BMC Infectious Diseases

BackgroundFamily-based HIV index case testing identifies family members with unknown HIV status and links them to care. Data are limited in southern Ethiopia. MethodsA facility-based cross-sectional study was conducted among 377 adults on antiretroviral therapy (ART) in Wolaita Zone, Southern Ethiopia, from November 2022 to May 2023. Participants were selected using systematic random sampling. Data were collected via interviewer-administered semi-structured questionnaire. Multivariable logistic regression identified factors associated with index case family testing. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated, and statistical significance was declared at p < 0.05. ResultsThe proportion of index case family testing for HIV was 84.9% (95% CI: 81.2- 88.6). In multivariable analysis, urban residence (AOR = 2.8; 95% CI: 1.16-6.75), duration on ART greater than 12 months (AOR = 13.0; 95% CI: 4.6-36.9), disclosure of HIV status to family members (AOR = 5.6; 95% CI: 1.9-16.5), discussion of HIV status with family members (AOR = 6.6; 95% CI: 1.9-23.2), and being counselled by health professionals to bring families for testing (AOR = 6.3; 95% CI: 2.1-19.0) were significantly associated with index case family testing. ConclusionThe prevalence of family-based HIV index case testing in Wolaita Zone was 84.9%, below the national 95% target. Health professionals should strengthen counselling on ART adherence, status disclosure, family discussion, and active referral to improve testing uptake among family members of people living with HIV.

Objectives: To identifiy risk factors for antimicrobial resistance (AMR) in seven pathogen-antimicrobial combinations in patients with cancer and cancer survivors. Methods: Using data from patients with recent or past cancer diagnostic codes in Oxfordshire, UK, we examined associations between 22 potential risk-factors and AMR in blood culture isolates, collected between 1-April-2015 and 31-March-2025. Results: Among 5,975 bacteraemias in 4,365 adults, we analysed 3,141 (52.6%) due to Enterobacterales and 620 (10.4%) due to Enterococcus faecalis/faecium in 2,752 patients. Fourteen risk-factors for antimicrobial-resistant bacteraemia were identified, varying across pathogen-antimicrobial combinations. Compared with no previous antimicrobial susceptibility test result, prior resistance to the same antibiotic in any culture in the last year was strongly associated with AMR across all pathogen-antimicrobial combinations (all p<=0.001). Prior antibiotic exposure and younger age were also positively associated with AMR in four and five combinations, respectively. Cancer type showed modest effects; lymphoid/haematopoietic malignancies were associated with higher odds (vs colorectal cancer) of trimethoprim-sulfamethoxazole-resistant Enterobacterales (aOR=2.07 95%CI 1.40-3.06) and vancomycin-resistant Enterococcus bacteraemia (aOR=6.68, 1.21-36.91). Conclusions: Previous resistance was the greatest risk factor for bacteraemia with AMR in cancer patients and survivors, with prior antibiotic exposure and age also contributing. Lymphoid/haematopoietic malignancies increased risk of resistance to specific antimicrobials. Keywords: antimicrobial resistance, bacteraemia, cancer, risk factors

BackgroundDelayed tuberculosis (TB) treatment remains a major challenge to TB control and is associated with increased mortality, drug resistance, and onward transmission. Food insecurity may contribute to delayed TB treatment through economic, physical, and psychosocial pathways. Depression and anxiety are also associated with delayed TB treatment and may mediate the relationship between food insecurity and delayed TB treatment. This study examined the association between food insecurity and delayed TB treatment initiation and assessed the mediation roles of depression and anxiety for this relationship among people newly diagnosed with TB. MethodsWe recruited 180 participants newly diagnosed with TB in Gaborone, Botswana. Food insecurity, depression, and anxiety were measured using the Household Food Insecurity Access Scale, PHQ-9, and Zung Self-Rating Anxiety Scale, respectively. Delayed TB treatment was defined as > 2 months since first TB symptoms. Logistic regression was used to examine the association between food insecurity and delayed TB treatment. Causal mediation analysis was conducted to assess the mediating roles of depression and anxiety. ResultsAmong the 180 participants, 45 (25%) experienced delayed TB treatment initiation. Participants with delayed TB treatment had slightly higher median scores for food insecurity (2 vs. 1, p = 0.11), depression (9 vs. 6, p = 0.001), and anxiety (37 vs. 34, p = 0.05). There was insufficient evidence of an overall association between food insecurity and delayed TB treatment initiation (OR = 1.04, 95% CI 0.98-1.11, p = 0.20). Mediation analysis found insufficient evidence of total and direct effects through depression and anxiety. However, there was evidence of significant indirect effect through depression (OR = 1.04, 95% CI 1.01-1.08, p < 0.001) and a borderline indirect effect through anxiety (OR = 1.02, 95% CI 1.00-1.04, p = 0.05). ConclusionMediation analysis revealed associations between food insecurity and delayed TB treatment initiation mediated by depression and anxiety which were not evident in total effects analysis. These findings highlight the importance of considering both socioeconomic and psychological factors in addressing delayed TB treatment. Further studies are needed to confirm these pathways.

