Tropical Medicine and Infectious Disease

Background Onchocerciasis (river blindness), caused by the filarial nematode Onchocerca volvulus and transmitted by Simulium blackflies, remains a public health challenge in sub-Saharan Africa. Following the transition from vector control to large-scale ivermectin distribution, microfilariae (mf) prevalence has declined substantially across Ghana. The World Health Organization targets onchocerciasis elimination, defined as sustained mf prevalence below 1%. This requires identifying areas of persistent or resurgent transmission to guide targeted mapping surveys and interventions. Methods A Bayesian spatiotemporal, multilevel, generalized additive model with a zero-inflated beta-binomial outcome was fitted to mf prevalence data from 1353 surveys across 671 villages and environmental and socio-economic predictors. Temporal prevalence trends for ecozones within operational transmission zones (OTZ) were modelled using a 2D spatial smooth to account for residual spatial autocorrelation. Temporal autocorrelation in prevalence was accounted for using a random effect for village nested within ecozone. Results Runoff probability and surface wetness were positively associated with prevalence, consistent with Simulium breeding in fast-flowing water. Despite high initial mf prevalence, by 2015 the median prevalence across all OTZs in Ghana was estimated to be between 0.43 and 1.97%. The probability that prevalence was <1% in 2015 ranged from 0.15 to 0.87. Assuming testing rates and mass drug administration have remained consistent (twice a year and >80% coverage), linear extrapolation predicted that the three OTZs have some probability of exceeding the elimination threshold by 2030, while two were predicted to have near-zero prevalence. The Tano-Ankobra OTZ, which includes both savanna and forest agro-ecological zones, was a persistent hotspot. Conclusions This first comprehensive spatio-temporal analysis of onchocerciasis in Ghana reflects the well-documented challenge of onchocerciasis control in forested riverine environments. Persistent transmission foci in eastern and southern Ghana, particularly in forest zones with sustained vector habitat, warrant targeted investigation and intensified intervention to meet WHO elimination thresholds.

Background: Treponema pallidum quantitative polymerase chain reaction (qPCR) positivity and cycle threshold (Ct) by rapid plasma reagin (RPR), disease stage, and other characteristics are poorly characterized in routine-care specimens, leaving it unclear when qPCR of such specimens is informative for diagnosis. Methods: This Japanese multicenter cross-sectional study explored qPCR positivity and Ct by these characteristics. Nonblood specimens collected during routine care underwent qPCR at a central laboratory for this study. Bayesian logistic and normal regressions modeled positivity and mean Ct of TP0574 and polA with stage-specific continuous automated RPR terms, patient characteristics, collection site, and facility random intercepts. Estimates were standardized over the analyzed specimens. Population-group predictions were instead averaged within each group. Results: Among 154 nonblood specimens from 145 patients (71.7% non-MSM men and women) at 14 facilities, 109 (70.8%) were qPCR positive. At RPR 1, adjusted positivity was 72.2% (95% credible interval, 60.9%--82.9%) in primary and 43.8% (16.7%--69.9%) in secondary syphilis. Positivity showed a modest downward trend with RPR in primary but increased in secondary syphilis, reflecting a stage-by-RPR interaction (secondary-to-primary ratio of odds ratios, 1.78; 1.25--2.65). Predicted positivity showed an upward trend with RPR values among MSM; adjusted positivity was relatively high for genital/urethral/urinary and anal/perianal/rectal specimens. Adjusted mean Ct increased with RPR in primary and followed an inverted-U pattern in secondary syphilis. Conclusions: In primary syphilis, nonblood qPCR positivity was high even at low RPR. When serologic findings remain inconclusive in this stage, qPCR is highly recommended for securing an early diagnosis.

