UA Open Access Publishing Fund / Background: Current understanding of tuberculosis (TB) genotype clustering in the US is based on individual risk factors. This study sought to identify whether area-based socioeconomic status (SES) was associated with genotypic clustering among culture-confirmed TB cases. Methods: A retrospective cohort analysis was performed on data collected on persons with incident TB in King County, Washington, 2004–2008. Multilevel models were used to identify the relationship between area-level SES at the block group level and clustering utilizing a socioeconomic position index (SEP). Results: Of 519 patients with a known genotyping result and block group, 212 (41%) of isolates clustered genotypically. Analyses suggested an association between lower area-based SES and increased recent TB transmission, particularly among US-born populations. Models in which community characteristics were measured at the block group level demonstrated that lower area-based SEP was positively associated with genotypic clustering after controlling for individual covariates. However, the trend in higher clustering odds with lower SEP index quartile diminished when additional block-group covariates. Conclusions: Results stress the need for TB control interventions that take area-based measures into account, with particular focus on poor neighborhoods. Interventions based on area-based characteristics, such as improving case finding strategies, utilizing location-based screening and addressing social inequalities, could reduce recent rates of transmission.

Yes / Traditional public health methods for detecting infectious disease transmission, such as contact tracing and molecular epidemiology, are time-consuming and costly. Information and communication technologies, such as global positioning systems, smartphones, and mobile phones, offer opportunities for novel approaches to identifying transmission hotspots. However, mapping the movements of potentially infected persons comes with ethical challenges. During an interdisciplinary meeting of researchers, ethicists, data security specialists, information and communication technology experts, epidemiologists, microbiologists, and others, we arrived at suggestions to mitigate the ethical concerns of movement mapping. These suggestions include a template Data Protection Impact Assessment that follows European Union General Data Protection Regulations. / European Research Council Proof of Concept “Enhanced Place Finding” (grant no. 727695).

Introdução: O enfermeiro é responsável em atuar no controle da contaminação do ambiente, visando a prevenção de transmissão de infecções relacionadas à assistência à saúde. Surtos de gastroenterite causados por norovirus (NoV) em locais fechados são caracterizados pela persistência do vírus no ambiente, aerolização das partículas virais e baixa dose infectante, mesmo em indivíduos saudáveis. Portanto, há necessidade de definição de um protocolo seguro para limpeza e desinfecção do piso contaminado com vômito e fezes, considerando a possibilidade de dispersão de aerossóis a partir do piso. Objetivo: Avaliar a presença residual de partículas de NoV-GII no ar e no piso quando implementados diferentes protocolos de descontaminação do piso, após contaminação intencional. Método: Trata-se de um estudo experimental laboratorial. Dois tipos de piso, vinil e granito (matérias primas frequentemente utilizadas nos pisos dos serviços de saúde), foram contaminados intencionalmente com fezes humanas positivas 10% para NoV-GII, dissolvidas em 500ml de solução tampão salino-fosfato. Os pisos foram submetidos a três tipos de tratamento: limpeza padronizada com fricção manual, água e detergente neutro; limpeza seguida de desinfecção com hipoclorito de sódio 1% por 10 minutos; limpeza seguida de desinfecção com dispositivo portátil de luz ultravioleta por cinco minutos (SURFACE-UV®). Amostras foram obtidas do piso, por meio do swab, e do ar, por meio de um coletador de ar (Coriolis® - Bertin Technologies, França), nos seguintes momentos: antes e após a contaminação intencional; após a limpeza e após os métodos de desinfecção. Para detecção de NoV-GII nas amostras, utilizou-se a técnica 4.6.2. Reação em Cadeia pela Polimerase quantitativa precedida de Transcrição Reversa (RT-qPCR), pelo método TaqMan®. Resultados: Não foram encontradas diferenças estatisticamente significantes entre os tipos de piso após os protocolos de descontaminação, tanto para o residual de NoV-GII no piso, quanto no ar. Os valores médios de Cycle Threshold (Ct) após limpeza seguida de desinfecção foram maiores (38,75 40,00) comparados aos de após limpeza (35,67 38,66), comprovando a maior eficácia desse protocolo (p<0,001). Em algumas amostras, a limpeza isolada foi capaz de reduzir