Frontiers in reproductive health最新文献

{"title":"Use of viability PCR for detection of live Chlamydia trachomatis in clinical specimens.","authors":"Lucia Vojtech, Shahrokh Paktinat, Tiffany Luu, Stella Teichmann, Olusegun O Soge, Robert Suchland, Lindley A Barbee, Christine M Khosropour","doi":"10.3389/frph.2023.1199740","DOIUrl":"10.3389/frph.2023.1199740","url":null,"abstract":"<p><strong>Background: </strong>The current testing approach to diagnose <i>Chlamydia trachomatis</i> (CT) infection relies on nucleic acid amplification tests (NAATs). These tests are highly sensitive, but do not distinguish between active infection and residual bacterial nucleic acid which may remain after resolution of infection, or via cross-contamination. Better methods to assess the viability of CT detected in clinical samples would be useful in determining the relevance of CT detection in a variety of clinical settings. The goal of this study was to test viability PCR (vPCR) as a method to distinguish viable bacteria from non-viable CT.</p><p><strong>Methods: </strong>The vPCR relies on a propidium monoazide dye (PMAxx), which intercalates into accessible DNA from dead organisms and prevents their detection in a PCR assay for the CT <i>ompA</i> gene. We used digital PCR to quantify absolute genome copy numbers from samples. We validated the vPCR approach using laboratory stocks of CT with known viability. Then, we tested total DNA, viable CT DNA, and culture results from 18 clinical vaginal specimens and 25 rectal clinical specimens, all of which had tested positive by NAAT.</p><p><strong>Results: </strong>In laboratory stocks of CT, vPCR using defined ratios of heat-killed to live bacteria tracked closely with expected results. In vaginal clinical specimens, vPCR and total DNA results were correlated, though total DNA genomes outnumbered viable genomes by 2.2-52.6-fold more copies. As expected, vPCR detected more total genomes than culture results. Both vPCR and total DNA correlated with culture results (Spearman correlation <i>R</i> = 0.8425 for total DNA and 0.8056 for vPCR). Ten rectal NAAT positive specimens were negative by total DNA PCR, vPCR, and were negative or inconclusive by culture. Of the 6 rectal specimens that were culture positive, all were total DNA and vPCR positive. vPCR additionally detected viable bacterial DNA in 8 specimens which were NAAT + and culture negative, though levels were very low (mean 1,357 copies/ml).</p><p><strong>Conclusions: </strong>vPCR is a fast and easy method to assess viability in clinical specimens and is more correlated with culture results than total DNA PCR. Inconsistent ratios between total DNA and vPCR results suggest that the amount of dead bacteria varies considerably in clinical specimens. Results from rectal specimens suggest that many NAAT positive specimens do not in fact represent live replicating bacteria, and likely result in significant overuse of unnecessary antibiotics.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"5 ","pages":"1199740"},"PeriodicalIF":0.0,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10436598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10424856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral HIV pre-exposure prophylaxis use among pregnant and postpartum women: results from real-world implementation in Lesotho.","authors":"Lieketseng J Masenyetse, Lauren Greenberg, Felleng Samonyane, Bokang Sekepe, Majoalane Mokone, Mafusi J Mokone, Vincent J Tukei, Laura K Beres","doi":"10.3389/frph.2023.1221752","DOIUrl":"10.3389/frph.2023.1221752","url":null,"abstract":"<p><strong>Introduction: </strong>Lesotho has reached epidemic control, PrEP is an important component in maintaining that and in reaching the goal of eliminating mother-to-child transmission.</p><p><strong>Methods: </strong>We conducted a retrospective review of existing, routine PrEP health records in 26 health facilities in Lesotho. PrEP visit data were collected for pregnant and postpartum women screened for PrEP and/or enrolled in PrEP programs from 1 January 2019 through 30 June 2021 with follow-up data collected up to the date of data abstraction per site between October 2021 and May 2022. Poisson regression with robust variance was used to evaluate the association between patient characteristics and continuation of PrEP.</p><p><strong>Results: </strong>Indications for starting PrEP were significantly associated with continuation in PrEP use. Women starting PrEP due to having a partner known to be living with HIV were the most likely to return for follow-up. In all age groups, the most common reason for starting PrEP was being in a serodiscordant relationship, though the proportion varies by age.</p><p><strong>Conclusion: </strong>As Lesotho is now in the process of optimizing PrEP use among pregnant and postpartum women, it is critical to revise data sources to capture information that will link PrEP records and ANC/PNC records and document pregnancy/postpartum status in order to better understand PrEP use and gaps in this population.