Introduction: Antibiotic misuse is a major driver of antimicrobial resistance (AMR), contributing to an estimated 1.27 million deaths globally. In Kenya, inappropriate antibiotic use is shaped by health-seeking behaviors and sociodemographic factors. However, little is known about how adults with productive coughs seek and use antibiotics, or how sociodemographic factors underpin these practices. This study explored antibiotic-seeking pathways, usage patterns, and the sociodemographic factors influencing these practices among adults with productive coughs attending selected chest and tuberculosis clinics in Nairobi County, Kenya. Methodology: A facility-based cross-sectional study was conducted among 400 adults ([&ge;]18 years) with productive coughs. Data were collected using a structured questionnaire on sociodemographic characteristics, antibiotic-seeking pathways, and use patterns. Results: Most participants were male (65.0%) and employed (67.0%), with 68.3% earning below Ksh 10,000 (approximately USD 80) monthly and 35.8% having basic education. A history of smoking (37.3%), tuberculosis (32.0%), or other comorbidities (29.8%) was common. Among 347 (86.7%) antibiotic users, 46.4% obtained antibiotics through general practitioners (GP) only, 31.4% via both GP and over-the-counter (OTC) sources, 15.3% from OTC only, and 6.9% through self-medication. Females were more likely to self-medicate (13.3% vs. 3.2%) and had higher odds of antibiotic use (cOR: 2.00; 95% CI: 1.04-4.10). Tuberculosis history was linked to greater GP reliance (61.7% vs. 37.4%). Low-income participants mainly used GP-only sources, while higher-income earners favored GP plus OTC routes (RRR: 2.67; 95% CI: 1.41-5.05). Empirical use was common (71.1%), dominated by Amoxicillin (90.8%), with multiple antibiotic use reported by 67.2% of the participants. Conclusion: Antibiotic use among adults with productive coughs in Nairobi was widespread and largely empirical, dominated by Amoxicillin and Amoxicillin/Clavulanic acid. Self-medication, unregulated antibiotic access, and inappropriate use highlight the urgent need for stricter prescription enforcement and strengthened stewardship programs to promote rational antibiotic use and curb AMR.

BackgroundDolutegravir (DTG)-based regimens are currently the preferred first-line therapy in many HIV programs; however, the influence of baseline advanced HIV disease (AHD) on virologic outcomes in routine national data in the DTG era remains unclear. MethodsWe conducted a retrospective cohort analysis using routinely collected data from Tanzanias National AIDS, STIs, and Hepatitis Control Programme (NASHCoP) database (2017-2021). A simple random sample of 50,000 patients was drawn from the de-duplicated national dataset, yielding 49,863 patients after data processing. The analytic cohort included 4,044 patients with baseline CD4 and endpoint viral load measurements. Viral load suppression was defined as <1000 copies/mL. Associations between baseline AHD, regimen status, and suppression were assessed using risk ratios and multivariable Poisson regression models, including an interaction term between AHD and DTG. ResultsOverall viral load suppression was 89.2% (3,607/4,044). Patients with baseline AHD had lower suppression than those without AHD (81.3% vs. 91.1%; RR 0.48, 95% CI 0.40-0.57). Suppression was higher among patients receiving DTG-based regimens than among those receiving non-DTG regimens (91.5% vs. 77.2%; RR 2.67, 95% CI 2.23-3.20). In the adjusted analysis, baseline AHD remained associated with reduced suppression (aRR 0.89, 95% CI 0.86-0.92), whereas DTG use was associated with improved suppression (aRR 1.15, 95% CI 1.10-1.20). A significant interaction between AHD and DTG was observed (aRR 1.40, 95% CI 1.20-1.63), indicating that the relative benefit of DTG was greater among patients with baseline AHD. ConclusionsAlthough viral load suppression was high in this Tanzanian routine-care cohort, patients with baseline AHD had poorer outcomes. DTG-based regimens were associated with improved overall suppression, with a greater relative benefit among patients with advanced disease. These findings support the continued prioritization of DTG-based therapy and reinforce the importance of early diagnosis and targeted management of patients with AHD.