a contaminação por NoV do piso até níveis indetectáveis. Quando houve residual de NoV-GII após a limpeza do piso, o protocolo cuja desinfecção foi realizada com hipoclorito de sódio foi mais eficaz do que a luz ultravioleta (p<0,001), sendo que os valores de Ct de todas as amostras foram acima de 40. Em 27 das 36 (75%) amostras de ar coletas após a limpeza do piso, foram detectadas partículas de NoV, com diferenças estatisticamente significantes entre as segundas e terceiras amostras, coletadas a 150cm do piso. Foram identificadas que, em média, 17 cópias de RNA viral/L estavam presentes no ar após a limpeza, com redução gradual após a desinfecção. Conclusões: Quando vômito e fezes com NoV-GII contaminam o piso, há aerolização desse vírus já no ato da limpeza. Essas partículas podem ser inaladas ou depositarem em superfícies frequentemente tocadas pelas mãos, estabelecendo o ciclo de transmissão oro-fecal. As partículas virais residuais no piso após a limpeza, indiscutivelmente devem ser eliminadas, evitando assim a reaerolização do NoV a partir dessa fonte. Nesse sentido, a limpeza seguida de desinfecção com hipoclorito de sódio a 1% por 10 minutos mostra superioridade como protocolo de descontaminação do piso, quando comparado ao protocolo com limpeza seguida de desinfecção com luz ultravioleta por 5 minutos de exposição. / Introduction: Nurses are responsible for controlling contamination of the environment, working to prevent the transmission of health-care-associated infections. Gastroenteritis outbreaks caused by Norovirus (NoV) in closed settings are characterized as the result of persistence of the virus in the environment, aerosolization of viral particles, and small infectious dose, even in healthy individuals. Therefore, a safe protocol to decontaminate the floor after vomit or feces have spilled must be defined, considering that subsequent aerosol dispersal may occur. Objective: To assess the presence of residual NoV-GII particles in the air and on the floor after different decontamination protocols are conducted on a deliberately contaminated floor. Method: This is an experimental laboratory study. Two types of floor, vinyl and granite (materials which are often used in the flooring of healthcare facilities), were intentionally contaminated with 10% NoV-GII-positive human feces dissolved in 500ml of a saline-phosphate buffer solution. The floors received three types of treatment: standard cleaning, with manual friction, water, and neutral detergent; cleaning followed by a ten- minute disinfection procedure using 1% sodium hypochlorite; and cleaning followed by a five- minute disinfection procedure using a portable ultraviolet light device (SURFACE-UV®). Swab samples were taken from the floor, and air samples were obtained using an air sampler (Coriolis® - Bertin Technologies, France) at the following moments: before and after the intentional contamination, after cleaning, and after disinfection. The TaqMan® method for real-time Reverse Transcription-Polymerase Chain Reaction was used to detect NoV-GII in the samples. Results: No statistically significant difference between the two types of floor was found for residual NoV-GII, either in the air or on the floor, after the decontamination protocols. The average Cycle Threshold (Ct) values found after cleaning followed by disinfection were higher (38.75 - 40.00) than those recorded after cleaning (35.67 - 38.66), thus attesting to the greater effectiveness of the latter protocol (p<0.001). In some samples, cleaning alone was enough to reduce floor contamination by NoV to undetectable levels. When residual NoV-GII was found after cleaning the floor, the disinfection protocol that involved using sodium hypochlorite proved more effective than UV-light exposure (p<0.001), and Ct values were higher than 40 for all samples. NoV particles were detected in 27 of the 36 (75%) air samples obtained after cleaning the floor, and significant statistical differences were found between the second and third samples, collected 150cm from the floor. An average of 17 copies of viral RNA/L were identified in the air after cleaning, gradually decreasing after disinfection. Conclusions: When NoV-GII-infected vomit or feces contaminate the floor, the virus is aerosolized even during cleaning. These particles may then be inhaled or settle on frequently touched surfaces, establishing the fecal-oral transmission cycle. Residual viral particles on the floor must undoubtedly be eliminated, thereby preventing NoV aerosolization from this source. Along these lines, cleaning followed by disinfection by 1% sodium hypochlorite for ten minutes proved to be a superior floor decontamination protocol when compared with cleaning followed by disinfection by UV-light exposure for five minutes.