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"5 ","pages":"1221752"},"PeriodicalIF":0.0,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10003954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlates of physical activity among people living with and without HIV in rural Uganda.","authors":"Smart Z Mabweazara,&nbsp;Jennifer Manne-Goehler,&nbsp;Prossy Bibangambah,&nbsp;June-Ho Kim,&nbsp;Sentongo Ruth,&nbsp;Linda C Hemphill,&nbsp;Samson Okello,&nbsp;Mark Hamer,&nbsp;Mark J Siedner","doi":"10.3389/frph.2023.1093298","DOIUrl":"10.3389/frph.2023.1093298","url":null,"abstract":"<p><strong>Background: </strong>Antiretroviral therapy (ART) has led to diminishing AIDS-related mortality but a concomitant increase in non-communicable diseases (NCDs) for people with HIV (PWH). Whereas physical activity (PA) has been shown to help prevent NCDs and NCD outcomes in other settings, there are few data on PA and its correlates among PWH in high-endemic settings. We aimed to compare PA by HIV serostatus in rural Uganda.</p><p><strong>Methods: </strong>We analysed data from the UGANDAC study, an observational cohort including PWH in ambulatory HIV care in Mbarara, Uganda, and age- and gender-matched people without HIV (PWOH). Our primary outcome of interest was PA, which we assessed using the International Physical Activity Questionnaire and considered as a continuous measure of metabolic equivalents in minutes/week (MET-min/week). Our primary exposure of interest was HIV serostatus. We fit univariable and multivariable linear regression models to estimate the relationship between HIV and PA levels, with and without addition of sociodemographic and clinical correlates of PA (MET-min/week). In secondary analyses, we explored relationships restricted to rural residents, and interactions between gender and serostatus.</p><p><strong>Results: </strong>We enrolled 309 participants, evenly divided by serostatus and gender. The mean age of PWH was 52 [standard deviation (SD) 7.2] and 52.6 (SD 7.3) for PWOH. In general, participants engaged in high levels of PA regardless of serostatus, with 81.2% (251/309) meeting criteria for high PA. However, PWOH reported higher mean levels of PA met-minutes/week than PWH (9,128 vs 7,152, <i>p </i>≤ 0.001), and a greater proportion of PWOH (88.3%; 136/154) met the criteria for high PA compared to PWH (74.2%; 115/155). In adjusted models, lower levels of PA persisted among PWH (<i>β</i> = -1,734, 95% CI: -2,645, -824, <i>p</i> ≤ 0.001). Results were similar in a sensitivity analysis limited to people living in rural areas.</p><p><strong>Conclusion: </strong>In a rural Ugandan cohort, PWOH had higher levels of PA than PWH. Interventions that encourage PA among PWH may have a role in improving NCD risk profiles among PWH in the region.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"5 ","pages":"1093298"},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10398393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cervical transcriptome changes during the menstrual cycle but does not predict the window of implantation.","authors":"Amruta D S Pathare, Merli Saare, Alvin Meltsov, Ankita Lawarde, Vijayachitra Modhukur, Aive Kalinina, Aire Sekavin, Viktorija Kukushkina, Helle Karro, Andres Salumets, Maire Peters","doi":"10.3389/frph.2023.1224919","DOIUrl":"10.3389/frph.2023.1224919","url":null,"abstract":"<p><strong>Introduction: </strong>The expression of genes in female reproductive organs is influenced by the cyclic changes in hormone levels during the menstrual cycle. While the molecular changes in the endometrium that facilitate embryo implantation have been extensively studied, there is limited knowledge about the impact of the menstrual cycle on cervical cells. Cervical cells can be easily and routinely collected using a cytobrush during gynecological examination, offering a standardized approach for diagnostic testing. In this study we investigated how the transcriptome of cervical cells changes during the menstrual cycle and assessed the utility of these cells to determine endometrial receptivity.</p><p><strong>Methods: </strong>Endocervical cells were collected with cytobrushes from 16 healthy women at different menstrual cycle phases in natural cycles and from four women undergoing hormonal replacement cycles. RNA sequencing was applied to gain insight into the transcriptome of cervical cells.</p><p><strong>Results: </strong>Transcriptome analysis identified four differentially expressed genes (DEGs) between early- and mid-secretory samples, suggesting that the transcriptome of cervical cells does not change significantly during the opening of the implantation window. The most differences appeared during the transition to the late secretory phase (2136 DEGs) before the onset of menstruation. Cervical cells collected during hormonal replacement cycles showed 1899 DEGs enriched in immune system processes.</p><p><strong>Conclusions: </strong>The results of our study suggested that cervical cells undergo moderate transcriptomic changes throughout the menstrual cycle; however, these changes do not reflect the gene expression pattern of endometrial tissue and offer little or no potential for endometrial receptivity diagnostics.