BackgroundSchistosoma mansoni is a leading cause of hepatosplenic disease in sub-Saharan Africa. Yet, associations with current Schistosoma mansoni infections and hepatosplenic organometry remain unclear in the context of widespread mass drug administration and co-endemic infections. MethodsFrom January to February 2024, we conducted a community-based, cross-sectional study nested within the SchistoTrack cohort in three districts of Uganda. Liver and spleen dimensions were assessed via point-of-care B-mode ultrasound for 3121 individuals. Organ dimensions were classified using the standard deviations from height-standardized internal reference values derived from an infection-free population. Multinomial logistic regressions were run for children (5-17 years) and adults (18+ years) separately. Population attributable fractions (PAFs) were used to estimate the proportion of abnormal organometry statistically attributable to each infection. Key exposures were S. mansoni, malaria, human immunodeficiency virus (HIV), and hepatitis B virus (HBV) alongside a comprehensive set of social, biomedical, and other covariates controlled for. ResultsModerate-to-severe splenic enlargement was observed in 29.1% (438/1507) of children and 23.3% (376/1614) of adults. Among adults, 20.9% (337/1614) had left liver lobe enlargement and 18.8% (303/1614) had right liver lobe shrinkage. In children, severe splenic enlargement was statistically attributable to malaria (PAF 46.7%; Relative Risk Ratio (RRR) 3.96, 95% CI 2.64-5.92) and S. mansoni infection intensity (PAF 23.6%; RRR 1.12, 95% CI 1.04-1.20). In adults, S. mansoni intensity was associated with moderate left liver lobe enlargement (PAF 12.4%; RRR 1.11, 95% CI 1.04-1.18). In adults, HIV was associated with severe left liver lobe shrinkage (RRR 4.50, 95% CI 1.19-17.00) and severe splenomegaly (RRR 3.62, 95% CI 1.58-8.33), while HBV was associated only with severe left liver lobe shrinkage (RRR 2.54, 95% CI 1.07-6.03). Praziquantel treatment in the past year showed inconsistent associations and no clear protective pattern. ConclusionCurrent S. mansoni infection intensity remains associated with splenomegaly in children despite controlling for concurrent malaria positivity, and with hepatomegaly in adults despite HIV and HBV associations.

Background: The global burden of dengue infection has rising, yet limited data exists on its impact in the Caribbean. We describe the incidence and associates of acute kidney injury in adults and children with dengue at a teaching hospital in Jamaica. Methods: A single-centre retrospective cohort study of admissions with laboratory confirmed dengue infection at University Hospital of the West Indies, Mona Jamaica between January 2023 to November 2024. AKI was defined using Kidney Disease Improving Global Outcomes definitions. Patients were included if aged >1year and had at least 2 creatinine values. Clinical, demographic and laboratory data were abstracted by chart review. Summary statistics were used to describe continuous and categorical data, and logistic regression to determine AKI associations. Stratified analysis was performed by age-group (adults-aged [&ge;] 16, and paediatric-aged <16 years). Results: Analyses included 167 persons, 62% (103) were male, mean age was 26.1{+/-}19.5 years. AKI occurred in 25.8%, 65.1% were KDIGO stage 1. AKI incidence was 30.2% and 18.0% among adults and children respectively. There were 3 in-hospital deaths. People with AKI were older 32{+/-}21.4 vs 24 {+/-}18.4 (p=0.021), and had longer duration of stay [6 vs 4 days (p <0.001)]. Male sex [OR 2.09 (95% CI:0.96-4.59), p=0.064], age per year [OR 1.02 (95% CI:1.01-1.04), p=0.015] symptom duration [OR1.11 (CI 0.99-1.24), p = 0.058], admission bilirubin [OR 1.02 (CI: 1.00-1.04), p = 0.022], NLR [OR 1.09 (CI 1.00-1.18), p = 0.037] were associated with AKI. In adults admission potassium was inversely associated with AKI [OR 0.46 (95% CI 0.21-1.01), p 0.056], while in children admission potassium [OR 3.00 (95% CI 0.88-10.6), p 0.088] was associated with AKI. Conclusion: AKI in dengue hospitalizations is higher than most reports at 25.8%. Targeted public health policy on vector control and early symptom recognition may be needed to improve outcomes.

