Lancet Global Health最新文献

{"title":"The effect of a social network-based intervention to promote HIV testing and linkage to HIV services among fishermen in Kenya: a cluster-randomised trial.","authors":"Carol S Camlin, Lila A Sheira, Zachary A Kwena, Edwin D Charlebois, Kawango Agot, James Moody, Benard Ayieko, Sarah A Gutin, Antony Ochung, Phoebe Olugo, Jayne Lewis-Kulzer, Holly Nishimura, Monica Gandhi, Elizabeth A Bukusi, Harsha Thirumurthy","doi":"10.1016/S2214-109X(24)00539-4","DOIUrl":"10.1016/S2214-109X(24)00539-4","url":null,"abstract":"<p><strong>Background: </strong>In sub-Saharan Africa, highly mobile men such as fishermen have a low uptake of HIV testing, prevention, and treatment. This study aimed to examine whether a HIV status-neutral, social network-based intervention could improve testing and linkage to prevention and treatment among fishermen in Kenya.</p><p><strong>Methods: </strong>The Owete cluster-randomised trial mapped the male social networks of fishermen in three communities along Lake Victoria in Siaya County, Kenya, and identified distinct social networks (clusters) with a highly connected, network-central man (promoter) in each network. Participant inclusion criteria were age 18 years or older, a listing in the Beach Management Unit registry, a governmental requirement to work as a fisherman at each site, and no participation in any other HIV-related study. Clusters were randomly assigned to an intervention group in which promoters were trained and offered multiple HIV self-tests to offer to cluster members, and transport vouchers (US$4) to encourage those members to link to HIV treatment or pre-exposure prophylaxis (PrEP). In control clusters, promoters received HIV information and referral vouchers for a free self-test or provider-administered test in nearby clinics that they were encouraged to offer to cluster members. We compared self-reported HIV testing in the past 3 months and linkage to HIV services among participants in intervention and control clusters at the 3-month follow-up visit in the intention-to-treat sample, defined as members of the social networks who were successfully contacted at 3 months using a cluster-adjusted two-sample test of proportions. The trial is registered at ClinicalTrials.gov, NCT04772469, and is completed.</p><p><strong>Findings: </strong>Between July 17, 2020 and Feb 2, 2022, 1509 eligible men participated in the beach census. 575 were excluded due to not being mapped to a close social network, and 934 men in 156 social network clusters were mapped. 453 men were randomly assigned to the intervention group and 481 were randomly assigned to the control group. 733 men completed a baseline survey (374 in the intervention group and 359 in the control group). 353 men in the intervention group and 313 in the control group completed the 3-month follow-up assessments and were included in the analysis of the primary outcome. Participants' median age was 35·5 years (IQR 30·1-42·3); 85% were married, with 22% in polygynous relationships. HIV testing via any modality at 3 months was higher in intervention compared with control clusters (65·6 [95% CI 59·5-71·7] vs 31·3% [25·4-37·2], p<0·0001). Self-reported HIV testing at 3 months was also higher in intervention clusters (60·4% [95% CI 54·2-66·7] vs 10·0% [6·8-13·3], p<0·0001). Additionally, following testing, linkage to HIV treatment or PrEP among those who tested was higher in intervention clusters (67·3% [95% CI 61·2-73·5] vs 15·6% [10·9-20·2], p<0·0001).</p><p><strong>Interpretati","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 4","pages":"e669-e678"},"PeriodicalIF":19.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decentralised care: a promising strategy in managing Ebola outbreaks.","authors":"Olushayo Oluseun Olu","doi":"10.1016/S2214-109X(25)00019-1","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00019-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a decentralised model of care on case isolation and patient outcomes during the 2018-20 Ebola outbreak in the Democratic Republic of the Congo: a retrospective observational study.","authors":"Patrick M Barks, Anton Camacho, Trish Newport, Filipe Ribeiro, Steve Ahuka-Mundeke, Richard Kitenge, Justus Nsio, Rebecca M Coulborn, Emmanuel Grellety","doi":"10.1016/S2214-109X(25)00011-7","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00011-7","url":null,"abstract":"<p><strong>Background: </strong>Partway into the 2018-20 Ebola outbreak in the Democratic Republic of the Congo (DR Congo), a new strategy of decentralised care was initiated to address delays in care seeking, improve community acceptance, and reduce the risk of Ebola virus disease (EVD) transmission through early case isolation. Unlike centralised EVD facilities (transit and treatment centres), which operated in parallel to the existing health-care system and focused exclusively on EVD, decentralised facilities were integrated into existing health-care structures with which communities were already familiar, and designed to continue providing health care for patients with other non-EVD illnesses. Here we aim to assess the strategy of decentralised care by comparing admission delays and patient outcomes among the three types of EVD facilities (decentralised, transit, and treatment).