Background Malaria and HIV remain major causes of illness in sub-Saharan Africa, accounting for 94% of the global malaria burden and over two-thirds of the global HIV burden. HIV-related immunosuppression increases susceptibility to malaria, with a higher malaria burden of up to 47% and severe malaria complications compared to HIV-negative individuals. Socio-demographic factors, individual knowledge, attitude, and perception are recognized determinants of malaria prevention behaviours, but no study has modelled their combined contribution, and there is scant research on these factors among people living with HIV. We assessed the level of knowledge, attitudes, and perceptions towards malaria, and identified the predictors of malaria prevention practice among HIV-positive individuals in Kampala, Uganda. Methods This cross-sectional study enrolled 620 HIV-positive patients attending the ART clinic of China-Uganda Friendship Hospital, Naguru, selected by systematic random sampling. Data collection was conducted from 21st July 2025 to 18th August 2025 using a structured, interviewer-administered questionnaire that measured socio-demographic characteristics, knowledge, attitude, perception, and the practice of malaria prevention. Associations were assessed using Mann-Whitney U, Kruskal-Wallis H, and Spearman correlation. The independent predictors of good malaria prevention practice were identified using binary logistic regression. Results Participants had a mean age of 34.8 years, were predominantly female (68.9%), Baganda (38.1%) by tribe, and the majority had a secondary level of education(46.0%). Most had good knowledge of malaria (97.3%) and a positive attitude (90.5%), while 57.3% held a positive perception of malaria risk and prevention; only 62.6% reported good malaria prevention practice, and most prevention methods used were sleeping under a mosquito net (71.1 3%) and closing windows early in the evening (70.3%). In regression analysis, knowledge (adjusted odds ratio [AOR] 1.198, 95% CI 1.03-1.40, p = 0.023) and attitude (AOR 1.101, 95% CI 1.04-1.17, p = 0.001) independently predicted good practice, while perception did not (AOR 1.00, 95% CI 0.96-1.04, p = 0.994). Scores of Attitude, perception, and malaria prevention practices varied significantly, though non-linearly, by education level, and were highest among non-educated participants. Conclusions Despite near-universal knowledge and predominantly positive attitudes in this study, more than a third of HIV-positive participants did not practice adequate malaria prevention, and perception did not independently predict malaria prevention practice once knowledge and attitude were accounted for. Programmes seeking to close this know-do gap should pair health education with structural support for prevention tools rather than education alone.

Background On the Zanzibar islands, Tanzania, mass drug administration (MDA) with praziquantel against Schistosoma haematobium infections has been implemented regularly since the early 2000s. Elimination of schistosomiasis as a public health problem has been achieved in most areas, with the goal of interruption of transmission. The RESIST project investigates the extent to which MDA-driven selection for praziquantel resistance is occurring and contributing to persistent transmission hotspots. Methodology As part of RESIST, the efficacy of praziquantel treatment was assessed in two schools on Pemba between October 2024 and March 2025. Longitudinal parasitological surveys were conducted before and two weeks after school-based MDA with praziquantel (40 mg/kg). Up to six urine samples per study participant were collected on different days pre- and post-MDA and examined for S. haematobium eggs by urine filtration microscopy. In a per-protocol analysis, drug efficacy was categorised as adequate, inconclusive, or reduced, based on hypothesis testing. A generalized linear mixed model was used to assess the association between pre-MDA infection intensity and drug efficacy at the individual level. Principal findings Pre-MDA, S. haematobium prevalence was 14.3% (62/434) in School 1 and 37.8% (233/617) in School 2. Post-MDA prevalence was 0.5% (2/434) and 9.6% (59/617), respectively. Egg reduction rates were 99.8% (90% confidence interval (CI): 99.2-100%) in School 1 and 94.8% (90% CI: 88.6-98.6%) in School 2, which were classified as adequate and inconclusive, respectively. In School 2, drug efficacy at the individual level was negatively associated with pre-MDA infection intensity. Conclusion/significance The efficacy of praziquantel on Pemba remains higher than the 90% threshold for optimal drug efficacy set by the World Health Organization. While the inconclusive efficacy results for School 2 can at least partially be explained by the variation in the participants pre-MDA infection intensities, further investigations are warranted to account for the disparity in praziquantel efficacy on Pemba. Trial registration: ISRCTN, ISRCTN59331501. Registered 24 October 2024, https://www.isrctn.com/ISRCTN59331501.

Background: Direct microscopy remains a practical first-line test for cutaneous leishmaniasis (CL), but it can miss infections when parasite numbers are low or lesions are chronic. We evaluated whether PCR could detect and identify Leishmania in Giemsa-stained smears that had already been reported as microscopy-negative. Methods: We retrospectively analyzed 131 microscopy-negative smears from patients with clinically suspected CL who attended health-center laboratories in Gonbad-e-Qabus and Torbat-e-Jam, Iran, between March 2013 and February 2015. DNA was recovered from the stained slides by phenol- chloroform-isoamyl alcohol extraction. kDNA PCR was used for molecular detection and species identification. Results: Leishmania DNA was detected in 34 of 131 microscopy-negative samples (25.9%; exact 95% CI, 18.7%-34.3%). Twenty-three positive samples (67.6%) were identified as L. major and 11 (32.4%) as L. tropica. All L. major-positive samples came from Gonbad-e-Qabus, whereas all L. tropica-positive samples came from Torbat-e-Jam. Most PCR-positive lesions (27/34, 79.4%) were chronic, secondarily infected, and/or clinically atypical. In a small laboratory verification panel, all 10 microscopy-positive smears were PCR-positive and all 10 non-leishmanial dermatosis controls were PCR-negative. Conclusions: About one in four clinically suspected cases with a negative smear still had detectable Leishmania DNA. PCR of previously stained slides can therefore provide useful second-line confirmation and species information, especially when lesions are chronic or atypical. The small control panel supports assay performance in the study laboratory but is not large enough to provide precise estimates of clinical sensitivity or specificity.