abstract: Understanding the consequences of changes in social networks is an important an- thropological research goal. This dissertation looks at the role of data-driven social networks on infectious disease transmission and evolution. The dissertation has two projects. The first project is an examination of the effects of the superspreading phenomenon, wherein a relatively few individuals are responsible for a dispropor- tionate number of secondary cases, on the patterns of an infectious disease. The second project examines the timing of the initial introduction of tuberculosis (TB) to the human population. The results suggest that TB has a long evolutionary history with hunter-gatherers. Both of these projects demonstrate the consequences of social networks for infectious disease transmission and evolution. The introductory chapter provides a review of social network-based studies in an- thropology and epidemiology. Particular emphasis is paid to the concept and models of superspreading and why to consider it, as this is central to the discussion in chapter 2. The introductory chapter also reviews relevant epidemic mathematical modeling studies. In chapter 2, social networks are connected with superspreading events, followed by an investigation of how social networks can provide greater understanding of in- fectious disease transmission through mathematical models. Using the example of SARS, the research shows how heterogeneity in transmission rate impacts super- spreading which, in turn, can change epidemiological inference on model parameters for an epidemic. Chapter 3 uses a different mathematical model to investigate the evolution of TB in hunter-gatherers. The underlying question is the timing of the introduction of TB to the human population. Chapter 3 finds that TB’s long latent period is consistent with the evolutionary pressure which would be exerted by transmission on a hunter- igatherer social network. Evidence of a long coevolution with humans indicates an early introduction of TB to the human population. Both of the projects in this dissertation are demonstrations of the impact of var- ious characteristics and types of social networks on infectious disease transmission dynamics. The projects together force epidemiologists to think about networks and their context in nontraditional ways. / Dissertation/Thesis / Doctoral Dissertation Anthropology 2019

Emerging multidrug-resistant tuberculosis (MDR/XDR-TB) has become a major public health problem, placing millions at risk. Further, nosocomial transmission of MDR/XDR-TB places both patients and healthcare workers at an even higher risk. Effective tuberculosis (TB) infection prevention and control (IPC) policies in high-risk settings must use evidence-based science and should be customized to the setting. However, the growing incidence of MDR/XDR-TB in some global settings raises questions about whether adequate healthcare-related TB IPC policies are in place and whether they are implemented effectively. The purpose of this systematic literature review was to catalogue healthcare-related TB IPC policy research conducted in high-prevalence settings and draw a picture of existing evidence-based TB IPC policies and their implementation, with a focus on preventing and controlling nosocomial transmission of MDR/XDR-TB. Two databases (PubMed and Embase) were searched from 1990 – 2013 and outputs were categorized by region/country, income, MDR/XDR-TB incidence, level of IC intervention, and time period. None of the 20 captured research studies were conducted in TB high-prevalence, low-income settings. Most (12/20) were implemented within the Pan American Health Organization region, followed by the African (4/20) and European (4, 20%) regions. Most studies reviewed (70%) were undertaken because of an outbreak and most (70%) were published between 1990 – 2000. This systematic literature review showed a gap in research on TB IPC policies addressing nosocomial transmission of MDR/XDR-TB in high-prevalence, low-income settings. TB IPC policy development and implementation should be routinely undertaken as a part of effective and efficient public health practice. Development of TB IPC global best practices should be guaranteed and a concerted effort to promote, distribute, train, and implement these TB IPC best practices in low-resource countries would help mitigate the growing incidence of MDR/XDR-TB worldwide.