BackgroundRecent global outbreaks of Mpox have posed significant diagnostic challenges, particularly in resource-limited settings. Conventional diagnostic methods are often inaccessible due to cost, logistical constraints, or lack of trained personnel. These limitations highlight the urgent need for alternative, scalable diagnostic strategies. This study explored the application of machine learning (ML) classifiers trained on clinical symptom data as a rapid, cost-effective tool for Mpox detection. MethodsAn open-access dataset of clinical symptoms from suspected Mpox cases was used to train and evaluate five supervised ML algorithms: Extra Trees, Quadratic Discriminant Analysis (QDA), Decision Trees, Perceptron, and Support Vector Classifier (SVC). Prior to training, data preprocessing steps, including normalization and handling of missing values, were performed after which model training was carried out using a stratified 80:20 train-test split. Performance was assessed using accuracy, recall, area under the receiver operating characteristic curve (ROC-AUC), and F1-score metrics. Subsequently, feature importance was analyzed using permutation-based techniques to determine the contribution of each clinical symptom to model predictions. ResultsAmong the five evaluated models, SVC, QDA, and Perceptron achieved superior and identical performance metrics, with accuracy, ROC-AUC, and F1-score values of 97.7%, and a recall of 95.5%. Each of these models correctly identified 44 true positive cases with zero false positives. In addition, QDA and SVC produced the lowest number of false negatives (2) and the highest number of true negatives (42), indicating robust discriminatory power. Feature importance analysis identified skin rash as the most predictive clinical feature, with a permutation importance score of 0.12. ConclusionsThese findings demonstrate the strong potential of machine learning classifiers for detecting Mpox based on clinical features. Incorporating these models into healthcare systems could significantly enhance early case detection, improve clinical decision-making, and bolster disease surveillance. Future research should focus on prospective validation of these ML classifiers in real-world clinical environments.

BackgroundImproving tuberculosis (TB) treatment success is critical for improving the health of individuals with TB, reducing transmission, and lowering treatment costs. We conducted a four-arm randomized controlled trial (RCT) to evaluate whether three digital interventions with increasing support improved treatment outcomes compared to the standard of care. MethodsIn this open-label, parallel RCT in Kenya, all TB patients at 902 participating clinics who had at least 2 months of treatment remaining were eligible for inclusion. Individuals were centrally randomized at a ratio of 4:3:12:12 into a control group that received only the standard of care, or one of the following three intervention groups that received the standard of care plus: (1) a daily SMS medication adherence reminder ( SMS); (2) access to a platform that sent a daily request for self-verification of medication adherence and provided disease information, motivational messages, and an adherence game ( platform); and (3) access to a platform with these same features, plus support from a team of trained supporters ( Keheala). The primary outcomes were: the proportion of individuals who experienced an unsuccessful treatment outcome (a composite of: died, failed treatment, or loss to follow-up), and loss to follow-up (LTFU). The secondary outcome was medication non-adherence, measured via unannounced urine isoniazid tests for a random sample of 731 individuals in the control and Keheala groups. ResultsBetween April 13, 2018 and December 20, 2019, 16,753 individuals were randomized, yielding 14,962 in the mITT population: 1,997 in the control, 1,475 in SMS, 6,057 in platform, and 5,433 in Keheala. Absolute risk of unsuccessful outcomes was 12.4% in the control group. It was reduced by 1.9 percentage points in the SMS group (95% C.I.: -0.1-4.0), 1.9 percentage points in the platform group (95% C.I.: 0.3-3.4), and 2.6 percentage points in the Keheala group (95% C.I.: 1.0-4.2); mostly due to reductions in LTFU. Medication non-adherence was 12.4% in the control group. It was reduced by 7.5 percentage points in the Keheala group (95% C.I.: 2.6-12.5). ConclusionsAll digital health interventions improved treatment outcomes. The Keheala intervention also reduced medication non-adherence. The interventions could be considered as a supplement to the standard of care, especially in resource-constrained regions where in-person support is impractical.

BackgroundTo date, accessible diagnostic tools to identify whether a patients pneumonia is a bacterial, or viral infection, are not accurate or timely enough to prevent preemptive antibiotic administration. Relying on single biomarkers or clinical presentations has been insufficient. We aimed to incorporate a wide range of novel biomarkers and clinical presentations in a multivariable model and validate its capacity to differentiate cases of bacterial and viral pneumonia. MethodsData from 457 children aged 2-59 months, admitted to Kilifi County Referral Hospital, Kenya, with bacterial (n = 229) and viral (n = 228) infections, were used to develop and validate a predictive multivariable Poisson regression model to differentiate pneumonia etiology. The Receiver Operating Characteristic curve was used to assess biomarker performance and validate the model internally. ResultsSixty-three percent (63%) of the children presented with severe pneumonia. 72% with viral pneumonia had severe pneumonia, compared to 54% with bacterial pneumonia who had severe pneumonia. In crude analyses, chest-wall indrawing, cough, convulsions, crackles, angiotensinogen, and Serpin Family A Member 1 were significantly associated with pneumonia etiology, controlling for age. However, only chest-wall indrawing remained significant in multivariable analyses after controlling for age. The model demonstrated fair, but inadequate, discrimination, with an Area Under the Curve of 0.61. ConclusionAmong the children admitted to hospital with WHO defined pneumonia, a wide range of biomarkers and clinical presentations still failed to distinguish bacterial from viral pneumonia.