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"5 ","pages":"1224919"},"PeriodicalIF":2.3,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10375708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9908737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to first childbirth and its predictors among reproductive-age women in Ethiopia: survival analysis of recent evidence from the EDHS 2019.","authors":"Tegene Atamenta Kitaw,&nbsp;Ribka Nigatu Haile","doi":"10.3389/frph.2023.1165204","DOIUrl":"10.3389/frph.2023.1165204","url":null,"abstract":"<p><strong>Background: </strong>Being a mother for the first time is the most significant event in a woman's life. \"Age at first birth\" refers to a mother's age in years when she gives birth to her first child. The age of first childbirth has physical, economic, and social implications. However, little is known about this issue in Ethiopia. Thus, this study sought to determine the time to first childbirth and its predictors at a national level.</p><p><strong>Methods: </strong>Data were extracted from the 2019 Ethiopia Demographic and Health Survey using STATA version 17 software. A total of 8,885 weighted reproductive-age women (15-49 years) were included in this study. A Kaplan-Meier survivor curve was generated to estimate the time of first childbirth. A log-rank test was used to compare the difference in survival curves. Akaike information criteria and Bayesian information criteria were calculated to select the appropriate survival model for the data. The Weibull accelerated failure time model with no frailty distribution was used to identify significant predictors.</p><p><strong>Results: </strong>The overall median survival time to first childbirth was 18 years. The significant predictors of time to first childbirth were the educational level of the mother [primary education (ϕ = 1.036, 95% CI: 1.011, 1.063), secondary and above education (ϕ = 1.154, 95% CI: 1.118, 1.191)], knowledge of any contraceptive method [know at least one (ϕ = 1.051, 95% CI: 1.006, 1.101)], and media exposure (ϕ = 1.048, 95% CI: 1.011, 1.086).</p><p><strong>Conclusion: </strong>The median survival time to first childbirth was 18 years, which is lower than the optimal age for first childbirth (late 20 s and early 30 s). The timing of first childbirth in Ethiopia is mainly influenced by the educational level of women, knowledge of contraceptive methods, and exposure to media. Thus, exposing women to educational materials and other awareness-creation campaigns regarding the consequences of early first childbirth and strategies to improve women's knowledge of contraceptive methods is highly recommended.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"5 ","pages":"1165204"},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10382129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9899695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating PrEP in maternal and child health clinics in Kenya: analysis of a service availability and readiness assessment (SARA) survey.","authors":"Sarah Hicks, Felix Abuna, Ben Odhiambo, Julia C Dettinger, Joseph Sila, George Oketch, Enock Sifuna, Nancy Ngumbau, Laurén Gómez, Grace C John-Stewart, John Kinuthia, Anjuli D Wagner","doi":"10.3389/frph.2023.1206150","DOIUrl":"10.3389/frph.2023.1206150","url":null,"abstract":"<p><strong>Background: </strong>Risk of HIV acquisition is high during pregnancy and postpartum, and pre-exposure prophylaxis (PrEP) is recommended for peripartum populations. Integrating PrEP into maternal and child health (MCH) clinics is feasible and acceptable. Understanding clinics' service availability and readiness is essential for effective scale up.</p><p><strong>Methods: </strong>The PrEP in Pregnancy, Accelerating Reach and Efficiency study (PrEPARE; NCT04712994) engaged PrEP-experienced facilities previously linked to a programmatic or research study in Western Kenya to document available services and commodities via a modified service availability and readiness assessment (SARA) survey with 20 PrEP tracer items covering: staffing/guidelines, services/equipment, and medicines/commodities. Facilities' prior study engagement occurred between 2017 and 2019; SARA survey data was collected between April 2020 and June 2021. Descriptive statistics were stratified by prior study engagement. ANOVA tests assessed associations between facility characteristics and gaps. Fisher's tests assessed differences in commodity availability and stockouts.</p><p><strong>Results: </strong>Of the 55 facilities surveyed, 60% had received PrEP training in the last two years, 95% offered PrEP integrated into MCH, and 64% and 78% had both auditory and visual privacy in PrEP and HIV testing service (HTS) delivery spaces, respectively. Supervision frequency was heterogeneous, but 82% had received a supervision visit within 3 months. Availability of commodities was variable and the most commonly unavailable commodities were PrEP in MCH (71% available) and risk assessment screening tool (RAST) and PrEP cards (60% and 75% available, respectively). The number of service and commodity gaps per facility ranged from zero to eight (median: 3; IQR: 2, 5). The most frequent gaps were: PrEP training and risk assessment cards (40% each), lack of privacy in PrEP (36%) and HIV testing services (31%) spaces, PrEP pills in MCH (29%), and PrEP cards (25%). There were no differences in mean number of gaps by county, previous study engagement, or public vs. private status. Level 4 facilities had fewer gaps (mean 2.2) than level 2, 3, and 5 facilities (mean 5.7, 4.5, and 5.3 respectively; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>PrEP service availability and readiness was generally high across MCH facilities. However, there is a need for increased frequency of provider training and supportive supervision focused on fidelity. To address key commodity stockouts such as PrEP pills, implementation of electronic logistics management information systems may be needed. Targeting these gaps is essential to effectively scale up integrated PrEP delivery, especially among facilities with limited infrastructure.