ABSTRACT Background Cutaneous leishmaniasis (CL) caused by Leishmania (Viannia) may involve parasite dissemination from the primary skin lesion to clinically healthy mucosal sites, a process potentially relevant to the development of mucosal leishmaniasis. Parasite burden and Leishmania RNA Virus 1 (LRV1) have been proposed as factors influencing parasite persistence, dissemination, and treatment response. We investigated whether parasite load and LRV1 detection in skin lesions were associated with Leishmania in clinically healthy nasal mucosa and, in a subset of patients, with therapeutic outcome. We also assessed the relationship between LRV1 and parasite load. Methodology/Principal findings We conducted a prospective observational cohort study. Parasite load and LRV1 were assessed by qPCR in skin lesions and clinically healthy nasal mucosa from patients with localized cutaneous leishmaniasis in Rondonia, Brazilian Amazon. Samples were evaluated before treatment (D0), at the end of treatment (D20), and during follow-up (D90-180). Among 178 patients screened, CL was confirmed in 113. LRV1 was detected in skin lesions in 34.51% of patients and in nasal mucosa in 24.13%. Leishmania DNA was detected in clinically healthy nasal mucosa in 12.38% of patients. LRV1 detection in the skin lesion was associated with detection of Leishmania in the nasal mucosa. Higher parasite loads were observed in more recent lesions. Among patients evaluated for therapeutic outcome, higher parasite load before treatment was associated with treatment failure and was the factor most strongly associated with an unfavorable response in multivariate analysis. Conclusions/Significance LRV1 detection in cutaneous lesions was associated with Leishmania in clinically healthy nasal mucosa, although the significance of this association and its relationship with parasite dissemination require further investigation. In contrast, parasite burden was associated with therapeutic outcome, with higher pre-treatment loads observed in patients who experienced treatment failure. The absence of an association between LRV1 and parasite load suggests that these two parameters may provide distinct information regarding parasite detection at mucosal sites and therapeutic response.

Background. The objective was through an analysis of longitudinal data from the DepIST-H cohort to estimate the incidence, describe the dynamics and factors associated with CT/NG infection in MSM in Togo. Methods. A total of 200 MSM in Lome, Togo, were included in the ANRS I MIE 12400/DepIST-H cohort, half living with HIV. After inclusion in the study, participants received follow-up clinical visits at 6 and 18 months, and laboratory tests were performed at baseline (M0) and at 12 and 24 months (M12 and M24). PCR tests for CT and NG were performed from pharyngeal, anal and urine samples collected using the Xpert(R) CT/GC kit (Sunnyvale, CA, USA). To identify the factors associated with anal bacterial STIs, offset term Poisson regression models were performed. Results. Among 200 MSM (median age 24 years), CT and NG incidence rates were high ({approx}22 cases per 100 person-years), particularly at the anal site. Multiple partners significantly increased anal NG incidence (aIRR 2.35). Anal NG incidence was significantly lower among participants with income-generating activity (aIRR 0.57). Trends suggested higher anal CT and NG incidence in the presence of pharyngeal infection, but associations were not statistically significant Conclusion. This study confirms that MSM remain highly exposed to STIs in Togo and highlights the need to strengthen prevention efforts within this population. Postexposure doxycycline prophylaxis and multisite pooled-sample screening represent promising avenues to strengthen prevention efforts within these populations.

