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Adding to Europe’s HIV testing gap: Lack of testing recommendations in national guidelines on HIV indicator conditions

According to data published by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for…

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According to data published by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe prior to World AIDS Day on 1 December, 106 508 people were newly diagnosed with HIV in the WHO European Region in 2021. There is one persistent pattern in the Region: every second HIV diagnosis (54%) happens at a late stage of infection [1].  

Early HIV diagnosis opens pathways to care and start of HIV treatment which in turn increases the chances of a long and healthy life for people living with HIV and it also helps preventing further transmission.

HIV testing as a step to timely diagnosis
A key strategy for timely diagnosis is testing for HIV. In particular testing of people who present with medical conditions that indicate an underlying HIV infection. In their article published on World AIDS Day 2022, Jordans et al. looked at the uptake of HIV testing recommendations in national clinical practice guidelines in Europe.

The authors invited 30 European countries to participate in the systematic guideline review and in the 15 countries that did, Jordans et al. identified a total of 791 HIV indicator condition guidelines. The classification by the authors ranged from guidelines that do not reference HIV at all, to those that report association with HIV, but do not recommend HIV testing to guidelines that report association with HIV and also recommend HIV testing.

Specific guidelines for the following HIV indicator conditions were available in all of the 15 participating countries: cervical cancer, cervical dysplasia, hepatitis C, malignant lymphoma/non-Hodgkin’s lymphoma, Mycobacterium tuberculosis, pregnancy, primary lung cancer, and sexually transmitted infections.

Based on the results of their review, Jordans et al. found that fewer than half of the HIV indicator condition specific guidelines in those 15 European countries include HIV testing recommendations. Guidelines for medical conditions known to be AIDS-defining performed even worse.

Missed opportunity to provide optimal care
Overall, the participating countries had at least one guideline available for 57% of the HIV indicator conditions, including 56% and 58% for western (n = 9) and eastern (n = 6) European countries, respectively. In addition, 545 of the 791 (69%) identified guidelines reported the association with HIV and 366 of the 791 (46%) guidelines recommended HIV testing. The authors noted that association with HIV was more common in guidelines from the eastern European countries and specifically those countries that have yet to achieve the so-called 90-90-90 targets.

Credit: Eurosurveillance

According to data published by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) Regional Office for Europe prior to World AIDS Day on 1 December, 106 508 people were newly diagnosed with HIV in the WHO European Region in 2021. There is one persistent pattern in the Region: every second HIV diagnosis (54%) happens at a late stage of infection [1].  

Early HIV diagnosis opens pathways to care and start of HIV treatment which in turn increases the chances of a long and healthy life for people living with HIV and it also helps preventing further transmission.

HIV testing as a step to timely diagnosis
A key strategy for timely diagnosis is testing for HIV. In particular testing of people who present with medical conditions that indicate an underlying HIV infection. In their article published on World AIDS Day 2022, Jordans et al. looked at the uptake of HIV testing recommendations in national clinical practice guidelines in Europe.

The authors invited 30 European countries to participate in the systematic guideline review and in the 15 countries that did, Jordans et al. identified a total of 791 HIV indicator condition guidelines. The classification by the authors ranged from guidelines that do not reference HIV at all, to those that report association with HIV, but do not recommend HIV testing to guidelines that report association with HIV and also recommend HIV testing.

Specific guidelines for the following HIV indicator conditions were available in all of the 15 participating countries: cervical cancer, cervical dysplasia, hepatitis C, malignant lymphoma/non-Hodgkin’s lymphoma, Mycobacterium tuberculosis, pregnancy, primary lung cancer, and sexually transmitted infections.

Based on the results of their review, Jordans et al. found that fewer than half of the HIV indicator condition specific guidelines in those 15 European countries include HIV testing recommendations. Guidelines for medical conditions known to be AIDS-defining performed even worse.

Missed opportunity to provide optimal care
Overall, the participating countries had at least one guideline available for 57% of the HIV indicator conditions, including 56% and 58% for western (n = 9) and eastern (n = 6) European countries, respectively. In addition, 545 of the 791 (69%) identified guidelines reported the association with HIV and 366 of the 791 (46%) guidelines recommended HIV testing. The authors noted that association with HIV was more common in guidelines from the eastern European countries and specifically those countries that have yet to achieve the so-called 90-90-90 targets.