Introdução: O enfermeiro é responsável em atuar no controle da contaminação do ambiente, visando a prevenção de transmissão de infecções relacionadas à assistência à saúde. Surtos de gastroenterite causados por norovirus (NoV) em locais fechados são caracterizados pela persistência do vírus no ambiente, aerolização das partículas virais e baixa dose infectante, mesmo em indivíduos saudáveis. Portanto, há necessidade de definição de um protocolo seguro para limpeza e desinfecção do piso contaminado com vômito e fezes, considerando a possibilidade de dispersão de aerossóis a partir do piso. Objetivo: Avaliar a presença residual de partículas de NoV-GII no ar e no piso quando implementados diferentes protocolos de descontaminação do piso, após contaminação intencional. Método: Trata-se de um estudo experimental laboratorial. Dois tipos de piso, vinil e granito (matérias primas frequentemente utilizadas nos pisos dos serviços de saúde), foram contaminados intencionalmente com fezes humanas positivas 10% para NoV-GII, dissolvidas em 500ml de solução tampão salino-fosfato. Os pisos foram submetidos a três tipos de tratamento: limpeza padronizada com fricção manual, água e detergente neutro; limpeza seguida de desinfecção com hipoclorito de sódio 1% por 10 minutos; limpeza seguida de desinfecção com dispositivo portátil de luz ultravioleta por cinco minutos (SURFACE-UV®). Amostras foram obtidas do piso, por meio do swab, e do ar, por meio de um coletador de ar (Coriolis® - Bertin Technologies, França), nos seguintes momentos: antes e após a contaminação intencional; após a limpeza e após os métodos de desinfecção. Para detecção de NoV-GII nas amostras, utilizou-se a técnica 4.6.2. Reação em Cadeia pela Polimerase quantitativa precedida de Transcrição Reversa (RT-qPCR), pelo método TaqMan®. Resultados: Não foram encontradas diferenças estatisticamente significantes entre os tipos de piso após os protocolos de descontaminação, tanto para o residual de NoV-GII no piso, quanto no ar. Os valores médios de Cycle Threshold (Ct) após limpeza seguida de desinfecção foram maiores (38,75 40,00) comparados aos de após limpeza (35,67 38,66), comprovando a maior eficácia desse protocolo (p<0,001). Em algumas amostras, a limpeza isolada foi capaz de reduzir a contaminação por NoV do piso até níveis indetectáveis. Quando houve residual de NoV-GII após a limpeza do piso, o protocolo cuja desinfecção foi realizada com hipoclorito de sódio foi mais eficaz do que a luz ultravioleta (p<0,001), sendo que os valores de Ct de todas as amostras foram acima de 40. Em 27 das 36 (75%) amostras de ar coletas após a limpeza do piso, foram detectadas partículas de NoV, com diferenças estatisticamente significantes entre as segundas e terceiras amostras, coletadas a 150cm do piso. Foram identificadas que, em média, 17 cópias de RNA viral/L estavam presentes no ar após a limpeza, com redução gradual após a desinfecção. Conclusões: Quando vômito e fezes com NoV-GII contaminam o piso, há aerolização desse vírus já no ato da limpeza. Essas partículas podem ser inaladas ou depositarem em superfícies frequentemente tocadas pelas mãos, estabelecendo o ciclo de transmissão oro-fecal. As partículas virais residuais no piso após a limpeza, indiscutivelmente devem ser eliminadas, evitando assim a reaerolização do NoV a partir dessa fonte. Nesse sentido, a limpeza seguida de desinfecção com hipoclorito de sódio a 1% por 10 minutos mostra superioridade como protocolo de descontaminação do piso, quando comparado ao protocolo com limpeza seguida de desinfecção com luz ultravioleta por 5 minutos de exposição. / Introduction: Nurses are responsible for controlling contamination of the environment, working to prevent the transmission of health-care-associated infections. Gastroenteritis outbreaks caused by Norovirus (NoV) in closed settings are characterized as the result of persistence of the virus in the environment, aerosolization of viral particles, and small infectious dose, even in healthy individuals. Therefore, a safe protocol to decontaminate the floor after vomit or feces have spilled must be defined, considering that subsequent aerosol dispersal may occur. Objective: To assess the presence of residual NoV-GII particles in the air and on the floor after different decontamination protocols are conducted on a deliberately contaminated floor. Method: This is an experimental laboratory study. Two types of floor, vinyl and granite (materials which are often used in the flooring of healthcare facilities), were intentionally contaminated with 10% NoV-GII-positive human feces dissolved in 500ml of a saline-phosphate buffer solution. The floors received three types of treatment: standard cleaning, with manual friction, water, and neutral detergent; cleaning followed by a ten- minute disinfection procedure using 1% sodium hypochlorite; and cleaning followed by a five- minute disinfection procedure using a portable ultraviolet light device (SURFACE-UV®). Swab samples were taken from the floor, and air samples were obtained using an air sampler (Coriolis® - Bertin Technologies, France) at the following moments: before and after the intentional contamination, after cleaning, and after disinfection. The TaqMan® method for real-time Reverse Transcription-Polymerase Chain Reaction was used to detect NoV-GII in the samples. Results: No statistically significant difference between the two types of floor was found for residual NoV-GII, either in the air or on the floor, after the decontamination protocols. The average Cycle Threshold (Ct) values found after cleaning followed by disinfection were higher (38.75 - 40.00) than those recorded after cleaning (35.67 - 38.66), thus attesting to the greater effectiveness of the latter protocol (p<0.001). In some samples, cleaning alone was enough to reduce floor contamination by NoV to undetectable levels. When residual