Justification: Accidental lab-acquired infections (LAIs) with potential pandemic pathogens (PPPs) in high-biosafety research facilities risk causing a pandemic. Routine testing of lab workers for LAIs coupled with isolation of infected workers could reduce the risk, but the impact of such an intervention may depend on pathogens' epidemiological characteristics. Objective: This study aims to understand how the epidemiological characteristics of PPPs moderate the efficacy of a routine testing and isolation intervention in preventing larger outbreaks after an LAI. Methods: We employed a discrete-time stochastic network infectious disease model to run 625,000 epidemic simulations encompassing 625 unique combinations of five parameters of interest: test frequency, pathogen transmissibility, the self-isolation rate for symptomatic cases, the percentage of cases that are asymptomatic, and the percentage of infectious time that is spent in the pre-symptomatic state among those who show symptoms. To summarize the Monte Carlo simulations, we paired visual analysis with logistic regression for formal hypothesis testing, with an emphasis on the interaction terms that capture the moderating effect of epidemiological parameters on the impact of test frequency. Main Results: There were four main findings. First, the relative reductions in risk of outbreak that were caused by increased test frequency were inversely correlated with pathogen transmissibility. Second, the effect of test frequency was magnified at higher asymptomatic shares when the symptomatic self-isolation rate was high, but minimally when the self-isolation rate is low. Third, the direction of how the symptomatic self-isolation rate moderated the effect of increased test frequency depended on the asymptomatic share. Fourth, as the pre-symptomatic share of infectious time increased, the effect of test frequency on the probability of an outbreak was strongly magnified largely independent of symptomatic self-isolation rates. Conclusions: Routine testing and isolation could significantly mitigate the risk of catastrophic PPP escapes, with the intervention's success varying based on pathogen characteristics. High shares of asymptomatic and pre-symptomatic transmission notably increased the relative risk reductions achieved by the intervention. These findings suggest prioritizing testing interventions for pathogens with high asymptomatic and pre-symptomatic transmission and highlight the symptomatic self-isolation rate as a policy intervention target.

Objectives: To evaluate whether on-site molecular point-of-care testing (POCT) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is associated with reduced antibiotic overtreatment for presumed sexually transmitted infections (STIs) among adults living with HIV in rural Uganda. Methods: We conducted a single-site quasi-experimental pre-post intervention study at Kumi Hospital, comparing syndromic management (April-August 2024) with CT/NG POCT-guided management (September 2024-January 2025). Adults living with HIV presenting with symptoms suggestive of an STI were included. Overtreatment in the pre-intervention phase was estimated by comparing antibiotic prescribing with the expected number of CT/NG infections based on positivity observed during the intervention phase. Results: A total of 404 participants were included (203 pre-intervention, 201 intervention). During the intervention phase, CT and/or NG were detected in 14 individuals (7.0%). Median test turnaround time was 95 minutes, enabling same-day treatment in 93% of positive cases. Antibiotic prescribing decreased from 99.0% to 11.4% following POCT implementation (P < 0.001), corresponding to an absolute reduction of 87.6 percentage points. Estimated overtreatment declined from 30.0% to 5.0% for NG and from 74.9% to 6.0% for CT (both P < 0.001). Conclusions: Implementation of CT/NG POCT in routine HIV care was associated with a marked reduction in antibiotic prescribing and estimated overtreatment for presumed STIs. These findings support the potential of POCT-guided, aetiology-based STI management to reduce unnecessary antimicrobial exposure in settings where syndromic management remains standard practice.