Jordans et al. note that for pregnancy and sexually transmitted infections, the latter being an important HIV indicator condition, guidelines are available in all European countries with at least one guideline recommending HIV testing in every country. This “indicates that a high assimilation of HIV testing recommendations in guidelines across the European continent is possible”.

The authors highlight that “clinical guidelines define medical practice in national healthcare systems. The omissions we found mean that people with HIV indicator conditions, remain untested. This is a missed opportunity to help healthcare professionals to provide optimal care for a broad range of patients, hinders efforts to stop the spread of HIV through a timely HIV diagnosis, and signals the need to improve national guidelines.”
 

—-Ends—-

References/notes to editors:
[1] WHO Regional Office for Europe, European Centre for Disease Prevention and Control. HIV/AIDS surveillance in Europe 2022 – 2021 data. Copenhagen: WHO Regional Office for Europe; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/hiv-aids-joint-report-surveillance-2021-data

[2] Jordans Carlijn C.E., Vasylyev Marta, Rae Caroline, Jakobsen Marie Louise, Vassilenko Anna, Dauby Nicolas, Grevsen Anne Louise, Jakobsen Stine Finne, Raahauge Anne, Champenois Karen, Papot Emmanuelle, Malin Jakob J., Boender T. Sonia, Behrens Georg M.N, Gruell Henning, Neumann Anja, Spinner Christoph D., Valbert Frederik, Akinosoglou Karolina, Kostaki Evangelia G., Nozza Silvia, Giacomelli Andrea, Lapadula Giuseppe, Mazzitelli Maria, Torti Carlo, Matulionyte Raimonda, Matulyte Elzbieta, Van Welzen Berend J., Hensley Kathryn S., Thompson Magdalena, Ankiersztejn-Bartczak Magdalena, Skrzat-Klapaczyńska Agata, Săndulescu Oana, Streinu-Cercel Adrian, Streinu-Cercel Anca, Miron Viktor Daniel, Pokrovskaya Anastasia, Hachfeld Anna, Dorokhina Antonina, Sukach Maryna, Lord Emily, Sullivan Ann K., Rokx Casper, on behalf of the Guidelines Review Group for the projects: Optimising testing and linkage to care for HIV across Europe (OptTEST by HiE) and the Joint Action on integrating prevention, testing and linkage to care strategies across HIV, viral hepatitis, TB and STIs in Europe (INTEGRATE).

National medical specialty guidelines of HIV indicator conditions in Europe lack adequate HIV testing recommendations: a systematic guideline review. Euro Surveill. 2022;27(48):pii=2200338.
Available from: https://doi.org/10.2807/1560-7917.ES.2022.27.48.2200338

Countries that participated in the study: Belarus, Belgium, Denmark, France, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Romania, Russia, Switzerland, Ukraine, United Kingdom.

[3] World AIDS Day was introduced by the World Health Organization (WHO) in 1988 and is observed annually on 1 December to raise awareness of the AIDS pandemic caused by HIV infection.

[4] HIV/AIDS: The human immunodeficiency virus (HIV) is a virus, which attacks the immune system and causes a lifelong severe illness with a long incubation period. The end-stage of the untreated infection, acquired immunodeficiency syndrome (AIDS), results from the destruction of the immune system. AIDS is defined by the presence of one or more “opportunistic” illnesses (other illnesses due to decreased immunity).

[5] Late diagnosis is defined as having a CD4 cell count below 350 cells/mm3 blood at the time of diagnosis. This is a measure of the person’s immune system functioning. 