NoV-GII was found after cleaning the floor, the disinfection protocol that involved using sodium hypochlorite proved more effective than UV-light exposure (p<0.001), and Ct values were higher than 40 for all samples. NoV particles were detected in 27 of the 36 (75%) air samples obtained after cleaning the floor, and significant statistical differences were found between the second and third samples, collected 150cm from the floor. An average of 17 copies of viral RNA/L were identified in the air after cleaning, gradually decreasing after disinfection. Conclusions: When NoV-GII-infected vomit or feces contaminate the floor, the virus is aerosolized even during cleaning. These particles may then be inhaled or settle on frequently touched surfaces, establishing the fecal-oral transmission cycle. Residual viral particles on the floor must undoubtedly be eliminated, thereby preventing NoV aerosolization from this source. Along these lines, cleaning followed by disinfection by 1% sodium hypochlorite for ten minutes proved to be a superior floor decontamination protocol when compared with cleaning followed by disinfection by UV-light exposure for five minutes.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A Escala de AvaliaÃÃo da Capacidade para Cuidar de CrianÃas Expostas ao HIV (EACCC-HIV) à um instrumento que estima o cuidado de mÃes Ãs crianÃas nascidas na vigÃncia do HIV. Objetivou-se avaliar a capacidade de mÃes para cuidar de crianÃas expostas ao HIV mediante a EACCC-HIV e verificar a associaÃÃo entre as dimensÃes da escala e as caracterÃsticas maternas. Estudo transversal desenvolvido em 2010 em Fortaleza-CE. Participaram 62 cuidadoras (mÃes) HIV+ com 64 filhos (dois gemelares) nascidos expostos ao HIV menores de 1 ano. Apreciaram-se as caracterÃsticas das mÃes e das crianÃas; as estratÃgias para reduÃÃo da transmissÃo vertical do HIV; Apgar familiar e a EACCC-HIV. A escala possui 52 itens e cinco fatores que sÃo utilizados para determinadas idades entre zero e 1 ano: Fator 1: capacidade para administrar o AZT xarope (crianÃas atà 42 dias de vida); Fator 2: capacidade para preparar e administrar o leite em pà (crianÃas atà 1 ano); Fator 3: capacidade para preparar e administrar alimentaÃÃo complementar (crianÃas > de 4 meses); Fator 4: capacidade para administrar a profilaxia com sulfametoxazol e trimetoprim (crianÃas > 42 dias); Fator 5: capacidade para garantir a adesÃo ao acompanhamento clÃnico e vacinaÃÃo (todas as crianÃas). As respostas sÃo mediadas por fator ou pela somatÃria de todos os itens, indicando-se o grau de cuidado desenvolvido pela mÃe. Para anÃlise utilizou-se o STATA 11.0, empregando-se nÃvel de significÃncia de 5%. A idade materna oscilou entre 18 e 42 anos, 33,9% com aids, 61,3% integrantes das classes D e E. Das crianÃas uma tinha aids (1,6%), 98,4% iniciaram o AZT nas primeiras horas de vida, 3,1% foram amamentadas, 61,3% tiveram consumo inadequado de leite artificial e 36,2% consumo inadequado de alimentaÃÃo complementar. O Apgar familiar indicou 34,4% severamente funcional. Enquanto o fator 1 da EACCC-HIV avaliou 11 crianÃas, das quais 72,7% recebiam cuidados considerados adequados, o fator 2 avaliou 64 crianÃas e indicou que 86,0% das mÃes possuÃam alta capacidade de cuidar. Pelo fator 3, o cuidado concentrou-se entre moderado (44,4%) e alto (50%). O fator 4 estimou o cuidado oferecido para 51 crianÃas, indicando que 76,5% tiveram alta capacidade para o cuidado, e o fator 5 avaliou respostas das 62 mÃes sobre as 64 crianÃas. Destas, 95,3% possuÃam alta capacidade para adesÃo ao acompanhamento clÃnico e vacinaÃÃo. Pela avaliaÃÃo global, 29,7% dos cuidados foram considerados como adequados (alta capacidade para o cuidado). A associaÃÃo de variÃveis indicou significÃncia entre Apgar da famÃlia e capacidade para administrar o leite em pà (fator 2); paridade e capacidade para administrar a profilaxia com sulfametoxazol e trimetropim; paridade e escolaridade e capacidade para garantir adesÃo ao acompanhamento clÃnico e vacinaÃÃo; e estÃdio evolutivo e tempo de diagnÃstico com avaliaÃÃo global da escala. Com a EACCC-HIV favoreceu-se avaliar o cuidado materno dispensado Ãs crianÃas e realizar intervenÃÃes em prol da saÃde infantil para a manutenÃÃo da qualidade de vida na vigÃncia da exposiÃÃo ao HIV ou para aquelas infectadas pelo vÃrus. / A Escala de AvaliaÃÃo da Capacidade para Cuidar de CrianÃas Expostas ao HIV (EACCC-HIV) à um instrumento que estima o cuidado de mÃes Ãs crianÃas nascidas na vigÃncia do HIV. Objetivou-se avaliar a capacidade de mÃes para cuidar de crianÃas expostas ao HIV mediante a EACCC-HIV e verificar a associaÃÃo entre as dimensÃes da escala e as caracterÃsticas maternas. Estudo transversal desenvolvido em 2010 em Fortaleza-CE. Participaram 62 cuidadoras (mÃes) HIV+ com 64 filhos (dois gemelares) nascidos expostos ao HIV menores de 1 ano. Apreciaram-se as caracterÃsticas das mÃes e das crianÃas; as estratÃgias para reduÃÃo da transmissÃo vertical do HIV; Apgar familiar e a EACCC-HIV. A escala possui 52 itens e cinco fatores que sÃo utilizados para determinadas idades entre zero e 1 ano: Fator 1: capacidade para administrar o AZT