The effectiveness of malaria vector control is increasingly threatened by widespread insecticide resistance, particularly to pyrethroids. In response, the World Health Organization recommends dual-active ingredients (dual-A.I.) insecticide-treated nets (ITNs) in resistant settings. This study evaluated the efficacy of several dual-A.I. ITNs in two experimental hut trial sites an area with high insecticide resistant malaria vectors in Tanzania with differing vector species composition and bionomics. Five ITNs were evaluated: a pyrethroid-only net (MAGNet(R)), three pyrethroid-piperonyl butoxide (PBO) nets (OlysetTM Plus, Veeralin(R), and PermaNet(R) 3.0), one dual-A.I. net (Interceptor(R) G2; chlorfenapyr + alpha-cypermethrin), and an untreated control net. Mosquitoes were collected from huts, morphologically identified, and monitored for mortality up to 72 h. WHO cone and tunnel tests using susceptible An. gambiae s.s. were conducted for quality control, while field-collected mosquitoes were used for bio-efficacy monitoring. Molecular species identification was performed using PCR assays, and genomic DNA was extracted from An. funestus s.l. and An. gambiae s.l. collected from the trials. All ITNs met WHO bio-efficacy criteria in cone and tunnel tests. An. gambiae s.l. predominated in Mwagagala (77%) but was rare in Magu (4%), where An. funestus complex was dominant. In Magu, Interceptor(R) G2 and Veeralin(R) achieved significantly higher mortality than MAGNet(R) at 24 h (53% and 45% vs 24%) and 72 h (61% and 53% vs 24%). In contrast, no significant mortality differences were observed among ITNs in Mwagagala. High resistance intensity was detected in both vector groups (mortality <20% in bioassays). In An. funestus from Magu, the 4.3 kb-SV resistant genotype was fixed, while G454A-CYP9K1 resistance was highly prevalent (RR: 0.70-1.00). Interceptor(R) G2 and Veeralin(R) outperformed the pyrethroid-only reference net against An. funestus complex but not against predominantly An. arabiensis populations.

Objectives To assess microfilaraemia, chronic lymphatic filariasis (LF)-related morbidity, and community knowledge and self-reported preventive behaviours in a rural community in northern Ghana following prolonged mass drug administration (MDA). Design Community-based cross-sectional study. Setting Birifor community, Lawra Municipality, Upper West Region, northern Ghana, from October 2024 to January 2025. Participants A total of 261 community members aged 10 years and above were selected using random sampling and participated in the study. Outcome measures Outcome measures included microfilaraemia detected by night blood microscopy, chronic LF-related morbidity identified through clinical examination, and community knowledge and self-reported preventive behaviours assessed using a structured questionnaire. Results No microfilariae were detected (0/261; 0%). Chronic lymphoedema was identified in five individuals (1.9%), all aged over 40 years. Awareness of LF was high (95.8%), yet only 39.5% of participants demonstrated good community knowledge and self-reported preventive behaviours. Misconceptions regarding transmission, particularly beliefs that LF is hereditary or caused by spiritual factors, were common. MDA participation was high (93.1%). All five individuals with chronic lymphoedema reported loss of income, and three (60%) reported additional household income loss due to caregiving responsibilities. Conclusions No microfilaraemia was detected, suggesting very low transmission in the study area, although residual infection cannot be excluded. Chronic LF-related morbidity and gaps in community knowledge persist despite high MDA participation. Sustained surveillance using more sensitive diagnostic approaches, together with morbidity management and disability prevention, community education and support for affected households, will be important to sustain LF elimination efforts.

Introduction Miltefosine is the only approved oral antileishmanial agent, but its use in women of childbearing potential (WOCBP) is restricted due to preclinical teratogenicity. Current labeling recommends contraception during treatment and for at least five months thereafter, based solely on its long terminal elimination half-life. This study re-evaluated the required contraceptive duration using an exposure margin-based approach. Methods Virtual populations were generated from anthropometric data of 382 Indian, 4,462 Eastern African, and 4,019 Brazilian WOCBP with leishmaniasis. Published population pharmacokinetic models were used to simulate miltefosine exposure following 14-42-day regimens for visceral leishmaniasis (VL), post-kala-azar dermal leishmaniasis (PKDL), and cutaneous leishmaniasis (CL). A developmental safety exposure threshold was derived from the rat no-observed-adverse-effect level (0.6 mg/kg/day for 10 days) and adjusted using a 10-fold safety margin. Contraceptive durations resulting in median residual post-contraception exposure (AUCEOC-{infty}) below this threshold were considered supportive of contraceptive discontinuation. Results The developmental safety exposure threshold was estimated at 2.5 mg{middle dot}day/L. Despite pharmacokinetic differences across geographical regions and disease manifestations, required minimum contraceptive durations were consistent: three months from treatment initiation for the 14-day regimen, four months for 21- and 28-day regimens, and five months for the 42-day regimen. For the 14-day regimen, a single dose of a long-acting injectable contraceptive administered at treatment initiation would provide sufficient coverage. Conclusion An exposure margin-based approach supports shorter contraceptive durations than current recommendations. For the 14-day VL regimen, three months of contraception may provide a practical alternative to current labeling.