[6] Sustainable Development Goals (SDG) and 90–90–90 targets: in 2015, 17 Sustainable Development Goals (SDGs), each with specific targets for 2030, were introduced by the UN, including target 3.3 to end AIDS as a public health threat by 2030. In 2014, UNAIDS and partners launched the so-called ‘90–90–90 targets’ with the aim for 2020 that 90% people living with HIV are diagnosed (early) and 90% of those diagnosed receive antiretroviral treatment (ART), which leads to viral suppression among 90% of those on such treatment, i.e. the virus is no longer detectable in the blood. Such an undetectable viral load also means that HIV-positive people on effective treatment do not transmit the virus. The latest data on progress towards these 90-90-90 across Europe and Central Asia can be found here: https://www.ecdc.europa.eu/en/publications-data/hiv-continuum-care-monitoring-implementation-dublin-declaration

Journal

Eurosurveillance

DOI

10.2807/1560-7917.ES.2022.27.48.2200338

Method of Research

Literature review

Article Title

National medical specialty guidelines of HIV indicator conditions in Europe lack adequate HIV testing recommendations: a systematic guideline review

Article Publication Date

1-Dec-2022

COI Statement

See details in the original article

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Government

Delivering aid during war is tricky − here’s what to know about what Gaza relief operations may face

The politics of delivering aid in war zones are messy, the ethics fraught and the logistics daunting. But getting everything right is essential − and…

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2 days ago

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October 20, 2023

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Palestinians on the outskirts of Gaza City walk by buildings destroyed by Israeli bombardment on Oct. 20, 2023. AP Photo/Ali Mahmoud

The 2.2 million people who live in Gaza are facing economic isolation and experiencing incessant bombardment. Their supplies of essential resources, including food and water, are quickly dwindling.

In response, U.S. President Joe Biden has pledged US$100 million in humanitarian assistance for the citizens of Gaza.

As a scholar of peace and conflict economics who served as a World Bank consultant during the 2014 war between Hamas and Israel, I believe that Biden’s promise raises fundamental questions regarding the delivery of humanitarian aid in a war zone. Political constraints, ethical quandaries and the need to protect the security of aid workers and local communities always make it a logistical nightmare.

In this specific predicament, U.S. officials have to choose a strategy to deliver the aid without the perception of benefiting Hamas, a group the U.S. and Israel both classify as a terrorist organization.

Logistics

When aiding people in war zones, you can’t just send money, a development strategy called “cash transfers” that has become increasingly popular due to its efficiency. Sending money can boost the supply of locally produced goods and services and help people on the ground pay for what they need most. But injecting cash into an economy so completely cut off from the world would only stoke inflation.

So the aid must consist of goods that have to be brought into Gaza, and services provided by people working as part of an aid mission. Humanitarian aid can include food and water; health, sanitation and hygiene supplies and services; and tents and other materials for shelter and settlement.

Due to the closure of the border with Israel, aid can arrive in Gaza only via the Rafah crossing on the Egyptian border.

The U.S. Agency for International Development, or USAID, will likely turn to its longtime partner on the ground, the United Nations Relief and Works Agency, or UNRWA, to serve as supply depots and distribute goods. That agency, originally founded in 1949 as a temporary measure until a two-state solution could be found, serves in effect as a parallel yet unelected government for Palestinian refugees.

USAID will likely want to tap into UNRWA’s network of 284 schools – many of which are now transformed into humanitarian shelters housing two-thirds of the estimated 1 million people displaced by Israeli airstrikes – and 22 hospitals to expedite distribution.

Map of Gaza and its neighbors
Gaza is a self-governing Palestinian territory. The narrow piece of land is located on the coast of the Mediterranean Sea, bordered by Israel and Egypt. PeterHermesFurian/iStock via Getty Images Plus

Politics

Prior to the Trump administration, the U.S. was typically the largest single provider of aid to the West Bank and Gaza. USAID administers the lion’s share of it.

Since Biden took office, total yearly U.S. assistance for the Palestinian territories has totaled around $150 million, restored from just $8 million in 2020 under the Trump administration. During the Obama administration, however, the U.S. was providing more aid to the territories than it is now, with $1 billion disbursed in the 2013 fiscal year.

But the White House needs Congress to approve this assistance – a process that requires the House of Representatives to elect a new speaker and then for lawmakers to approve aid to Gaza once that happens.

Ethics

The United Nations Relief and Works Agency is a U.N. organization. It’s not run by Hamas, unlike, for instance, the Gaza Ministry of Health. However, Hamas has frequently undermined UNRWA’s efforts and diverted international aid for military purposes.