</p><p><strong>Methods: </strong>We performed a retrospective analysis of routinely collected data from all individuals admitted to EVD facilities (12 treatment, nine transit, and 21 decentralised facilities) at any point during the Ebola outbreak from July 27, 2018, to June 24, 2020 in DR Congo. We used multivariate mixed-effect regression to model admission delays (the number of days between symptom onset and admission to an EVD facility) and patient outcomes (survived or died), as functions of facility type at first admission and date of admission, while controlling for a variety of other covariates.</p><p><strong>Findings: </strong>Over the course of the outbreak 60 465 patients were admitted to EVD facilities, of which 2289 (3·8%) were confirmed to be EVD positive. Covariate-adjusted admission delays were somewhat higher among patients presenting to transit facilities (adjusted rate ratio 1·14 [95% CI 0·95-1·32]) or treatment facilities (1·18 [1·00-1·36]) compared with decentralised facilities. Similarly, compared with decentralised facilities, adjusted case-fatality risks were slightly higher among patients presenting to transit facilities (adjusted risk ratio 1·04 [0·82-1·26]) or treatment facilities (1·03 [0·82-1·24]).</p><p><strong>Interpretation: </strong>As was observed during the 2013-16 west Africa outbreak and the 2020 outbreak in the Equateur province of DR Congo, patients suspected of EVD that presented to decentralised facilities had modestly shorter admission delays than patients presenting to centralised facility types. Case-fatality risks were slightly lower among patients presenting to decentralised facilities; however, this finding was not statistically significant and so it is difficult to assess the generalisability.</p><p><strong>Funding: </strong>Médecins Sans Frontières.</p><p><strong>Translation: </strong>For the French translation of the abstract see Supplementary Materials section.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of aid sanctions on maternal and child mortality, 1990-2019: a panel analysis.","authors":"Ruth M Gibson, Paul H Wise, Joseph L Dieleman, Yoto V Yotov, Aleksandra Kirilakha, Gary L Darmstadt, Eran Bendavid, Constantinos Syropoulos, Michele Barry, Sebastien Bradley","doi":"10.1016/S2214-109X(25)00058-0","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00058-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Aid sanctions are a type of financial punishment imposed on a country by other countries or international organisations in response to a political coup, armed conflict, or human rights abuses. Humanitarian catastrophes in Burkina Faso, Sudan, and Myanmar have brought aid sanctions to the centre of the foreign affairs strategy debate because of their inadvertent negative effects on human health. Our analysis investigates the effects of aid sanctions from 1990 to 2019 on maternal and child mortality. These questions are particularly relevant in the context of the abrupt shift in US foreign aid policy in 2025, leading to aid prohibitions that might resemble aid sanctions in their effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were drawn from a broad set of sources, including population health metrics databases, established sanctions databases, and a novel global dataset on aid sanctions created for this study. We assessed the prevalence of the use of aid sanctions worldwide during 1990-2019 and estimated their impact on official development assistance (ODA) and development assistance for health (DAH). We investigated the effect of aid sanctions on infant (age &lt;1 year), children younger than 5 years (hereafter referred to as under-5), maternal (within 42 days of the end of pregnancy), and all-age mortality rates using panel difference-in-differences ordinary least squares estimation. We applied linear regression methods and included country and year fixed effects, country-specific time trends, and multiple control variables. We also conducted a series of sensitivity analyses, including entropy balancing, to confirm the validity of our results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;During our study period, 67 low-income or middle-income countries (LMICs) and sovereign territories (hereafter referred to as countries) were targeted by 88 unique aid sanction episodes. Relative to our control group of 66 never-sanctioned countries, aid sanctions reduced ODA by an estimated US$213·07 million per year (95% CI 502·28 to -76·12) for the average target country and reduced DAH by $16·42 million (32·57 to 0·27)--a 17% reduction in DAH. Aid sanctions resulted in an additional 129·3 infant deaths per 100 000 livebirths (11·7 to 246·9), an additional 47·1 under-5 deaths per 100 000 livebirths (-2·8 to 97·0), and an additional 10·9 (2·2-19·6) maternal deaths per 100 000 livebirths, per year. Relative to mean in-sample mortality rates, aid sanctions thus increased infant, under-5, and maternal mortality rates by 3·1%, 3·6%, and 6·4%, respectively, on an annual basis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Interpretation: &lt;/strong&gt;Over the period 1990-2019, infant, under-5, and maternal mortality rates among LMICs declined at average annualised rates of 2·6%, 3·2%, and 2·0%, respectively. Aid sanction episodes lasting 5 years-the median duration observed in our sample-would thus negate nearly 30% of the overall improvements in infant and under-5 mortality seen in the","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A roadmap for integrating nutritional assessment, counselling, and support into the care of people with