Tuberculosis (TB) remains a major global public health threat, with an estimated 10.7 million incident cases and 1.23 million deaths in 2024. Treatment interruption undermines TB control efforts, yet the effectiveness of Community Health Promoters (CHPs) in tracing patients lost to follow-up (LTFU) is poorly understood. We assessed the proportion of LTFU TB patients successfully traced through CHP-led tracing strategy and explored challenges of implementation CHP strategy. We conducted a mixed-methods cross-sectional study in Kilifi County, Kenya, among adult TB patients recorded as LTFU between July 2022 and December 2023. Patients identified through the national electronic TB surveillance system were linked to their respective community health units and assigned to CHPs for tracing. CHPs attempted to contact patients by telephone and through repeated household visits and, where necessary, sought information from relatives, neighbours, and local administrative leaders. For successfully traced patients, quantitative data were collected using structured questionnaires. Qualitative data were collected through five focus group discussions with 30 traced TB patients and 30 in-depth interviews with CHPs, TB clinic staff, programme managers, and County Health Management Team members. Qualitative data were coded and analysed thematically using a primarily deductive approach guided by the study objectives, while allowing additional themes to emerge. Of 140 patients identified for tracing, 36 (25.7%, 95% confidence interval 18.7-33.8) were successfully traced; 90 (64.3%) had relocated outside Kilifi County and 14 (10.0%) had died. Qualitative findings indicated that treatment interruption was driven by financial hardship, including transport costs, medication side effects, stigma, and difficulties maintaining continuity of care after relocation. CHPs supported treatment adherence through health education, counselling, appointment reminders, and household follow-up. However, their ability to trace patients was constrained by patient mobility, limited financial support for community-based activities, shortages of health workers, competing responsibilities, and gaps in systems for tracking patients across administrative boundaries. CHP-led tracing reached only one-quarter of LTFU TB patients, largely because many had relocated outside the county. Health systems should strengthen patient tracking across county boundaries and equip CHPs with the resources, staffing, and support needed for effective community-based TB tracing.

Background Madagascar has one of the highest burdens of schistosomiasis globally, yet epidemiological evidence from the South-east of the country remains limited. Existing surveillance estimates suggest relatively low prevalence in this region. This contrasts with the region's environmental suitability for transmission and its population's high occupational risk through rice farming. Methods A cross-sectional exploratory study was conducted across 13 villages around the Manombo Special Reserve, Farafangana District, between May and July 2025. Participants were surveyed for geographic, environmental and behavioural risk factors for schistosomiasis infection. Infection was diagnosed by Kato-Katz stool microscopy. Multivariable mixed-effects logistic and linear regression, with village as a random intercept, estimated associations with infection and intensity respectively, adjusting for the water catchment area of household water sources, sex, age group, recent praziquantel treatment and village-level open defecation rate. Results 227 participants were included. Overall S. mansoni prevalence was 53.3% (95% CI 46.8-59.8%); median infection intensity was 96 (IQR 48-288) eggs per gram of stool among those infected. Surface water contact was near-universal (97.3%). Prevalence varied markedly between neighbouring villages. No demographic, behavioural, or WASH variable was independently associated with infection. The water catchment area of household water sources was the primary predictor of infection. Conclusions Prevalence substantially exceeded current surveillance estimates, suggesting this population is underserved by existing control programmes. Water catchment area was the dominant determinant of transmission heterogeneity, possibly consistent with Biomphalaria habitat suitability. Water catchment area may represent a valuable and underutilised unit for targeting schistosomiasis surveillance and control in Madagascar.

Background: Unexplained spatial heterogeneity in field-observed Human Blood Index (HBI) hinders vector-borne disease control. We synthesized micro-morphological sensory structure densities across primary disease vectors to formulate a novel Proboscis Sensory Index (PSI) from micro-morphological sensory structure densities to evaluate its capacity to predict vector anthropophily, zooprophylactic modulation, and spatial transmission risk across Northern Nigeria. Methods: A systematic review of 42 studies (N = 18,647 blood-fed mosquitoes across 126 georeferenced sites, 2005 to 2025) synthesized baseline species-specific PSI metrics from electron microscopy sensilla counts. A multi-variable binomial Generalized Linear Mixed Model (GLMM) evaluated interactions between PSI, livestock, human density, and environmental covariates. Predictive accuracy was validated against field-derived Entomological Inoculation Rates (EIR) and historical outbreak records. Results: The overall pooled HBI was 0.642 (95% CI: 0.588 to 0.694), exhibiting significant variation across the Sudan (0.728), Guinea (0.615), and Sahel (0.584) savannas. Species specific PSI values graded from Anopheles gambiae s.s. (8.91 {+/-} 0.34), Anopheles funestus (8.12 - 0.38), and Anopheles arabiensis (7.68 {+/-} 0.41) to Culex quinquefasciatus (4.87 {+/-} 0.52). In GLMM analysis, PSI was the strongest predictor of anthropophily ({beta} = 0.89, aOR = 2.44, 95% CI: 2.32 to 2.56, p < 0.001), with fixed effects explaining 78% of total field variance (Marginal R2 = 0.78). High PSI species maintained elevated anthropophily regardless of livestock availability, whereas low-PSI species displayed steep zooprophylactic diversion ({Delta}HBI = -0.71, p < 0.001) under high cattle density. Incorporating PSI reduced localized EIR prediction error by 64.2% (RMSE = 15.0 vs. 41.8 infective bites/person/month), and high-resolution (1 km2) predictive mapping correctly identified 87.1% (27/31) of historically documented outbreak Local Government Areas. Conclusion: Micro-sensory organ density dictates vector host preference and livestock-mediated zooprophylactic potential. Integrating PSI into spatial models resolves localized transmission heterogeneity, guiding targeted vector control prioritizing indoor residual spraying and dual-ingredient nets in high PSI foci, while leveraging endectocides and larval management in low-PSI pastoral corridors.