Hamas has repeatedly used UNRWA schools as rocket depots. They have repeatedly tunneled beneath UNRWA schools. They have dismantled European Union-funded water pipes to use as rocket fuselages. And even since the most recent violence broke out, the UNRWA has accused Hamas of stealing fuel and food from its Gaza premises.

Humanitarian aid professionals regularly have to contend with these trade-offs when deciding to what extent they can work with governments and local authorities that commit violent acts. They need to do so in exchange for the access required to help civilians under their control.

Similarly, Biden has had to make concessions to Israel while brokering for the freedom to send humanitarian aid to Gaza. For example, he has assured Israel that if any of the aid is diverted by Hamas, the operation will cease.

This promise may have been politically necessary. But if Biden already believes Hamas to be uncaring about civilian welfare, he may not expect the group to refrain from taking what they can.

Security best practices

What can be done to protect the security of humanitarian aid operations that take place in the midst of dangerous conflicts?

Under International Humanitarian Law, local authorities have the primary responsibility for ensuring the delivery of aid – even when they aren’t carrying out that task. To increase the chances that the local authorities will not attack them, aid groups can give “humanitarian notification” and voluntarily alert the local government as to where they will be operating.

Hamas has repeatedly flouted international norms and laws. So the question of if and how the aid convoy will be protected looms large.

Under the current agreement between the U.S., Israel and Egypt, the convoy will raise the U.N. flag. International inspectors will make sure no weapons are on board the vehicles before crossing over from Arish, Egypt, to Rafah, a city located on the Gaza Strip’s border with Egypt.

The aid convoy will likely cross without militarized security. This puts it at some danger of diversion once inside Gaza. But whether the aid convoy is attacked, seized or left alone, the Biden administration will have demonstrated its willingness to attempt a humanitarian relief operation. In this sense, a relatively small first convoy bearing water, medical supplies and food, among other items, serves as a test balloon for a sustained operation to follow soon after.

If the U.S. were to provide the humanitarian convoy a military escort, by contrast, Hamas could see its presence as a provocation. Washington’s support for Israel is so strong that the U.S. could potentially be judged as a party in the conflict between Israel and Hamas.

In that case, the presence of U.S. armed forces might provoke attacks on Gaza-bound aid convoys by Hamas and Islamic jihad fighters that otherwise would not have occurred. Combined with the mobilization of two U.S. Navy carrier groups in the eastern Mediterranean Sea, I’d be concerned that such a move might also stoke regional anger. It would undermine the Biden administration’s attempts to cool the situation.

On U.N.-approved missions, aid delivery may be secured by third-party peacekeepers – meaning, in this case, personnel who are neither Israeli nor Palestinian – with the U.N. Security Council’s blessing. In this case, tragically, it’s unlikely that such a resolution could conceivably pass such a vote, much less quickly enough to make a difference.

Topher L. McDougal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Diagnosis and management of postoperative wound infections in the head and neck region

“The majority of wound infections often manifest themselves immediately postoperatively, so close followup should take place […]” Credit: 2023 Barbarewicz…

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October 20, 2023

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“The majority of wound infections often manifest themselves immediately postoperatively, so close followup should take place […]”

Credit: 2023 Barbarewicz et al.

“The majority of wound infections often manifest themselves immediately postoperatively, so close followup should take place […]”

BUFFALO, NY- October 20, 2023 – A new research perspective was published in Oncoscience (Volume 10) on October 4, 2023, entitled, “Diagnosis and management of postoperative wound infections in the head and neck region.”

In everyday clinical practice at a department for oral and maxillofacial surgery, a large number of surgical procedures in the head and neck region take place under both outpatient and inpatient conditions. The basis of every surgical intervention is the patient’s consent to the respective procedure. Particular attention is drawn to the general and operation-specific risks. 

Particularly in the case of soft tissue procedures in the facial region, bleeding, secondary bleeding, scarring and infection of the surgical area are among the most common complications/risks, depending on the respective procedure. In their new perspective, researchers Filip Barbarewicz, Kai-Olaf Henkel and Florian Dudde from Army Hospital Hamburg in Germany discuss the diagnosis and management of postoperative infections in the head and neck region.

“In order to minimize the wound infections/surgical site infections, aseptic operating conditions with maximum sterility are required.”

