In 2014, the Joint United Nations Programme on HIV/AIDS set an 'ambitious' 90-90-90 target for 2020. By 2016, there were disparities observed among countries in their progress towards the targets and ...some believed the targets were not achievable. In this report, we present the results of data from the Ethiopia Population-based HIV Impact Assessment survey analyzed to assess progress with the targets and associated factors.
We conducted a nationally representative survey in urban areas of Ethiopia. Socio-demographic and behavioural data were collected from consenting participants using a structured interview. HIV testing was done following the national HIV rapid testing algorithm and seropositivity confirmed using a supplemental laboratory assay. HIV viral suppression was considered if the viral load was <1,000 RNA copies/ml. Screening antiretroviral drugs was done for efavirenz, lopinavir, and tenofovir, which were in use during the survey period. In this analysis, we generated weighted descriptive statistics and used bivariate and logistic regression analysis to examine for associations. The 95% confidence interval was used to measure the precision of estimates and the significance level set at p<0.05.
Of 19,136 eligible participants aged 15-64 years, 614 (3% 95% CI: 0.8-3.3) were HIV-positive, of which 79.0% (95% CI: 4.7-82.7) were aware of their HIV status, and 97.1% (95% CI: 95.0-98.3 were on antiretroviral therapy, of which 87.6% (95% CI: 83.9-90.5) achieved viral load suppression. Awareness about HIV-positive status was significantly higher among females (aOR = 2.8 95% CI: 1.38-5.51), significantly increased with age, the odds being highest for those aged 55-64 years (aOR = 11.4 95% CI: 2.52-51.79) compared to those 15-24 years, and was significantly higher among those who used condom at last sex in the past 12 months (aOR = 5.1 95% CI: 1.68-15.25). Individuals with secondary education and above were more likely to have achieved viral suppression (aOR = 8.2 95% CI: 1.82-37.07) compared with those with no education.
Ethiopia made encouraging progress towards the UNAIDS 90-90-90 targets. The country needs to intensify its efforts to achieve the targets. A particular focus is required to fill the gaps in knowledge of HIV-positive status to increase case identification among population groups such as males, the youth, and those with low education.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Fortunately, the Ebola outbreak has been controlled. In this final report, data on the duration of the persistence of Ebola virus in semen are provided.
To estimate prenatal sexually transmitted disease-human immunodeficiency virus (HIV) screening rates among insured women with prenatal care and the association of chlamydia and gonorrhea screening ...with Pap testing.
We estimated prenatal screening rates for syphilis, hepatitis B, HIV, chlamydia, and gonorrhea among women aged 15-44 years using a 2009-2010 U.S. administrative claims database that captures information for health services provided for both Medicaid- and commercially insured persons. Procedural and diagnostic codes were used to identify pregnant women with a live birth in 2010 with continuous insurance coverage at least 210 days before delivery and at least one typical prenatal blood test. Strengths of association between chlamydia and gonorrhea screening and Pap testing were measured using a χ test of independence.
Among 98,709 Medicaid-insured pregnant women, 95,064 (96.3%) were screened for syphilis, 95,082 (96.3%) for hepatitis B, 81,339 (82.4%) for HIV, 82,047 (83.1%) for chlamydia, and 73,799 (74.8%) for gonorrhea. Among 266,012 commercially insured women, 260,079 (97.8%) were screened for syphilis, 257,675 (96.8%) for hepatitis B, 227,276 (85.4%) for HIV, 187,071 (70.3%) for chlamydia, and 182,400 (68.6%) for gonorrhea. Prenatal screening for chlamydia and gonorrhea among both groups of women was more likely to be performed if a Pap test was also done (P<.001).
Prenatal screening for syphilis and hepatitis B was nearly universal among Medicaid- and commercially insured women; HIV screening rates were much lower and varied by insurance type and demographic characteristics. Chlamydia screening was suboptimal and most often occurred with Pap testing.
III.
This article presents findings from a phenomenological study that sought to understand the influence of race on the lived experiences and spousal relationships within Black-White multiracial ...marriages. Through the use of semistructured interviews, this qualitative study examined the role played by race and racial identity in individual development within fiveBlack-White interracial marriages. Analysis of the interviews revealed three major themes: (a) connection/disconnection with a racial group; (b) marital identity, and (c) personal identity. As there continues to be a growth in the numbers of interracial couples, it is essential for marriage and family counselors to understand the impact racial identity has on the many aspects of relationship development.
Successful linkage to HIV services and initiation of antiretroviral treatment (ART) for children living with HIV (CLHIV) is critical to improve pediatric ART coverage. We aimed to assess confirmatory ...testing, linkage, and rapid ART initiation among newly diagnosed CLHIV in Ethiopia from the perspectives of caregivers and healthcare workers (HCWs).
We conducted standardized surveys with HCWs and caregivers of children 2-14 years who were diagnosed with HIV but not yet on ART who had been identified during a cross-sectional study in Ethiopia from May 2017-March 2018. Eight health facilities based on their HIV caseload and testing volume and 21 extension sites were included. Forty-one children, 34 care givers and 40 healthcare workers were included in this study. Three months after study enrollment, caregivers were surveyed about timing and experiences with HIV service enrollment, confirmatory testing, and ART initiation. Data collected from HCWs included perceptions of confirmatory testing in CLHIV before ART initiation. SPSS was used to conduct descriptive statistics.
The majority of the 41 CLHIV were enrolled to HIV services (n = 34, 83%) and initiated ART by three months (n = 32, 94%). Median time from diagnosis to ART initiation was 12 days (interquartile range 5-18). Five children died before the follow-up interview. Confirmatory HIV testing was conducted in 34 children and found no discordant results; the majority (n = 23, 68%) received it within one week of HIV diagnosis. Almost all HCWs (n = 39/40, 98%) and caregivers (n = 31/34, 91%) felt better/the same about test results after conducting confirmatory testing.