Precision targeting is essential for maximising impact and cost-effectiveness of interventions at this stage of the HIV response in Malawi. We aimed to measure gaps in access to and use of condoms, HIV testing, pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision among HIV-negative individuals at public health facilities and social venues (bars, rest houses and liquor stores) in Blantyre, Malawi. We analysed cross-sectional data from 2,227 HIV-negative patients at government clinics and 1,634 patrons at social venues recruited in the Clinic vs Venue (CLOVE) study between January and March 2022. We estimated gaps in access to and use of condoms, HIV testing, PrEP and circumcision. Estimates were stratified by risk group, defined as reporting transactional sex, having multiple sex partners in the past 4 weeks, being female aged 15 to 24, or being male aged 30 and above. Access and use were based on self-reports. Overall, 30% of clinic and 60% of venue participants reported higher risk. Among men, we found a gap between access to condoms and condom use at last sex (76.7% vs 29.8% among clinic men; 75.4% vs 36.7% among venue men). Among women, the gap between access and use of condoms was 65.9% vs 18.0% at clinics and 79.9% vs 46.0% in the venues. Approximately 80-85% of participants reported knowing where to get an HIV test in Blantyre but less than half reported testing in the past 6 months. Use of PrEP was low (~2%). Comparable proportions of men who paid for sex and those with multiple partners (~77%) reported being circumcised, but this was lower among those aged 30 years or older (~57%). Despite expanded HIV prevention services in Blantyre, gaps remain in the uptake of prevention services among people reachable at public health facilities and social venues. Use of PrEP was particularly low across all groups. Condom and testing use remained suboptimal despite high reported access. Targeted efforts are needed to address barriers to uptake, particularly for PrEP among high-risk venue-based populations.

Background: The biological mechanism linking rainfall with leptospirosis transmission is well established, but rigorous quantitative evidence for the insular Caribbean remains scarce, limited mostly to descriptive reports of post-hurricane outbreaks. We aimed to quantify the association between rainfall and leptospirosis incidence in the Dominican Republic, where leptospirosis is endemic, between 2012 and 2026 using a distributed-lag approach. Methods: We conducted an ecological time-series study complemented by a province panel with fixed effects. Case data (5,412 valid cases) were obtained from the national surveillance system (SIP-0276FA51); rainfall data were obtained from 15 INDOMET rain gauge stations across 13 provinces (2000 to 2026). We calculated the cross-correlation function between lagged monthly rainfall (0 to 6 months) and case counts, fitted a negative binomial distributed-lag regression model (lags 0 to 3 months) adjusted for seasonality and trend, triangulated findings with a 13-province fixed-effects panel, compared four rainfall exposure metrics, assessed extreme-rainfall threshold sensitivity, and estimated the population attributable fraction (PAF) with a parametric bootstrap. Results: The rainfall-case association peaked at a 1-month lag (r = 0.551; 95 % CI 0.437-0.647; p < 0.001) and remained significant through 3 months. In the distributed-lag model, all four lags were independently significant, with the 1-month lag showing the strongest effect (incidence rate ratio [IRR] = 1.156 per additional 50mm; 95 % CI 1.090-1.226; p < 0.001). The province panel yielded an almost identical 1-month lag effect (IRR = 1.147; 95 % CI 1.127-1.167). Rainfall above the historical 90th percentile increased case risk the following month (rate ratio = 1.95), with effect magnitude increasing monotonically with threshold stringency. An estimated 28.2 % (95 % CI 19.0-36.6 %) of cases were attributable to rainfall above the recorded historical minimum. Conclusions: Rainfall is a robust, consistent predictor of leptospirosis incidence in the Dominican Republic, with the strongest association observed at a 1-month lag and a lag pattern broadly consistent with findings from distributed-lag studies in Thailand and the Philippines. These findings, which to our knowledge constitute the first formal quantification of this association for the insular Caribbean, provide an evidence base for rainfall-linked early-warning systems, with the strongest signal at approximately one month and elevated risk extending through three months after rainfall.