tuberculosis.","authors":"Pranay Sinha, Madhavi Bhargava, Madeline E Carwile, Madolyn R Dauphinais, Phumeza Tisile, Chelsie Cintron, Lindsey M Locks, Janika Hauser, Matt Oliver, Scott K Heysell, Saurabh Mehta, Julia L Finkelstein, Kobto G Koura, J Peter Cegielski, Rein M G J Houben, C Finn McQuaid, Anurag Bhargava","doi":"10.1016/S2214-109X(25)00021-X","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00021-X","url":null,"abstract":"<p><p>Undernutrition-the leading risk factor for tuberculosis worldwide-is associated with impaired immunity, more extensive disease, delayed sputum conversion, and worse treatment outcomes, including mortality. In this Health Policy, we propose a comprehensive roadmap for integrating nutritional assessment, counselling, and support into tuberculosis treatment as part of person-centred care. At treatment initiation, we recommend standard nutritional assessment with anthropometric measurements and haemoglobin estimation, in addition to macronutrient and micronutrient support alongside nutritional counselling. Weight should be monitored during treatment and lack of weight gain at the end of the intensive phase should prompt an investigation of causes, such as food insecurity, poor treatment adherence, malabsorption, uncontrolled diabetes, or drug resistance. At the end of treatment, we recommend reassessing anthropometric measures to assess nutritional recovery. People with tuberculosis who remain underweight should receive close follow-up to detect early relapse. We call for annual reporting of nutritional metrics by WHO, explicit inclusion of nutritional assessment and care in national strategic plans, domestic or international support of nutritional programmes for people with tuberculosis, increased support for operational research initiatives, and integration of nutritional care into the WHO Multisectoral Accountability Framework at national and regional levels.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No health without aid and development.","authors":"Charlotte Hanlon, Martyn Pickersgill, Seth Amanfo, Harry Campbell, Anna Chiumento, Jeff Collin, Michael Eddleston, Liz Grant, Ewen Harrison, Aisha Holloway, Sumeet Jain, Stephen Lawrie, Angus Macbeth, Chelsea Morroni, Lotte Segal, Nadine Seward, Rosie Stenhouse, Robert C Stewart, Harish Nair","doi":"10.1016/S2214-109X(25)00111-1","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00111-1","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Africa's defining moment: the time to lead the HIV response is now.","authors":"Mumbi Chola, Izukanji Sikazwe, Magda Robalo, Pokuaa Oduro-Bonsrah, Alex Coutinho, Robb Sheneberger, Jekwu Ozoemene, Pierre M'pele, Damaris Nyamweya, Sasha Stevenson, Yvette Raphael, Sesupo Makakole Nene, John Ataguba, Mohamed Chakroun, Michel Sidibe","doi":"10.1016/S2214-109X(25)00102-0","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00102-0","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":""},"PeriodicalIF":19.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thank you to The Lancet Global Health's statistical and peer reviewers in 2024.","authors":"Zoë Mullan","doi":"10.1016/S2214-109X(25)00050-6","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00050-6","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 3","pages":"e407-e413"},"PeriodicalIF":19.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mpox vaccination strategies in DR Congo.","authors":"Rajesh Kanna Gopal, Pitchaipillai Sankar Ganesh, Naji Naseef Pathoor","doi":"10.1016/S2214-109X(25)00006-3","DOIUrl":"https://doi.org/10.1016/S2214-109X(25)00006-3","url":null,"abstract":"","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":"13 3","pages":"e415"},"PeriodicalIF":19.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis and people who use drugs: why focus on this overlooked population is important and why adapted interventions are necessary.","authors":"Morgana D'Ottavi, Peter Godfrey-Faussett, Corinne S Merle, Mircea T Sofonea, Didier Laureillard, Peter Vickerman, Jean-Pierre Molès, Frederick L Altice, Philippe Van de Perre, Jack Stone, Nicolas Nagot","doi":"10.1016/S2214-109X(24)00481-9","DOIUrl":"10.1016/S2214-109X(24)00481-9","url":null,"abstract":"<p><p>People who use drugs show a higher incidence and prevalence of tuberculosis than people who do not use drugs in areas where Mycobacterium tuberculosis is endemic. However, this population is largely neglected in national tuberculosis programmes. Strategies for active case finding, screening, and linkage to care designed for the general population are not adapted to the needs of people who use drugs, who are stigmatised and difficult to reach. Moreover, access to care, linkage to care, and treatment adherence are challenging for such a marginalised population. Learning from the HIV field about successful interventions targeting this group, we advocate for the implementation of tuberculosis interventions adapted for people who use drugs, highlighting the key role that community-based approaches could have in both design and implementation. Alongside reducing health inequities by reducing the excess tuberculosis burden among people who use drugs, these targeted interventions can also reduce tuberculosis transmission at the population level.</p>","PeriodicalId":48783,"journal":{"name":"Lancet Global Health","volume":" ","pages":"e593-e598"},"PeriodicalIF":19.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}