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"5 ","pages":"1206150"},"PeriodicalIF":2.3,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participant experiences with a multipurpose vaginal ring for HIV and pregnancy prevention during a phase 1 clinical trial: learning from users to improve acceptability.","authors":"Mary Kate Shapley-Quinn, Mei Song, Beatrice A Chen, Brid Devlin, Ellen Luecke, Jill Brown, Diana L Blithe, Sharon L Achilles, Ariane van der Straten","doi":"10.3389/frph.2023.1147628","DOIUrl":"10.3389/frph.2023.1147628","url":null,"abstract":"<p><strong>Introduction: </strong>With high concurrent global rates of HIV incidence and unintended pregnancy, there is a need to provide options beyond condoms to enable users to simultaneously prevent HIV acquisition and pregnancy. Multiple vaginal rings are in development as \"MPTs\" (multipurpose prevention technologies) as they are shown to provide several co-occurring benefits such as discretion, convenience, reversibility and user control.</p><p><strong>Methods: </strong>In this Phase 1 trial of a 3-month MPT ring in the U.S., 25 participants (low-risk for HIV and pregnancy) were randomized to use the study ring for 90 days continuously or in 28-day cycles with 2-day removal periods in between. All participants completed in-depth interviews at the end of their study participation.</p><p><strong>Results: </strong>Overall, the ring was well tolerated. Participants resoundingly endorsed the concept of an extended-use, dual-purpose vaginal ring, but reported too many functional challenges and side effects to endorse this particular ring. Participants assigned to the continuous regimen reported more positive experiences with ring use than those in the cyclic group. A minority of participants who experienced minimal side effects and did not experience challenges with vaginal retention of the ring found it appealing. However, the majority of participants experienced challenges (ring slippage, expulsions, side effects, vaginal bleeding changes) with product use that outweighed the potential benefits and led them to report that - in the future - they would not be interested in using this specific version of the ring in its current form. A subset expressed interest in using the current MPT ring under certain conditions (e.g., if fewer expulsions, less bleeding, higher risk for HIV/pregnancy).</p><p><strong>Discussion: </strong>User feedback regarding participant experiences and challenges with the study ring was continuously shared with the product developer, underscoring the value of early-stage end-user feedback in product development.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"5 ","pages":"1147628"},"PeriodicalIF":2.3,"publicationDate":"2023-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10359149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9867141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategic actions to advance multipurpose prevention technologies in low- and middle-income countries.","authors":"Bethany Young Holt, Ariane van der Straten, Taryn Barker, Z Mike Chirenje, Anne-Isabelle Cameron, Cherise Scott, Carmen Pérez Casas, Joseph Romano","doi":"10.3389/frph.2023.1150857","DOIUrl":"10.3389/frph.2023.1150857","url":null,"abstract":"<p><strong>Background: </strong>HIV, other sexually transmitted infections (STIs) and unintended pregnancies are critical and interlinked health risks for millions of women of reproductive age worldwide. Multipurpose prevention technologies (MPTs) offer an innovative approach for expanding combined pregnancy and/or disease prevention. So far, MPT development efforts have focused mostly on HIV prevention, but about half of product candidates comprise compounds active against non-HIV STIs as well. This review aims to provide a framework that promotes the efficient advancement of the most promising preclinical products through the development pathway and into the hands of end-users, with a focus on women in low- and middle-income countries (L/MICs).</p><p><strong>Methods: </strong>This mini review provides a summary of the current landscape of the MPT field. It comprises a landscape assessment of MPTs in development, complemented by a series of 28 in-depth, semi-structured key informant interviews (KIIs) with experts representing different L/MIC perspectives.</p><p><strong>Main results: </strong>We identified six primary action strategies to advance MPTs for L/MICs, including identification of key research gaps and priorities. For each action strategy, progress to date and key recommendations are included.