ObjectiveTo evaluate risk of dementia after cancer diagnosis among Medicaid beneficiaries with HIV. DesignLongitudinal observational study of Medicaid enrollment, inpatient, and outpatient claims data from 14 states, 2001-2015. MethodsBeneficiaries aged 18-64 with HIV and [&ge;]6 months of enrollment were matched 1:1 on cancer status by age, sex, race, year, and state. We estimated the weighted cumulative incidence functions (CIFs) of dementia at 1, 2, and 5 years after cancer diagnosis using the Aalen-Johansen estimator to account for the competing risk of death and cluster stratified analyses to account for matching. We calculated the corresponding risk differences (RD) and 95% confidence intervals (CI) using nonparametric bootstrap. ResultsAt 5 years, the CIF of dementia was 9.6% (95%CI: 8.2, 11.6) and 4.7% (95%CI: 3.7, 6.1) among those with and without AIDS-defining cancer, respectively (RD: 4.9%; 95%CI: 2.9, 7.0). At 5 years, the CIF of dementia was 7.1% (95%CI: 5.9, 7.8) and 5.3% (95%CI: 4.2, 6.2) among those with and without non-AIDS-defining cancer, respectively (RD: 1.8%; 95%CI: 0.34, 2.9). Dementia incidence appeared higher among beneficiaries with lung cancer (2yr RD: 1.9%; 95%CI: 0.01, 5.2) and beneficiaries [&le;]50 with colon cancer (2yr RD: 4%; 95%CI: 0.3, 10.5), but lower among beneficiaries [&le;]50 with prostate cancer (2yr RD: -1.9%; 95%CI: -2.3, -1.6). Dementia incidence did not differ among beneficiaries with and without breast cancer. ConclusionsDementia risk may be increased among people with HIV with certain cancers, including AIDS-defining cancers. Dementia risk appears to vary by cancer type and age at diagnosis.

BackgroundIn public health surveillance, silence--the absence of data--is often more significant than the signal. Traditional epidemiological mapping tools efficiently visualize data density but struggle to mathematically define data absence. Standard approaches conflate stochastic sparsity with systemic suppression and remain vulnerable to edge effects. MethodsWe introduce a topological framework that detects structural voids--regions of unexpected data absence within clusters. Using Distance-to-Measure (DTM) filtration with adaptive thresholding via the Kneedle algorithm [11], we eliminate arbitrary parameter choices. Version 2.1 extends the original framework with three methodological additions: (1) a temporal void classifier combining the Fano factor and a two-state Hidden Markov Model (HMM) to distinguish persistent structural silence from stochastic fluctuation across reporting periods; (2) a causal taxonomy (BORDER, ACCESS, INFRASTRUCTURE, SYSTEM, UNKNOWN) that maps detected voids to probable reporting failure mechanisms via covariate decision trees; and (3) an Observed-to-Expected (O/E) completeness engine calibrated against WHO-standard disease incidence rates across seven conditions. Parameters are derived geometrically from the DTM distribution itself. We validate against known ground truth through a censoring simulation framework using public Kenyan health facility data. Detection accuracy is quantified using the Jaccard index [12], centroid error, and recovery rate. ResultsTDA Engine achieves Jaccard = 0.82 (95% CI: 0.74-0.89) on simulated suppression events, significantly outperforming KDE (0.45) and relative risk surfaces (0.38). Centroid error is 342 m (IQR: 187-512 m). The temporal classifier correctly labels 91% of structurally silent units across six-period validation datasets (HMM posterior P (structural) [&ge;]0.60). Permutation tests yield p = 0.003 (95% CI: 0.001-0.008) [13], confirming statistical significance beyond complete spatial randomness. ConclusionTDA Engine v2.1 provides a mathematically rigorous, topology-based framework for detecting structural voids in censored epidemiological data and classifying them by temporal persistence and probable causal mechanism. By shifting from density-based to geometry-based inference with quantitative validation metrics and causal labelling, we enable public health officials to distinguish between natural gaps and potential suppression, and to direct field investigation resources accordingly. We emphasize that structural voids are geometric anomalies consistent with suppression, not proof thereof--requiring contextual validation.

BackgroundTuberculosis (TB) incidence peaks in women during their reproductive years and is a leading cause of maternal mortality. Pregnant women with TB have a high risk of failure to initiate TB treatment and poor TB treatment and pregnancy outcomes. We determined the time to treatment initiation in pregnant women diagnosed with TB in a routine programmatic setting. MethodsUsing routine linked electronic data, we identified women 15-45 years of age with laboratory-confirmed and/or clinically diagnosed TB, October 2018-December 2020, in two high-burden sub-districts in Cape Town, South Africa. We compared demographic and clinical characteristics in women with TB by pregnancy status, used time-to-event analysis to determine the time from TB diagnosis to initiation of antituberculosis treatment and Cox regression to assess determinants of treatment initiation. ResultsOf 5,459 women diagnosed with TB, 292 (5.3%) were pregnant. The median age for pregnant women was 28.6 years (interquartile range [IQR]: 23.7-33.7) and non-pregnant women 31 years (IQR:25.2-36.5). HIV prevalence was similar in pregnant (177/292; 60.6%) vs non-pregnant (3200/5167; 61.9%) women. Median time to treatment initiation was two days for pregnant and non-pregnant women. Most women initiated treatment within the first month after their TB diagnosis, after which the rate plateaued in both groups. Time to treatment initiation over 6 months was statistically different (Kaplan Meier Log-rank test, p = 0.0064) with pregnant women lagging behind non-pregnant women. ConclusionsMore than 5% of women diagnosed with TB were pregnant at the time of TB diagnosis. While pregnant women with TB were appropriately initiated on treatment, almost 15% were never started on treatment and there were delays in treatment initiation. While strategic interventions to prioritise early treatment initiation are needed, there should be a specific focus on pregnant women who have not initiated treatment within one month after TB diagnosis.