Aim: Brucellosis remains endemic throughout the Mediterranean basin, the Middle East and Central Asia. Genitourinary involvement is an uncommon but clinically consequential focal complication that closely mimics urological emergencies and may precipitate unnecessary surgery. Contemporary data describing its frequency, laboratory signature and treatment outcomes in endemic settings remain limited. Material-Methods: We retrospectively screened all adults ([&ge;]18 years) with confirmed brucellosis managed at a tertiary infectious diseases unit between January 2008 and December 2020. Genitourinary involvement was defined as epididymo-orchitis, orchitis, epididymitis and/or brucellar pyelonephritis. Clinical, laboratory, ultrasonographic, therapeutic and outcome variables were abstracted using a standardised form. Proportions are reported with Wilson score 95% confidence intervals (CI). Reporting followed the STROBE statement. Result: Genitourinary involvement was identified in 18 of 125 patients with brucellosis (14.4%; 95% CI 9.3-21.6); 16 (88.9%) were men and the mean age was 35.2 years (range 22-62). Scrotal disease dominated the male presentation: epididymo-orchitis in 10 of 16 men (62.5%; 95% CI 38.6-81.5), orchitis in 4 (25.0%) and epididymitis in 2 (12.5%). Both women presented with pyelonephritis, one of whom developed a tubo-ovarian abscess requiring drainage. Constitutional features were near-universal (fatigue 100%, night sweats 88.9%, fever 77.8%). Leukocyte counts remained within the reference interval in every patient (mean 5,680/mm3), whereas erythrocyte sedimentation rate (mean 32 mm/h) and C-reactive protein (mean 24.2 mg/L) were only mildly to moderately raised. The Coombs anti-Brucella test was positive in 18 of 18 patients (100%) and the standard agglutination test in 17 of 18 (94.4%), whereas blood culture yielded Brucella melitensis in only 1 of 18 (5.6%). Concomitant extragenitourinary focal disease was present in 8 patients. All patients received doxycycline plus rifampicin; none required modification of the regimen or orchiectomy, and no treatment failure occurred (0 of 18; 95% CI 0-17.6). Median follow-up was 12 weeks (range 6-52) and no relapse was documented within this interval. Conclusions: In endemic regions, genitourinary brucellosis should be suspected in any patient with acute scrotal or flank symptoms accompanied by constitutional complaints, even when the leukocyte count is normal and acute-phase reactants are only marginally elevated. Coombs anti-Brucella serology rather than blood culture is the diagnostic cornerstone, and prompt doxycycline-rifampicin therapy averts surgical intervention.

The need to meet the World Health Organization 2030 target for elimination of lymphatic Filariasis necessitates various activities such as mass administration of medicines (MAM), pre-transmission assessment surveys (pre-TAS)/ epidemiological monitoring survey (EMS) and transmission assessment survey. However for this study, pre-TAS/EMS was conducted to validate elimination milestones and elucidate the lingering immunological consequences of chronic infection. This study conducted a comprehensive evaluation across twelve Local Government Areas (LGAs) in Osun State, screening,7388 individuals for circulating filarial antigen (CFA) using Abbott Filarial Test Strips (FTS), while simultaneously investigating immune modulation in patients with clinical elephantiasis through detailed haematological profiling. Results indicated that the prevalence of the disease at sentinel and spot check sites have been lowered below threshold levels thereby qualifying for a first transmission assessment survey (TAS1), evidenced by a 0% antigenemia rate across all surveyed LGAs, a figure significantly below the World Health Organization's <2% threshold. . The average percentage of individual participation in MDA/MAM programs was found to be 56.09%, whereby, Ola-Oluwa LGA recorded the highest at 84.70% while the list MDA program participation was found at Ilesha East with 18.97%, highlighting a potential vulnerability in vector control compliance. Furthermore, haematological assessments of chronic cases revealed a distinct state of immune suppression, characterized by significant reductions in total white blood cell and lymphocyte counts, alongside persistent monocytosis and eosinopenia. These findings suggest that while Osun State has successfully transitioned into a post-transmission phase, the lingering physiological impacts on the chronically ill and the moderate rates of preventive practice necessitate sustained surveillance and enhanced public health interventions to ensure permanent disease eradication

