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BackgroundThere have been a range of quality improvement (QI) and quality assurance initiatives in low- and middle-income countries to improve antiretroviral therapy (ART) treatment outcomes for people living with HIV. To date, these initiatives have not been systematically assessed and little is known about how effective, cost-effective, or sustainable these strategies are in improving clinical outcomes.MethodsWe conducted a systematic review adhering to PRISMA guidelines (PROSPERO ID: CRD42017071848), searching PubMed, MEDLINE, Embase, Web of Science, and the Cochrane database of controlled trials for articles reporting on the effectiveness of QI and quality assurance initiatives in HIV programs in low- and middle-income countries in relation to ART uptake, retention in care, adherence, viral load suppression, mortality, and other outcomes including cost-effectiveness and long-term sustainability.ResultsOne thousand eight hundred sixty articles were found, of which 29 were included. QI approaches were categorized as follows: (1) health system approaches using QI methods; (2) QI learning networks including collaboratives; (3) standard-based methods that use QI tools to improve performance gaps; and (4) campaigns using QI methods. The greatest improvements were seen in ART uptake [median increase of 14.0%; interquartile range (IQR) -9.0 to 29.3], adherence [median increase of 22.0% (IQR -7.0 to 25.0)], and viral load suppression [median increase 26.0% (IQR -8.0 to 26.0)].ConclusionsQI interventions can be effective in improving clinical outcomes; however, there was significant variability, making it challenging to identify which aspects of interventions lead to clinical improvements. Standardizing reporting and assessment of QI initiatives is needed, supported by national quality policies and directorates, and robust research.

Background Ensuring vaccination coverage reaches established herd immunity thresholds (HITs) is the cornerstone of any vaccination programme. Diverse migrant populations in European countries have been associated with cases of vaccine-preventable diseases (VPDs) and outbreaks, yet it is not clear to what extent they are an under-immunized group. Methods We did a systematic review and meta-analysis to synthesize peer-reviewed published primary research reporting data on the immune status of migrants in EU/EEA countries, the UK and Switzerland, calculating their pooled immunity coverage for measles, mumps, rubella and diphtheria using random-effects models. We searched on Web of Science, Embase, Global Health and MEDLINE (1 January 2000 to 10 June 2022), with no language restrictions. The protocol is registered with PROSPERO (CRD42018103666). Findings Of 1103 abstracts screened, 62 met eligibility criteria, of which 39 were included in the meta-analysis. The meta-analysis included 75 089 migrants, predominantly from outside Europe. Pooled immunity coverage among migrant populations was well below the recommended HIT for diphtheria (n  = 7, 57.4% [95% confidence interval (CI): 43.1–71.7%] I 2 = 99% vs HIT 83–86%), measles (n  = 21, 83.7% [95% CI: 79.2–88.2] I 2 = 99% vs HIT 93–95%) and mumps (n  = 8, 67.1% [95% CI: 50.6–83.6] I 2 = 99% vs HIT 88–93%) and midway for rubella (n  = 29, 85.6% [95% CI: 83.1–88.1%] I 2 = 99% vs HIT 83–94%), with high heterogeneity across studies. Interpretation Migrants in Europe are an under-immunized group for a range of important VPDs, with this study reinforcing the importance of engaging children, adolescents and adults in 'catch-up' vaccination initiatives on arrival for vaccines, doses and boosters they may have missed in their home countries. Co-designing strategies to strengthen catch-up vaccination across the life course in under-immunized groups is an important next step if we are to meet European and global targets for VPD elimination and control and ensure vaccine equity. [ABSTRACT FROM AUTHOR]

Background Healthcare workers (HCWs), particularly those from ethnic minority groups, have been shown to be at disproportionately higher risk of infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) compared to the general population. However, there is insufficient evidence on how demographic and occupational factors influence infection risk among ethnic minority HCWs. Methods and findings We conducted a cross-sectional analysis using data from the baseline questionnaire of the United Kingdom Research study into Ethnicity and Coronavirus Disease 2019 (COVID-19) Outcomes in Healthcare workers (UK-REACH) cohort study, administered between December 2020 and March 2021. We used logistic regression to examine associations of demographic, household, and occupational risk factors with SARS-CoV-2 infection (defined by polymerase chain reaction (PCR), serology, or suspected COVID-19) in a diverse group of HCWs. The primary exposure of interest was self-reported ethnicity. Among 10,772 HCWs who worked during the first UK national lockdown in March 2020, the