Introduction: Following a large chikungunya outbreak during 2006 to 2008, Sri Lanka did not report any outbreaks for a 16 year period until end of 2008, possibly due to population immunity. Therefore, understanding baseline immunity prior to outbreaks is crucial to inform implementation of vaccine strategies. Methods: We assessed the age stratified seroprevalence for chikungunya in an urban (n=816) and a semi urban (n=380) community in Colombo, Sri Lanka, from September to November 2024, prior to the commencement of the large chikungunya outbreak, in December 2024. Sociodemographic, socioeconomic and clinical data were collected and chikungunya specific IgG measured in serum samples. Results: Of 1196 participants, 410 (34.3%) were chikungunya IgG seropositive. Seroprevalence was significantly higher in urban populations compared with semi urban populations (39.6% vs 22.9%; p<0.001) and increased significantly with age in urban areas but not in semi-urban areas. Living in an urban area was the strongest independent risk factor of chikungunya seropositivity (aOR 7.48, 95% CI 4.05 to 13.81; p<0.001), consistent with the higher population density, poor housing conditions and overcrowding observed in that setting. The use of mosquito nets was independently associated with reduced risk of seropositivity (aOR 0.50, 95% CI 0.27 to 0.93; p=0.029). Almost no individuals aged <16 years had evidence of prior infection (0.55%), indicating minimal transmission in the preceding 16 years. In the urban cohort, seropositivity was significantly associated with diabetes, central obesity, overweight, and hypertension. Conclusions: There appears to have been minimal chikungunya transmission in the 16 years preceding the 2024 outbreak, with a large population susceptible to chikungunya. Higher seroprevalence in urban populations highlights the role of population density, overcrowding, and housing conditions as key drivers of transmission.

BackgroundCampylobacter is a major cause of childhood diarrhoea across Africa and asymptomatic carriage is frequently reported, however risk factors for Campylobacter presence remain poorly defined. This meta-analysis aimed to calculate the pooled prevalence of Campylobacter in diarrhoeic and non-diarrhoeic stool, assess its association with diarrhoea, identify risk factors for Campylobacter presence and antimicrobial resistance (AMR) patterns. MethodEnglish language studies on Campylobacter in children (<18 years) in Africa were searched. Prevalence of Campylobacter and AMR, Odds Ratios (OR) for Campylobacter presence in diarrhoeic stool and risk factors for Campylobacter were estimated. Heterogeneity was assessed using I2 and bias assessed via funnel plots and Eggers test. ResultsA total of 168 studies were included in the meta-analysis. The pooled prevalence of Campylobacter in diarrhoeic stool was 11.25% (9.41-13.23%), in non-diarrhoeic stool 12.56% (7.79-18.27%), and mixed stool types 33.47% (20.53-47.81%). The OR for Campylobacter presence in diarrhoeic stool versus non-diarrhoeic stool was 1.95 (95% CI: 1.62-2.33). Age affected the OR with children 0-6 months old having an OR 2.57 (1.74-3.81), 7-12 months old an OR 1.60 (1.07-2.40), 13-24 months old an OR 1.02 (0.68-1.52) and 25-60 months old an OR 1.76 (0.77-4.05). Risk factors for Campylobacter presence in stool were children living in rural areas (pooled Adjusted Odds Ratio (pAOR) = 2.59 95% CI 1.43-4.69) and having contact with animals (pAOR 4.28 95% CI: 2.40-7.61). AMR prevalence ranged from 54.85% for ampicillin to 9.85% for chloramphenicol. Heterogeneity was high across all analyses. ConclusionCampylobacter prevalence is high in symptomatic and asymptomatic children across Africa. Contact with animals and living in an urban environment are risk factors for Campylobacter presence. Risk factor identification in the African context would be strengthened with standardized risk factors. Further research is needed to clarify the public health significance of asymptomatic carriage. What is already known on this topic - Campylobacter is a significant cause of diarrhoea in children and asymptomatic carriage is common. However, the burden of asymptomatic carriage and risk factors are not well understood in Africa. What this study adds - This meta-analysis highlights the high burden of asymptomatic Campylobacter carriage, its relation to age, and identified risk factors for Campylobacter in children in Africa. How this study might affect research, practice or policy - Standardising risk factor assessments can guide future control strategies. Further research into the impact of asymptomatic carriage is warranted.