xarope (crianÃas atà 42 dias de vida); Fator 2: capacidade para preparar e administrar o leite em pà (crianÃas atà 1 ano); Fator 3: capacidade para preparar e administrar alimentaÃÃo complementar (crianÃas > de 4 meses); Fator 4: capacidade para administrar a profilaxia com sulfametoxazol e trimetoprim (crianÃas > 42 dias); Fator 5: capacidade para garantir a adesÃo ao acompanhamento clÃnico e vacinaÃÃo (todas as crianÃas). As respostas sÃo mediadas por fator ou pela somatÃria de todos os itens, indicando-se o grau de cuidado desenvolvido pela mÃe. Para anÃlise utilizou-se o STATA 11.0, empregando-se nÃvel de significÃncia de 5%. A idade materna oscilou entre 18 e 42 anos, 33,9% com aids, 61,3% integrantes das classes D e E. Das crianÃas uma tinha aids (1,6%), 98,4% iniciaram o AZT nas primeiras horas de vida, 3,1% foram amamentadas, 61,3% tiveram consumo inadequado de leite artificial e 36,2% consumo inadequado de alimentaÃÃo complementar. O Apgar familiar indicou 34,4% severamente funcional. Enquanto o fator 1 da EACCC-HIV avaliou 11 crianÃas, das quais 72,7% recebiam cuidados considerados adequados, o fator 2 avaliou 64 crianÃas e indicou que 86,0% das mÃes possuÃam alta capacidade de cuidar. Pelo fator 3, o cuidado concentrou-se entre moderado (44,4%) e alto (50%). O fator 4 estimou o cuidado oferecido para 51 crianÃas, indicando que 76,5% tiveram alta capacidade para o cuidado, e o fator 5 avaliou respostas das 62 mÃes sobre as 64 crianÃas. Destas, 95,3% possuÃam alta capacidade para adesÃo ao acompanhamento clÃnico e vacinaÃÃo. Pela avaliaÃÃo global, 29,7% dos cuidados foram considerados como adequados (alta capacidade para o cuidado). A associaÃÃo de variÃveis indicou significÃncia entre Apgar da famÃlia e capacidade para administrar o leite em pà (fator 2); paridade e capacidade para administrar a profilaxia com sulfametoxazol e trimetropim; paridade e escolaridade e capacidade para garantir adesÃo ao acompanhamento clÃnico e vacinaÃÃo; e estÃdio evolutivo e tempo de diagnÃstico com avaliaÃÃo global da escala. Com a EACCC-HIV favoreceu-se avaliar o cuidado materno dispensado Ãs crianÃas e realizar intervenÃÃes em prol da saÃde infantil para a manutenÃÃo da qualidade de vida na vigÃncia da exposiÃÃo ao HIV ou para aquelas infectadas pelo vÃrus. / The Assessment Scale of the Ability to take Care of Children Exposed to HIV (EACCC-HIV) estimates mothersâ care delivery to children born in conditions of HIV. The goal was to assess mothersâ ability to take care of children exposed to HIV through the EACCC-HIV and to verify the association between scale dimensions and maternal characteristics. This cross-sectional study was carried out in Fortaleza-CE in 2010. Participants were 62 HIV+ caregivers (mothers) with 64 children (two twins) exposed to HIV at birth and younger than one year. The mothers and childrenâs characteristics were evaluated; strategies to reduce vertical HIV transmission: Family Apgar and EACCC-HIV. The scale contains 52 items and five factors, used for certain ages between zero and 1 year: Factor 1: ability to administer AZT syrup (children up to 42 days of life); Factor 2: ability to prepare and administer powder milk (children up to 1 year); Factor 3: ability to prepare and administer complementary feeding (children > 4 months); Factor 4: ability to administer prophylaxis with sulfamethoxazole and trimethoprim (children > 42 days); Factor 5: ability to guarantee adherence to clinical monitoring and vaccination (all children). Answers are mediated by a factor or by the sum of all items, indicating the degree of care the mother develops. STATA 11.0 software was used for analysis, with significance set at 5%. Maternal age ranged between 18 and 42 years, 33.9% suffering from aids, 61.3% in lower socioeconomic classes. One of the children had aids (1.6%), 98.4% had starting AZT in the first hours of life, 3.1% was breastfed, 61.3% showed inadequate artificial milk consumption and 36.2% inadequate complementary feeding consumption. The Family Apgar indicated 34.4% severely functional. While factor 1 of the EACCC-HIV assessed 11 children, 72.7% of whom received adequate care, factor 2 assessed 64 children and indicated high ability for care delivery in 86.0% of the mothers. According to factor 3, care was concentrated between moderate (44.4%) and high (50%). Factor 4 estimated the care offered to 53 children, indicating high ability for care delivery in 76.5%, and factor 5 assessed the 62 mothersâ answers on the 64 children. In total, 95.3% showed high ability for adherence to clinical monitoring and vaccination. According to the global assessment, 29.7% of care was considered adequate (high ability for care delivery). The association between variables indicated significance between family Apgar and ability to administer powder milk (factor 2); parity and ability to administer prophylaxis with sulfamethoxazole and trimethropim; parity and education level and ability to guarantee adherence to clinical monitoring and vaccination: and staging and diagnosis time with global assessment of the scale. Through the EACCC-HIV, maternal care for the children could be assessed