Feasibility of Establishing HIV Case-Based Surveillance to Measure Progress Along the Health Sector Cascade: Situational Assessments in Tanzania, South Africa, and Kenya.

BACKGROUND: To track the HIV epidemic and responses to it, the World Health Organization recommends 10 global indicators to collect information along the HIV care cascade. Patient diagnosis and medical record data, harnessed through case-based surveillance (CBS), can be used to measure 8 of these. While many high burden countries have well-established systems for monitoring patients on HIV treatment, few have formally adopted CBS. OBJECTIVE: In response to the need for improved strategic HIV information and to facilitate the development of CBS in resource-limited countries, we aimed to conduct situational assessments of existing data collection systems in Tanzania, South Africa, and Kenya. METHODS: We developed a standardized protocol and a modularized data collection tool to be adapted for the particular focus of the assessments within each country. The three countries were selected based on their stage of readiness for CBS. The assessment included three parts: a desk review of relevant materials on HIV surveillance and program monitoring, stakeholder meetings, and site visits. RESULTS: In all three countries, routine HIV program monitoring is conducted, and information on new HIV diagnoses and persons accessing HIV care and treatment services is collected. Key findings from the assessments included substantial stakeholder support for the development of CBS, significant challenges in linking data within and between systems, data quality, the ability to obtain data from multiple sources, and information technology infrastructure. Viral load testing capacity varied by country, and vital registry data were not routinely linked to health systems to update medical records. CONCLUSIONS: Our findings support the development of CBS systems to systematically capture routinely collected health data to measure and monitor HIV epidemics and guide responses. Although there were wide variations in the systems examined, some of the current program and patient monitoring systems can be adapted to function effectively for CBS, especially if supported by an improved patient registration system with shared unique health identifiers

Calibration of TCCON column-averaged CO2: the first aircraft campaign over European TCCON sites

The Total Carbon Column Observing Network (TCCON) is a ground-based network of Fourier Transform Spectrometer (FTS) sites around the globe, where the column abundances of CO2, CH4, N2O, CO and O2 are measured. CO2 is constrained with a precision better than 0.25% (1-σ). To achieve a similarly high accuracy, calibration to World Meteorological Organization (WMO) standards is required. This paper introduces the first aircraft calibration campaign of five European TCCON sites and a mobile FTS instrument. A series of WMO standards in-situ profiles were obtained over European TCCON sites via aircraft and compared with retrievals of CO2 column amounts from the TCCON instruments. The results of the campaign show that the FTS measurements are consistently biased 1.1% ± 0.2% low with respect to WMO standards, in agreement with previous TCCON calibration campaigns. The standard a priori profile for the TCCON FTS retrievals is shown to not add a bias. The same calibration factor is generated using aircraft profiles as a priori and with the TCCON standard a priori. With a calibration to WMO standards, the highly precise TCCON CO2 measurements of total column concentrations provide a suitable database for the calibration and validation of nadir-viewing satellite

Operational research in low-income countries: what, why, and how?

Operational research is increasingly being discussed at institutional meetings, donor forums, and scientific conferences, but limited published information exists on its role from a disease-control and programme perspective. We suggest a definition of operational research, clarify its relevance to infectious-disease control programmes, and describe some of the enabling factors and challenges for its integration into programme settings. Particularly in areas where the disease burden is high and resources and time are limited, investment in operational research and promotion of a culture of inquiry are needed so that health care can become more efficient. Thus, research capacity needs to be developed, specific resources allocated, and different stakeholders (academic institutions, national programme managers, and non-governmental organisations) brought together in promoting operational research

Civil Aircraft for the regular investigation of the atmosphere based on an instrumented container: The new CARIBIC system

An airfreight container with automated instruments for measurement of atmospheric gases and trace compounds was operated on a monthly basis onboard a Boeing 767-300 ER of LTU International Airways during long-distance flights from 1997 to 2002 (CARIBIC, Civil Aircraft for Regular Investigation of the Atmosphere Based on an Instrument Container, http://www.caribic-atmospheric.com). Subsequently a more advanced system has been developed, using a larger capacity container with additional equipment and an improved inlet system. CARIBIC phase #2 was implemented on a new long-range aircraft type Airbus A340-600 of the Lufthansa German Airlines (Star Alliance) in December 2004, creating a powerful flying observatory. The instrument package comprises detectors for the measurement of O3, total and gaseous H2O, NO and NOy, CO, CO2, O2, Hg, and number concentrations of sub-micrometer particles (>4 nm, >12 nm, and >18 nm diameter). Furthermore, an optical particle counter (OPC) and a proton transfer mass spectrometer (PTR-MS) are incorporated. Aerosol samples are collected for analysis of elemental composition and particle morphology after flight. Air samples are taken in glass containers for laboratory analyses of hydrocarbons, halocarbons and greenhouse gases (including isotopic composition of CO2) in several laboratories. Absorption tubes collect oxygenated volatile organic compounds. Three differential optical absorption spectrometers (DOAS) with their telescopes mounted in the inlet system measure atmospheric trace gases such as BrO, HONO, and NO2. A video camera mounted in the inlet provides information about clouds along the flight track. The flying observatory, its equipment and examples of measurement results are reported