BackgroundCervical cancer is one of the most common cancers in women, particularly among women living with HIV (WLWH). Persistent infection with High-risk oncogenic human papillomavirus (Hr-HPV) is the primary etiological factor. However, data on Hr-HPV prevalence among WLWH in Kinshasa, Democratic Republic of the Congo, remains poorly documented. This study aimed to determine the prevalence of Hr-HPV infection and identify associated risk factors in this population. MethodsA cross-sectional study was conducted on WLWH aged 25 to 65 years receiving antiretroviral therapy at the DREAM Centre in Kinshasa. Cervical sample were collected and analysing using multiplex PCR for detection of Hr-HPV genotypes. Sociodemographic data and risk factors were collected via questionnaires, and associations with Hr-HPV infection were assessed using multivariate logistic regression. ResultsA total of 436 women were included. The prevalence of Hr-HPV infection was 47.25%. HPV types 16 and 18 (alone or in co-infection) were detected in 23.79% of participants. In a multivariate logistic regression analysis, WHO clinical stage 3-4 (aOR 1.75; 95% CI 1.16-2.64; p=0.008) and HIV viral load [&ge;]1000 copies/mL (aOR 3.08; 95% CI 1.28-7.42; p=0.012) and Antiretroviral therapy duration <2 years (aOR 0.52; 95% CI 0.29-0.93; p=0.028) were significantly associated with Hr-HPV infection. ConclusionsNearly one in two WLWH in Kinshasa was infected with Hr-HPV, and one in four carried HPV-16/18 genotypes. Advanced HIV disease and uncontrolled viral replication were strongly associated with Hr-HPV infection. These findings underscore the urgent need to integrate systematic Hr-HPV screening into HIV care programs, particularly for women with advanced clinical stage or persistent viremia.

BackgroundRespiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in children, often leading to hospitalisation in infants. In low-resource settings where routine RSV diagnostics are unavailable, clinical overlap with bacterial pneumonia frequently results in unnecessary antibiotic use, contributing to antimicrobial resistance. ObjectiveTo evaluate the frequency and clinical determinants of antibiotic use among RSV-positive children under two years at a tertiary hospital in Ghana. MethodsThis cross-sectional study was conducted from June to November 2023 at the Department of Child Health, Korle Bu Teaching Hospital. Children with acute respiratory illness were enrolled and tested for RSV using molecular point-of-care and reverse transcriptase-polymerase chain reaction methods. Antibiotic use and clinical characteristics were analysed among RSV-positive cases. ResultsOf 128 children enrolled, 72 (56.2%) tested positive for RSV. Among these, 48 (66.7%) received antibiotics. Antibiotic use was significantly associated with markers of disease severity, including hypoxia (p = 0.009), tachypnea (p = 0.015), dyspnea (p < 0.001), and hospital admission (p < 0.001). Only 11 (23%) had suspected or confirmed bacterial co-infections. ConclusionA substantial proportion of RSV-positive children received antibiotics. These findings underscore the importance of antimicrobial stewardship programs, rapid diagnostics, and preventive interventions, such as maternal RSV vaccination. Strengthening diagnostic capacity and clinical decision-making in pediatric care is crucial for reducing inappropriate antibiotic use and addressing antimicrobial resistance in low-resource settings.

BackgroundIntestinal parasitic infections are a preventable public health burden and a marker of WASH-related inequities, especially among migrants in precarious conditions. ObjectivesTo estimate prevalence, parasite spectrum, and factors among migrant adults and children in Arica, Chile. MethodsCross-sectional study (2021- 2023) using clinical and survey records from a community programme. Stool microscopy used the Burrows sedimentation method on three samples; paediatric testing included the Graham tape test, modified Ziehl-Neelsen staining, and a Cryptosporidium rapid test. Associations were assessed with bivariate tests and univariate logistic regression. FindingsOf 345 participants, 68.1% were parasite-positive; 65.5% had polyparasitism. The most common parasites were Entamoeba coli (31.1%), Giardia duodenalis (30.6%), Entamoeba histolytica/dispar (27.7%), and Enterobius vermicularis (20.0%). Living in shared dwellings increased infection odds (OR 2.76); indoor animals (OR 2.18) and livestock ownership (OR 3.12) also increased risk. ConclusionsParasitic infections are prevalent among migrants in Arica, mainly due to environmental and housing vulnerabilities. Programs should focus on sensitive screening, WASH, and housing interventions.