and interventions could be made to enhance child health, with a view to maintaining quality of life in cases of exposure to or contamination by HIV. / The Assessment Scale of the Ability to take Care of Children Exposed to HIV (EACCC-HIV) estimates mothersâ care delivery to children born in conditions of HIV. The goal was to assess mothersâ ability to take care of children exposed to HIV through the EACCC-HIV and to verify the association between scale dimensions and maternal characteristics. This cross-sectional study was carried out in Fortaleza-CE in 2010. Participants were 62 HIV+ caregivers (mothers) with 64 children (two twins) exposed to HIV at birth and younger than one year. The mothers and childrenâs characteristics were evaluated; strategies to reduce vertical HIV transmission: Family Apgar and EACCC-HIV. The scale contains 52 items and five factors, used for certain ages between zero and 1 year: Factor 1: ability to administer AZT syrup (children up to 42 days of life); Factor 2: ability to prepare and administer powder milk (children up to 1 year); Factor 3: ability to prepare and administer complementary feeding (children > 4 months); Factor 4: ability to administer prophylaxis with sulfamethoxazole and trimethoprim (children > 42 days); Factor 5: ability to guarantee adherence to clinical monitoring and vaccination (all children). Answers are mediated by a factor or by the sum of all items, indicating the degree of care the mother develops. STATA 11.0 software was used for analysis, with significance set at 5%. Maternal age ranged between 18 and 42 years, 33.9% suffering from aids, 61.3% in lower socioeconomic classes. One of the children had aids (1.6%), 98.4% had starting AZT in the first hours of life, 3.1% was breastfed, 61.3% showed inadequate artificial milk consumption and 36.2% inadequate complementary feeding consumption. The Family Apgar indicated 34.4% severely functional. While factor 1 of the EACCC-HIV assessed 11 children, 72.7% of whom received adequate care, factor 2 assessed 64 children and indicated high ability for care delivery in 86.0% of the mothers. According to factor 3, care was concentrated between moderate (44.4%) and high (50%). Factor 4 estimated the care offered to 53 children, indicating high ability for care delivery in 76.5%, and factor 5 assessed the 62 mothersâ answers on the 64 children. In total, 95.3% showed high ability for adherence to clinical monitoring and vaccination. According to the global assessment, 29.7% of care was considered adequate (high ability for care delivery). The association between variables indicated significance between family Apgar and ability to administer powder milk (factor 2); parity and ability to administer prophylaxis with sulfamethoxazole and trimethropim; parity and education level and ability to guarantee adherence to clinical monitoring and vaccination: and staging and diagnosis time with global assessment of the scale. Through the EACCC-HIV, maternal care for the children could be assessed and interventions could be made to enhance child health, with a view to maintaining quality of life in cases of exposure to or contamination by HIV.

A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg in fulfillment of the requirements for the degree of Master of Science in Medicine, Johannesburg , 2013 / South Africa’s Prevention of Mother-to-Child Transmission (PMTCT) programme is critical for eliminating vertical HIV transmission and reducing infant mortality. Early treatment of HIV-infection to curb infant deaths requires earlier diagnostic testing than the currently recommended six-week test. This study describes the continuum of PMTCT care at a Johannesburg hospital to identify interventions for improvement and investigates birth HIV testing for infants. Data from a cohort study at the hospital evaluating diagnostic assays in HIV-exposed infants were collated with routine clinical data, validated and analysed. Among 838 mother-infant pairs, 38% of mothers attended antenatal clinics early enough to receive optimal antenatal prophylaxis. Only 72% of infants accessed six-week testing at the hospital; a further 10% underwent testing elsewhere. Of 38 HIV-infected infants, 29 were infected in-utero and could have been identified at birth (sensitivity of 76.3% for birth testing), compared to only 26 (68%) diagnosed by six-week testing at the hospital. Majority (88%) of these 26 infants accessed antiretroviral therapy, but treatment was only initiated at a median age of 16.0 weeks and 43% of HIV-infected infants who initiated treatment had defaulted or died before the end of the study. Mathematical modelling demonstrated that birth testing would be superior to a six-week test to maximise infants diagnosed and life years saved, with the ideal algorithm being a birth and ten-week test. The PMTCT programme can be enhanced by earlier antenatal care for women and earlier infant diagnosis. Birth testing would diagnose HIV-infection before infants die or default from the PMTCT programme, thereby enabling effective monitoring of MTCT, and would allow earlier treatment initiation to reduce early infant mortality.