</p><p><strong>Conclusions: </strong>To realize the life-saving potential of MPTs and maximize the momentum made to date, a strategic, collaborative and well-funded response to the gaps and next steps outlined in this paper is critical. A coordinated response can add rigor and efficiency to the development process, to successfully advance the most promising MPT products to the hands of end-users.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"5 ","pages":"1150857"},"PeriodicalIF":2.3,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10351869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9837165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testicular pathological alterations associated with SARS-CoV-2 infection.","authors":"Judy Ly, Rafael K Campos, E Eldridge Hager-Soto, Vidyleison N Camargos, Shannan L Rossi","doi":"10.3389/frph.2023.1229622","DOIUrl":"10.3389/frph.2023.1229622","url":null,"abstract":"<p><p>Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the etiologic agent of the coronavirus disease 2019 (COVID-19), which caused one of the pandemics with the highest mortalities with millions of deaths and hundreds of millions of cases to date. Due to its potential for airborne transmission, many studies have focused on SARS-CoV-2 primarily as a respiratory disease. However, the spread of SARS-CoV-2 to non-respiratory organs has been experimentally demonstrated and clinically observed. During autopsy studies, histopathological lesions, and disruption of the blood-testes barrier (BTB) have been observed in the male reproductive tract. Here, we review findings from both autopsy cases and animal models that demonstrate testicular disease due to COVID-19 and present an overview of the pathological alterations that occur in the testes resulting from SARS-CoV-2 infection and explore its potential mechanisms.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"5 ","pages":"1229622"},"PeriodicalIF":2.3,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10338913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9826441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integration of sexually transmitted infection and HIV pre-exposure prophylaxis services in sub-Saharan Africa: a scoping review.","authors":"Priyanka Anand, Linxuan Wu, Kenneth Mugwanya","doi":"10.3389/frph.2023.944372","DOIUrl":"10.3389/frph.2023.944372","url":null,"abstract":"<p><strong>Background: </strong>Persons living in sub-Saharan Africa (SSA) face disproportionate risk from overlapping epidemics of HIV and bacterial sexually transmitted infections (STIs). Pre-exposure prophylaxis (PrEP) for prevention is gradually being scaled up globally including in several settings in SSA, which represents a key opportunity to integrate STI services with HIV pre-exposure prophylaxis (PrEP). However, there is limited literature on how to successfully integrate these services, particularly in the SSA context. Prior studies and reviews on STI and PrEP services have largely focused on high income countries.</p><p><strong>Methods: </strong>We conducted a scoping review of prior studies of integration of STI and PrEP services in SSA. We searched PubMed, EMBASE, Cochrane, and CINAHL, in addition to grey literature to identify studies that were published between January 2012 and December 2022, and which provided STI and PrEP services in SSA, with or without outcomes reported. Citations and abstracts were reviewed by two reviewers for inclusion. Full texts were then retrieved and reviewed in full by two reviewers.</p><p><strong>Results: </strong>Our search strategy yielded 1951 records, of which 250 were retrieved in full. Our final review included 61 reports of 45 studies. Most studies were conducted in Southern (49.2%) and Eastern (24.6%) Africa. Service settings included public health clinics (26.2%), study clinics (23.0%), sexual and reproductive care settings (23.0%), maternal and child health settings (8.2%), community based services (11.5%), and mobile clinics (3.3%). A minority (11.4%) of the studies described only syndromic STI management while most (88.6%) included some form of etiological laboratory STI diagnosis. STI testing frequency ranged from baseline testing only to monthly screening. Types of STI tested for was also variable. Few studies reported outcomes related to implementation of STI services. There were high rates of curable STIs detected by laboratory testing (baseline genitourinary STI rates ranged from 5.6-30.8% for CT, 0.0-11.2% for GC, and 0.4-8.0% for TV).</p><p><strong>Discussion: </strong>Existing studies have implemented a varied range of STI services along with PrEP. This range reflects the lack of specific guidance regarding STI services within PrEP programs. However, there was limited evidence regarding implementation strategies for integration of STI and PrEP services in real world settings.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"5 ","pages":"944372"},"PeriodicalIF":2.3,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10338918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9881024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}