median age was 45 (interquartile range [IQR] 35 to 54), 75.1% were female and 29.6% were from ethnic minority groups. A total of 2,496 (23.2%) reported previous SARS-CoV-2 infection. The fully adjusted model contained the following dependent variables: demographic factors (age, sex, ethnicity, migration status, deprivation, religiosity), household factors (living with key workers, shared spaces in accommodation, number of people in household), health factors (presence/absence of diabetes or immunosuppression, smoking history, shielding status, SARS-CoV-2 vaccination status), the extent of social mixing outside of the household, and occupational factors (job role, the area in which a participant worked, use of public transport to work, exposure to confirmed suspected COVID-19 patients, personal protective equipment [PPE] access, aerosol generating procedure exposure, night shift pattern, and the UK region of workplace). After adjustment, demographic and household factors associated with increased odds of infection included younger age, living with other key workers, and higher religiosity. Important occupational risk factors associated with increased odds of infection included attending to a higher number of COVID-19 positive patients (aOR 2.59, 95% CI 2.11 to 3.18 for [greater than or equal to]21 patients per week versus none), working in a nursing or midwifery role (1.30, 1.11 to 1.53, compared to doctors), reporting a lack of access to PPE (1.29, 1.17 to 1.43), and working in an ambulance (2.00, 1.56 to 2.58) or hospital inpatient setting (1.55, 1.38 to 1.75). Those who worked in intensive care units were less likely to have been infected (0.76, 0.64 to 0.92) than those who did not. Black HCWs were more likely to have been infected than their White colleagues, an effect which attenuated after adjustment for other known risk factors. This study is limited by self-selection bias and the cross sectional nature of the study means we cannot infer the direction of causality. Conclusions We identified key sociodemographic and occupational risk factors associated with SARS-CoV-2 infection among UK HCWs, and have determined factors that might contribute to a disproportionate odds of infection in HCWs from Black ethnic groups. These findings demonstrate the importance of social and occupational factors in driving ethnic disparities in COVID-19 outcomes, and should inform policies, including targeted vaccination strategies and risk assessments aimed at protecting HCWs in future waves of the COVID-19 pandemic. Trial registration The study was prospectively registered at ISRCTN (reference number: ISRCTN11811602)., Author(s): Christopher A. Martin 1,2, Daniel Pan 1,2, Carl Melbourne 3, Lucy Teece 4, Avinash Aujayeb 5, Rebecca F. Baggaley 1, Luke Bryant 1, Sue Carr 6,7, Bindu Gregary 8, [...]

Background and Aims: Antimicrobial resistance (AMR) is among the top public health concerns around the globe. Migrants, especially forced migrants, could be at higher risk of acquiring and transmitting AMR during their journeys or in host countries. There is limited understanding regarding migrants' living conditions and the wider factors contributing to their risk of acquiring infections, and behaviors around antimicrobial use, and AMR development. In this study, we aimed to explore transit experiences, living conditions, and antibiotic use of migrants living in the United Kingdom. Methods: We conducted semistructured qualitative interviews with 27 participants and identified five themes regarding migrants' journey and their living conditions during transit and after arriving in the United Kingdom, their access to water, sanitation and hygiene (WASH), and their use of antibiotics. Results: Migrants, particularly forced migrants, experienced unfavorable living conditions, poor access to WASH, and challenges in accessing healthcare, which further contributed to health conditions like urinary and skin problems. Isolation and difficulty in accessing healthcare played significant roles in migrants' perceived need for storing and using antibiotics as a safety net. Conclusion: The findings highlight the need for coordinated and multilevel interventions to address these challenges and contribute toward tackling AMR and improving the health of this population group. [ABSTRACT FROM AUTHOR]