Source: Dissertation Abstracts International, Volume: 70-07, Section: B, page: 4122. Adviser: John Michael Swint. Includes bibliographical references

As alterações neurocognitivas associadas ao HIV-1 (HAND) são frequentes em adultos infectados pelo HIV-1 via transmissão sexual. Existe pouca informação sobre HAND em adultos infectados pelo HIV-1 via transmissão vertical. Este estudo teve como objetivos identificar a prevalência das HAND em adultos infectados por transmissão vertical assim como identificar a prevalência de depressão nessa população. Pacientes e métodos: trata-se de um estudo de delineamento transversal, realizado entre janeiro 2016 e maio de 2017, no Serviço de Extensão ao Atendimento de Pacientes HIV/aids (SEAP) da Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. O SEAP é um serviço exclusivamente ambulatorial, localizado na cidade de São Paulo. Os critérios de inclusão foram: (i) pacientes com diagnóstico de infecção pelo HIV-1 por transmissão vertical; (ii) idade igual ou superior a 18 anos; (iii) escolaridade mínima de 4 anos; e (iv) consentimento para participar do estudo. Os critérios de exclusão foram: (i) diagnóstico concomitante de doenças neurológicas oportunistas ou condições neurológicas, previamente documentadas; (ii) uso de substâncias psicoativas; (iii) incapacidade física para aplicação dos testes, (iv) recusa da assinatura do Termo de Consentimento Livre e Esclarecido. Foram utilizados como instrumentos de pesquisa: questionário sociodemográfico, escala de ansiedade e depressão hospitalar, escala de atividades de vida diária de Lawton e bateria neuropsicológica formal. Para análise estatística foram calculadas frequência, média e desvio padrão, assim como testes qui-quadrado, anova e análise posthoc. Valores de p < 0.05 foram considerados estatisticamente significativos. Foi utilizado o programa SPSS 21.0. Resultados: foram avaliados 28 participantes: 15 (53.6%) foram do sexo feminino e a idade média e o desvio padrão (DP) foi de 22 (6.7) anos. Foi identificado HAND em 23 (82,1%) pacientes: 12 (42.9%) tiveram alteração neurocognitiva assintomática (ANI), 6 (21,4%) tiveram comprometimento neurocognitivo leve (MND) e 5 (17.9%) tiveram demência associada ao HIV-1 (HAD). A atenção, velocidade de processamento e velocidade motora foram as funções cognitivas mais comprometidas. 3 (10.7%) pacientes apresentaram depressão; 3 (60%) dos 5 pacientes com HAD apresentaram depressão. Conclusões: neste estudo encontramos elevada prevalência de HAND em adultos infectados pelo HIV-1 via transmissão vertical, chamando atenção também a elevada proporção de pacientes com HAD. Por outro lado, identificamos baixa prevalência de depressão na população total do estudo, mas a prevalência de depressão foi elevada dentre os pacientes com HAD / Neurocognitive disorders associated with HIV-1 (HAND) are common in adults sexually infected with HIV-1. There is little information about HAND in adults vertically infected with HIV-1. This study aimed to identify the prevalence of HAND in adults vertically infected with HIV-1 as well as to identify the prevalence of depression in this population. Patients and methods: This is a cross-sectional study, conducted between January 2016 and May 2017, at the Extension Service for HIV/aids Patients (SEAP) of the Division of Infectious and Parasitic Diseases of the Hospital das Clínicas of University of São Paulo Medical School. SEAP is an exclusively outpatient service, located in the city of São Paulo. Inclusion criteria were: (i) patients diagnosed with HIV-1 infected by vertical transmission; (ii) age equal to or more than 18 years; (iii) minimum schooling of 4 years; and (iv) consent to participate in the study. Exclusion criteria were: (i) concomitant diagnosis of opportunistic neurological diseases or neurological conditions, previously documented; (ii) use of psychoactive substances; (iii) physical incapacity to apply the tests, (iv) refusal to sign the Free and Informed Consent Form. The following research assessment tools were used: sociodemographic questionnaire, hospital anxiety and depression scale, Lawton daily life activity scale and formal neuropsychological battery. For statistical analysis, we calculated frequency, mean and standard deviation, as well as chi-square, anova and post-hoc analysis. Values of p < 0.05 were considered statistically significant. The SPSS 21.0 program was used. Results: 28 participants were evaluated: 15 (53.6%) were female and the mean age and standard deviation (SD) were 22 (6.7) years. HAND was identified in 23 (82.1%) patients: 12 (42.9%) had asymptomatic neurocognitive impairment (ANI), 6 (21.4%) had mild neurocognitive impairment and 5 (17.9%) had dementia associated with HIV-1 (HAD). Attention, processing speed and motor speed were the most compromised cognitive functions. 3 (10.7%) patients presented depression; 3 (60%) of the 5 patients with HAD had depression. Conclusions: in this study we found a high prevalence of HAND in adults vertically infected, also calling attention to the high proportion of patients with HAD. On the other hand, we identified a low prevalence of depression in the total study population, but the prevalence of depression was high among patients with HAD