Long-acting injectable human immunodeficiency virus (HIV) medicines expand treatment and prevention choices, but willingness to use them does not establish readiness to begin. We examined readiness to start these options, associated factors and conditions for acceptance among people living with HIV and pre-exposure prophylaxis (PrEP)-service clients in Uganda. This cross-sectional study analysed 225 participants at Mildmay Hospital and Kajjansi Health Centre IV in central Uganda. Readiness meant preferring initiation immediately or within three months. Modified Poisson regression estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs), including age-by-service-group interaction. Separate models examined informational, perceptual and financial factors, adjusting for service group, age and sex. Logistic marginal standardisation checked demographic and expanded age comparisons. Overall, 108 participants (48.0%) were ready to start injectable HIV treatment or prevention, 111 (49.3%) wanted more information about these options, and six (2.7%) preferred initiation in six to twelve months. Readiness was 80.8% among people living with HIV aged 15-24 years and 34.4% among those aged 25 years or older (aPR 2.35, 95% CI 1.63-3.38). Corresponding proportions among PrEP-service clients were 39.2% and 41.4% (aPR 0.95, 95% CI 0.60-1.50; interaction p=0.002). In separate adjusted models, clinic-staff information (aPR 1.94, 95% CI 1.42-2.66), belief in greater effectiveness (2.00, 1.43-2.80) and a one-point increase in benefit score (3.27, 2.36-4.55) were associated with higher readiness. A one-point increase in concern score (0.70, 0.60-0.80) and financial difficulty sometimes or more often (0.68, 0.48-0.96) were associated with lower readiness. Fewer side effects was the leading condition for accepting injectable HIV treatment or prevention across service and readiness groups. Nearly half of participants were ready to start, while a similar proportion wanted further information about injectable options. Programmes should assess intended initiation timing alongside willingness and address safety, appointment flexibility, privacy and affordability through counselling and service planning.

Background: Localized or segmental overgrowth is a rare condition that may co-occur with vascular malformations. These diseases generally are caused by somatic mutations in the PI3K/AKT/mTOR pathway. Most lesions are progressive and may cause symptoms including pain, functional impairment, and disfigurement. Treatment options are limited, especially for the overgrowth component. Objective: To evaluate the efficacy and safety of the mTOR inhibitor sirolimus in patients with overgrowth with or without a vascular malformation over a 6-months treatment period. Methods: We conducted a single-arm, open-label, phase II study including 18 patients (12 pediatric, six adult) with overgrowth, all of whom initiated oral sirolimus. 16/18 (88.9%) participants received oral sirolimus for 6 months, with dosing adjusted to achieve target blood trough levels of 3-8 ng/mL. Primary outcome was radiological response at six months assessed by the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Secondary outcome parameters were evaluated at three, six and nine months and included size and visual appearance of the overgrowth, quality of life (QoL), pain intensity, performance status, and safety. Results: No patient achieved complete or partial radiological response. 17 of 18 patients (94.4%) maintained stable disease at month six; one was not evaluable. QoL measured with WHOQOL-BREF improved modestly in patients aged >= 18 years (n=5, mean difference to baseline +9.3 (95%-CI: -0.9 to 19.5) in physical and +9.2 (95%-CI: 0.7 to 17.7) in psychological domains at month 6). In pediatric participants, no relevant improvement in KINDL total scores was observed over the study period. No significant changes occurred in pain scores. Performance status measured by the Lansky/Karnofsky scales showed minor improvement (mean +3.5 points (95%-CI: 1.0 to 6.1)). All patients experienced at least one adverse event, but no serious adverse events or CTCAE v5.0 grade [&ge;]3 toxicities occurred. Sirolimus was well tolerated. Six patients decided to resume sirolimus after study completion. Conclusions: Sirolimus induced minor lesion shrinkage in a subset of patients, although this did not meet the predefined radiological RECIST endpoint. However, sirolimus can lead to functional improvement in some adults, which may indicate that the primary radiological outcome did not capture patient-perceived benefit.

Wolbachia-based interventions were less effective in achieving introgression in Rio de Janeiro than other settings. Reduced introgression occurred in locations where dengue was historically high, raising concerns of inequity. We examined factors affecting Wolbachia introgression in Rio through trajectory modeling, spatiotemporal Bayesian models, and Ae. aegypti abundance estimation. During the intervention (2017-2020), Wolbachia introgression was 26% (median; IQR,14-44%), with four distinct trajectories. Despite receiving more releases, densely populated areas with low socioeconomic status had lower introgression. In spatiotemporally explicit multivariable regressions, higher Ae. aegypti abundance, temperature, population density and lower socioeconomic status were associated with reduced introgression. Improved characterization of Ae. aegypti abundance and other structural/environmental predictors of introgression could be used to calibrate release doses to ensure equitable benefits from Wolbachia interventions.