheurs internationaux ont identifie les problemes principaux qui affectaient la distribution de la TAR: un approvisionnement inapproprie des medicaments; des patients perdus de vue et des services de laboratoire inadequats. Des solutions visant a resoudre ces problemes ont ete envisagees. Les collaborations ont encourage les medecins locaux a lancer leurs propres projets de recherche afin de trouver des solutions possibles aux problemes rencontres a la clinique. Lecons tirees La clinique VIH de Bissau a du faire face a de nombreux obstacles pour distrlbuer une TAR d'une qualite suffisamment elevee, et les vies des patients ont ete mises en peril. Lefficacite de la TAR pourrait etre augmentee en la distribuant dans le cadre de collaborations de recherche Internationale, puisque ces collaborations peuvent aider a identifier les problemes, a trouver des solutions et a augmenter la capacite du systeme de sante. Situacion La introduccion de la terapia antirretroviral (TARV) para tratar la Infeccion del VIH en el Africa subsahariana ha mejorado la calidad de vida de millones de personas y ha reducido la mortalidad. No obstante, siguen existiendo problemas considerables relacionados con la infraestructura para el suministro de la terapia antirretroviral. Enfoque En una clinica del VIH de Guinea-Bissau, los medicos y los investigadores detectaron problemas en el suministro de la terapia antirretroviral mediante la creacion de una base de datos y la colaboracion con investigadores internacionales. Marco regional El grupo del estudio de cohorte para el VIH de Bissau se creo en 2007, fruto de la colaboracion entre los medicos del VIH locales y los Investigadores del VIH Internacionales. Se selecciono a los pacientes de la clinica de VIH en el hospital principal del pais de la capital Bissau. Cambios importantes Entre 2005 y 2013, se trato a 5514 pacientes seropositivos para el VIH en la clinica. Trabajando en equipo, el personal sanitario local y los investigadores internacionales Identificaron los problemas principales que repercuten en el suministro de la terapia antirretroviral: el suministro inadecuado de medicamentos; la perdida de pacientes durante el seguimiento y los servicios de laboratorio inadecuados. Se disenaron soluciones para estos problemas. Las colaboraciones animaron a los medicos locales a emprender sus propios proyectos de investigacion a fin de hallar soluciones a los problemas en la clinica. Lecciones aprendidas La clinica del VIH de Bissau afronto diversos obstaculos en el suministro de una terapia antirretroviral de calidad suficientemente alta y se pusieron en riesgo las vidas de los pacientes. Es posible aumentar la eficacia de la terapia antirretroviral si esta se suministra como parte de la colaboracion de una investigacion internacional, ya que este tipo de colaboraciones pueden ayudar a Identificar los problemas, hallar soluciones y aumentar la capacidad del sistema sanitario., Introduction In sub-Saharan Africa, the introduction of antiretroviral therapy (ART) for patients with human immunodeficiency virus (HIV) infections has improved the lives of millions of people and decreased mortality. (1) [...]

Background There is strong observational evidence that respirators are highly effective in protecting the users from being infected with Middle East respiratory syndrome and severe acute respiratory syndrome coronavirus (SARS-CoV), but the evidence for SARS-CoV-2 during daily work is limited. This study utilized a subset of healthcare workers' temporary use of a new brand respirator with frequent defects when caring for coronavirus disease 2019 (COVID-19) patients to assess the protective effect of regular respirators against SARS-CoV-2 infection. Methods We retrospectively followed 463 participants wearing a regular respirator and 168 wearing the new brand respirator day-by-day when caring for COVID-19 patients until testing polymerase chain reaction positive for SARS-CoV-2 between 27th December 2020 and 14th January 2021. Results We observed seven and eight incident SARS-CoV-2-infected cases. This corresponded with daily infection rates of 0.2 and 0.5%, an incidence rate ratio of 0.4 [95% confidence interval (CI) 0.1; 1.0], and an incidence rate difference of 0.3% (95% CI −0.1; 0.8) when comparing a regular with the new brand respirator. Discussion We regard the new brand respirator a sham intervention, and this study thus provides further evidence for the protective effect of respirators when exposed to SARS-CoV-2 virus. [ABSTRACT FROM AUTHOR]

Background The objective of this study was to perform a seroprevalence survey on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among Danish healthcare workers to identify high-risk groups. Methods All healthcare workers and administrative personnel at the 7 hospitals, prehospital services, and specialist practitioner clinics in the Central Denmark Region were invited to be tested by a commercial SARS-CoV-2 total antibody enzyme-linked immunosorbent assay (Wantai Biological Pharmacy Enterprise Co, Ltd, Beijing, China). Results A total of 25 950 participants were invited. Of these, 17 971 had samples available for SARS-CoV-2 antibody testing. After adjustment for assay sensitivity and specificity, the overall seroprevalence was 3.4% (95% confidence interval [CI], 2.5%–3.8%). The seroprevalence was higher in the western part of the region than in the eastern part (11.9% vs 1.2%; difference: 10.7 percentage points [95% CI, 9.5–12.2]). In the high-prevalence area, the emergency departments had the highest seroprevalence (29.7%), whereas departments without patients or with limited patient contact had the lowest seroprevalence (2.2%). Among the total 668 seropositive participants, 433 (64.8%) had previously been tested for SARS-CoV-2 RNA, and 50.0% had a positive reverse-transcription polymerase chain reaction (PCR) result. Conclusions We found large differences in the prevalence of SARS-CoV-2 antibodies in staff working in the healthcare sector within a small geographical area of Denmark. Half of all seropositive staff had been tested positive by PCR prior to this survey. This study raises awareness of precautions that should be taken to avoid in-hospital transmission. Regular testing of healthcare workers for SARS-CoV-2 should be considered to identify areas with increased transmission. [ABSTRACT FROM AUTHOR]

Abstract Background Legionella is a common cause of bacterial pneumonia. Community-acquired [CAL] and hospital-acquired legionellosis [HAL] may have different presentations and outcome. We aimed to compare clinical characteristics and examine predictors of mortality for CAL and HAL. Methods We identified hospitalized cases of legionellosis in 4 Danish counties from January 1995 to December 2005 using the Danish national surveillance system and databases at departments of clinical microbiology. Clinical and laboratory data were retrieved from medical records; vital status was obtained from the Danish Civil Registration System. We calculated 30- and 90-day case fatality rates and identified independent predictors of mortality using logistic regression analyses. Results We included 272 cases of CAL and 60 cases of HAL. Signs and symptoms of HAL were less pronounced than for CAL and time from in-hospital symptoms to legionellosis diagnosis was shorter for CAL than for HAL (5.5 days vs. 12 days p < 0.001). Thirty-day case fatality was 12.9% for CAL and 33.3% for HAL; similarly 90-day case fatalities in the two groups were 15.8% and 55.0%, respectively. In a logistic regression analysis (excluding symptoms and laboratory tests) age >65 years (OR = 2.6, 95% CI: 1.1-5.9) and Charlson comorbidty index ≥2 (OR = 2.7, 95% CI: 1.1-6.5) were associated with an increased risk of death in CAL. We identified no statistically significant predictors of 30-day mortality in HAL. Conclusions Signs and symptoms were less pronounced in HAL compared to CAL. Conversely, 30-day case fatality was almost 3 times higher. Clinical awareness is important for the timely diagnosis and treatment especially of HAL. There is a need for further studies of prognostic factors in order to improve the therapeutic approach to legionellosis and potentially reduce mortality.