Anthropogenic methane plume detection from point sources in the Paris megacity area and characterization of their δ¹³C signature

International audienceMitigating anthropogenic methane emissions is one of the available tools for reaching the near term objectives of the Paris Agreement. Characterizing the isotopic signature of the methane plumes emitted by these sources is needed to improve the quantification of methane sources at the regional scale. Urbanized and industrialized regions such as the Paris megacity are key places to better characterize anthropogenic methane sources. In this study, we present the results of the first mobile surveys in the Paris region, assessing methane point sources from 10 landfills (which in the regional inventory are the main emission sector of methane in the region), 5 gas storage sites (supplying Paris) and 1 waste water treatment (WWT) facility (Europe’s largest, second worldwide). Local atmospheric methane concentration (or mixing ratio) enhancements in the source plumes were quantified and their d13C in CH4 (further noted d13CH4) signature characterized. Among the 10 landfills sampled, at 6 of them we detected atmospheric methane local enhancements ranging from 0.8 to 8.5 parts per million (ppm) with d13CH4 signatures between -63.7 ± 0.3 permils (‰) to - 58.2 ± 0.3 ‰. Among the 5 gas storage sites surveyed, we could observe that 3 of them were leaking methane with local methane concentration enhancements ranging from 0.8 to 8.1 ppm and d13CH4 signatures spanning from -43.4 ± 0.5 ‰ to -33.8 ± 0.4 ‰. Dutch gas with a d13CH4 signature of -33.8 ± 0.4 ‰ (typical of thermogenic gas) was also likely identified. The WWT site emitted local methane enhancements up to 4.0 ppm. For this site, two d13CH4 signatures were determined as -51.9 ± 0.2 ‰ and -55.3 ± 0.1 ‰, typical of a biogenic origin. About forty methane plumes were also detected in the Paris city, leading to local concentration enhancements whose origin was in two cases interpreted as natural gas leaks thanks to their isotopic composition. However, such enhancements were much less common than in cities of North America. More isotopic surveys are needed to discriminate whether such urban methane enhancements are outcoming from gas line leaks and sewer network emanations. Furthermore, our results lead us to the conclusion that the regional emissions inventory could underestimate methane emissions from the WWT sector. Further campaigns are needed to assess the variability and seasonality of the sources and of their isotopic signature, and to estimate their emissions using methods independent of the inventory

Global Pharmacovigilance for Antiretroviral Drugs: Overcoming Contrasting Priorities

Jur Strobos and colleagues describe the deliberations of a recent multi-stakeholder meeting discussing the creation of a sustainable global pharmacovigilance system for antiretroviral drugs that would be applicable in resource limited settings

Prevalence of transfusion-transmitted Chagas disease among multitransfused patients in Brazil

<p>Abstract</p> <p>Background</p> <p>Blood transfusion has always been an important route for Chagas Disease (CD) transmission. The high prevalence of CD in Latin America and its lifelong asymptomatic clinical picture pose a threat for the safety of the blood supply. The outcome of measures designed to improve transfusion safety can be assessed by evaluating the prevalence of CD among multitransfused patients</p> <p>Methods</p> <p>In order to assess the impact of CD control measures on the safety of the blood supply, an observational cross-sectional study was designed to determine the prevalence of CD in 351 highly transfused patients, in which vectorial transmission was excluded. This study compared patients that received transfusion products before (n = 230) and after (n = 121) 1997, when measures to control transfusion-transmitted CD were fully implemented in Brazil.</p> <p>Results</p> <p>The study group consisted of 351 patients exposed to high numbers of blood products during their lifetime (median number of units transfused = 51, range 10–2086). A higher prevalence of transfusion-transmitted CD (1.30%) was observed among multitransfused patients that received their first transfusion before 1997, compared with no cases of transfusion-transmitted CD among multitransfused patients transfused after that year. The magnitude of the exposure to blood products was similar among both groups (mean number of units transfused per year of exposure = 25.00 ± 26.46 and 23.99 ± 30.58 respectively; P = 0.75, Mann-Whitney test).</p> <p>Conclusion</p> <p>Multiple initiatives aimed to control vector and parental transmission of CD can significantly decrease transfusion-transmitted CD in Brazil. Our data suggest that mandatory donor screening for CD represents the most important measure to interrupt transmission of CD by blood transfusions.</p