The 2013-2016 Ebola outbreak in Guinea, Liberia and Sierra Leone was the worst in history with over 28 000 cases and 11 000 deaths. Here we examine the psychosocial consequences of the epidemic. Ebola is a traumatic illness both in terms of symptom severity and mortality rates. Those affected are likely to experience psychological effects due to the traumatic course of the infection, fear of death and experience of witnessing others dying. Survivors can also experience psychosocial consequences due to feelings of shame or guilt (e.g. from transmitting infection to others) and stigmatization or blame from their communities. At the community level, a cyclical pattern of fear occurs, with a loss of trust in health services and stigma, resulting in disruptions of community interactions and community break down. Health systems in affected countries were severely disrupted and overstretched by the outbreak and their capacities were significantly reduced as almost 900 health-care workers were infected with Ebola and more than 500 died. The outbreak resulted in an increased need for health services, reduced quality of life and economic productivity and social system breakdown. It is essential that the global response to the outbreak considers both acute and long-term psychosocial needs of Individuals and communities. Response efforts should involve communities to address psychosocial need, to rebuild health systems and trust and to limit stigma. The severity of this epidemic and its long-lasting repercussions should spur investment in and development of health systems. La flambee de maladie a virus Ebola qui a frappe la Guinee, le Liberia et la Sierra Leone en 2013-2016 a ete la pire de toute l'histoire, avec plus de 28 000 cas et 11 000 deces. Dans ce dossier, nous examinons les consequences psychosociales de cette flambee epidemique. La maladie a virus Ebola est une maladie traumatisante, compte tenu a la fois de la gravite de ses symptomes et des taux de mortalite qui y sont associes. Les personnes affectees sont susceptibles de developper des troubles psychologiques a cause de l'evolution traumatisante de l'infectlon, de la peur de mourir et du fait de voir d'autres personnes mourlr autour d'eux. Les survlvants peuvent aussi avoir des sequelles psychologiques liees a un sentiment de honte ou de culpabilite (pour avoir transmis l'infection a d'autres personnes, par exemple) ou a cause de leur stigmatisation ou de leur mise en accusation au sein de leur communaute. A l'echelle communautaire, un schema cyclique de peur intervient, avec une perte de confiance envers les services de sante, et la stigmatisation des personnes affectees entraine une rupture des Interactions au sein de la communaute et une fracture de la communaute. Dans les pays touches, les systemes de sante ont ete lourdement ebranles et meme depasses par la flambee de la maladie. Leur capacite s'est considerablement reduite, pres de 900 agents de sante ont ete infectes et plus de 500 sont decedes. Cette flambee epidemique a majore les besoins de services de sante, reduit la qualite de vie et la productivite economique et entraine la fracture du systeme social. La reponse internationale doit absolument tenir compte aussi bien des besoins psychosociaux immediats des individus et des communautes que de ceux a plus long terme. Il serait judicieux que les communautes soient integrees dans les efforts de riposte pour repondre aux besoins psychosociaux, reconstruire les systemes de sante, retablir la confiance des populations et limiter les stigmatisations. La gravite de cette flambee epidemique ainsi que ses repercussions durables devraient inciter a investir dans les systemes de sante et a les consoliden El brote de Ebola en 2013 y 2016 en Guinea, Liberia y Sierra Leona fue el peor de la historia, con mas de 28 000 casos y 11 000 muertes. En este articulo se examinan las consecuencias psicosociales de la epidemia. El Ebola es una enfermedad traumatica, tanto por la gravedad de sus sintomas como por las tasas de mortalidad. Los afectados pueden sufrir efectos psicologicos dado el proceso traumatico de la infeccion, temer a la muerte y ser testigos de la muerte de otros. Los supervivientes tambien pueden sufrir consecuencias psicosociales debido a los sentimientos de verguenza y culpa (por ejemplo, por transmitir la infeccion a otros) y la estigmatizacion o reproche de sus comunidades. A nivel comunitario, se produce un patron ciclico de temor que se traduce en la perdida de la confianza en los servicios sanitarios, lo que da lugar a la interrupcion de las interacciones de las comunidades y una ruptura de las mismas. Los sistemas sanitarios de los paises afectados se vieron gravemente perjudicados y desbordados por el brote, y sus capacidades se redujeron significativamente, puesto que casi 900 trabajadores sanitarios fueron infectados por el virus del Ebola y mas de 500 murieron. El brote provoco una mayor necesidad de servicios de salud, redujo la calidad de vida y la productividad economica y fracturo el sistema social. Es fundamental que la respuesta mundial al brote tenga en cuenta las profundas necesidades psicosociales a largo plazo, tanto para individuos como para comunidades. Las medidas de respuesta deberian comportar que las comunidades abordasen las necesidades psicosociales, reconstruyesen los sistemas sanitarios y la confianza y redujesen la estigmatizacion. La gravedad de esta epidemia y sus repercusiones a largo plazo deberian estimular la inversion y el desarrollo de los sistemas sanitarios., Introduction The 2013-2016 Ebola virus disease epidemic was the largest ever recorded with over 28000 cases and 11 000 deaths. (1) Guinea, Liberia and Sierra Leone experienced the most widespread [...]