Furthermore, depending on the extent of the surgical procedure and the patient‘s previous illnesses, peri- and/or postoperative antibiotics should be considered in order to avoid postoperative surgical site infection. Abscesses, cellulitis, phlegmone and (depending on the location of the procedure) empyema are among the most common postoperative infections in the respective surgical area. The main pathogens of these infections are staphylococci, although mixed (germ) patterns are also possible. 

“Risk factors for the development of a postoperative surgical site infection include, in particular, increased age, smoking, multiple comorbidities and/or systemic diseases (e.g., diabetes mellitus type II) as well as congenital and/ or acquired immune deficiency [10, 11].”

 

Continue reading the paper: DOI: https://doi.org/10.18632/oncoscience.589 

Correspondence to: Florian Dudde

Email: floriandudde@gmx.de 

Keywords: surgical site infection, head and neck surgery

 

About Oncoscience: 

Oncoscience is a peer-reviewed, open-access, traditional journal covering the rapidly growing field of cancer research, especially emergent topics not currently covered by other journals. This journal has a special mission: Freeing oncology from publication cost. It is free for the readers and the authors.

To learn more about Oncoscience, visit Oncoscience.us and connect with us on social media:

For media inquiries, please contact media@impactjournals.com.

Oncoscience Journal Office

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Orchard Park, NY 14127

Phone: 1-800-922-0957, option 4

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Journal

Oncoscience

DOI

10.18632/oncoscience.589

Method of Research

Commentary/editorial

Subject of Research

People

Article Title

Diagnosis and management of postoperative wound infections in the head and neck region

Article Publication Date

4-Oct-2023

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International

G77 Nations, China, Push Back On U.S. “Loss And Damage” Climate Fund In Days Leading Up To UN Summit

G77 Nations, China, Push Back On U.S. "Loss And Damage" Climate Fund In Days Leading Up To UN Summit

As was the case in primary school with…

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2 days ago

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October 20, 2023

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G77 Nations, China, Push Back On U.S. "Loss And Damage" Climate Fund In Days Leading Up To UN Summit

As was the case in primary school with bringing in presents, make sure you bring enough for the rest of the class, otherwise people get ornery...

This age old rule looks like it could be rearing its head in the days leading up to the UN COP 28 climate summit, set to take place in the United Arab Emirates in about six weeks. 

At the prior UN COP 27, which took place in Egypt last year, the U.S. pushed an idea for a new World Bank "loss and damage" climate slush fund to help poor countries with climate change. But the G77 nations plus China, including many developing countries, are pushing back on the idea, according to a new report from the Financial Times. 

The goal was to arrange how the fund would operate and where the money would come from for the "particularly vulnerable" nations who would have access to it prior to the upcoming summit in UAE.

But as FT notes, Pedro Luis Pedroso Cuesta, the Cuban chair of the G77 plus China group, has said that talks about these details were instead "deadlocked" over issues of - you guessed it - where the money is going and the governance of the fund.

The U.S.'s proposal for the fund to be governed by the World Bank has been rejected by the G77 after "extensive" discussions, the report says. Cuesta has said that the nations seek to have the fund managed elsewhere, but that the U.S. wasn't open to such arrangements. 

Cuesta said: “We have been confronted with an elephant in the room, and that elephant is the US. We have been faced with a very closed position that it is [the World Bank] or nothing.”

Christina Chan, a senior adviser to US climate envoy John Kerry, responded: “We have been working diligently at every turn to address concerns, problem-solve, and find landing zones.” She said the U.S. has been "clear and consistent" in their messaging on the need for the fund. 

Cuesta contends that the World Bank, known for lending to less affluent nations, lacks a "climate culture" and often delays decision-making, hindering quick responses to climate emergencies like Pakistan's recent severe flooding.

The G77 coalition voiced concerns about the World Bank's legal framework potentially limiting the fund's ability to accept diverse funding sources like philanthropic donations or to access capital markets.

With just days left before the UN COP 28 summit, the World Bank insists that combating climate change is integral to its mission and vows to collaborate on structuring the fund.

Tyler Durden Fri, 10/20/2023 - 15:45

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