Opportunities remain to strengthen linkage for newly diagnosed CLHIV in Ethiopia through intensifying early follow-up to ensure prompt confirmatory testing and rapid ART initiation. Additional services could help caregivers with decision-making around treatment initiation for their children.
Implementing effective and efficient case-finding strategies is crucial to increasing pediatric antiretroviral therapy coverage. In Ethiopia, universal HIV testing is conducted for children ...presenting at high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC); however, low positivity rates observed at inpatient, malnutrition and OVC entry points warrant re-assessing current case-finding strategies. The aim of this study is to develop HIV risk screening tool applicable for testing children presenting at inpatient, malnutrition and OVC entry points in low-HIV prevalence settings.
The study was conducted from May 2017-March 2018 at 29 public health facilities in Amhara and Addis Ababa regions of Ethiopia. All children 2-14 years presenting to five high-risk entry points including malnutrition treatment, inpatient wards, tuberculosis (TB) clinics, index testing for children of positive adults, and referral of orphans and vulnerable children (OVC) were enrolled after consent. Data were collected from registers, medical records, and caregiver interviews. Screening tools were constructed using predictors of HIV positivity as screening items by applying both logistic regression and an unweighted method. Sensitivity, specificity and number needed to test (NNT) to identify one new child living with HIV (CLHIV) were estimated for each tool.
The screening tools had similar sensitivity of 95%. However, the specificities of tools produced by logistic regression methods (61.4 and 65.6%) which are practically applicable were higher than those achieved by the unweighted method (53.6). Applying these tools could result in 58‒63% reduction in the NNT compared to universal testing approach while maintaining the overall number of CLHIV identified.
The screening tools developed using logistic regression method could significantly improve HIV testing efficiency among children presenting to malnutrition, inpatient, and OVC entry points in Ethiopia while maintaining case identification. These tools are simplified to practically implement and can potentially be validated for use at various entry points. HIV programs in low-prevalence countries can also further investigate and optimize these tools in their settings.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This paper outlines power system architecture trades performed on the N3-X hybrid wing body aircraft concept under NASA's Research and Technology for Aerospace Propulsion (RTAPS) study effort. The ...purpose of the study to enumerate, characterize, and evaluate the critical dynamic and safety issues for the propulsion electric grid of a superconducting Turboelectric Distributed Propulsion (TeDP) system pursuant to NASA N+3 Goals (TRL 4-6: 2025, EIS: 2030-2035). Architecture recommendations focus on solutions which promote electrical stability, electric grid safety, and aircraft safety. Candidate architectures were developed and sized by balancing redundancy and interconnectivity to provide fail safe and reliable, flight critical thrust capability. This paper outlines a process for formal contingency analysis used to identify these off-nominal requirements. Advantageous architecture configurations enabled a reduction in the NASA's assumed sizing requirements for the propulsors. However, significant weight penalties were also identified by including estimates of protection equipment sizing. Following an architecture down-selecting process, first order dynamic models were generated to assess the energy storage requirements for the TeDP system.
Purpose – This article is aims to inform aircraft propulsion system designers of the implications which fundamental power distribution design assumptions have on the effectiveness and viability of ...turboelectric distributed propulsion (TeDP) systems. Improvements and challenges associated with selecting alternating or direct current for normal- and superconducting distribution systems are presented. Additionally, for superconducting systems, the benefits of bi-polar DC distribution are discussed, as well as the implications of operating voltage on the mass and efficiency of TeDP grid components. Design/methodology/approach – The approach to this paper selects several high-level fundamental configuration decisions, which must be made, and it qualitatively discusses potential implications of these decisions. Findings – Near term TeDP architectures which employ conventionally conducting systems may benefit from alternating current (AC) distribution concepts to eliminate the mass and losses associated with power conversion. Farther term TeDP concepts which employ superconducting technologies may benefit from direct current (DC) distribution to reduce the cryocooling requirements stemming from AC conduction losses. Selecting the operating voltage for superconducting concepts requires a divergence from the present day criteria employed with terrestrial superconducting transmission systems. Practical implications – The criteria presented in the paper will assist in the early conceptual architecting of TeDP systems. Originality/value – The governing principles behind the configuration of multi-MW airborne electrical microgrid systems are presently immature. This paper represents a unique look and the motivating principles behind fundamental electrical configuration decisions in the context of TeDP.
NASA's N3-X aircraft design under the Research and Technology for Aerospace Propulsion Systems (RTAPS) study is being designed to meet the N+3 goals, one of which is the reduction of aircraft fuel ...burn by 70% or better. To achieve this goal, NASA has analyzed a hybrid body wing aircraft with a turboelectric distributed propulsion system. The propulsion system must be designed to operate at the highest possible efficiency in order to meet the reduced fuel burn goal. To achieve maximum efficiency, NASA has proposed to use a superconducting and cryogenic electrical system to connect the electrical output of the generators to the motors. In addition to being more efficient, superconducting electrical system components have higher power density (kW/kg) and torque density (Nm/kg) than components that operate at normal temperature. High density components are required to minimize the weight of the electric propulsion system while meeting the high power demand. Minimizing the electric propulsion system weight helps to reduce the amount of fuel required for propulsion. In this paper, evaluation of the electrical system components such as cryogenic and superconducting generators, motors, power converters, DC and AC cables, energy storage, circuit breakers, and fault-current limiters is presented. A review of the present status of these components and sub-systems is also presented and the progress of technology for future applications is discussed.
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