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The Caribbean region is lacking an assessment of the antibody response and side effects experienced after AstraZeneca COVID-19 vaccination (AZD1222). We examined severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike receptor-binding domain (RBD) IgG levels and report the side effects noted in a Jamaican population after AZD1222 vaccination. Median RBD IgG levels for persons without evidence of previous SARS-CoV-2 infection were 43.1 binding international units (bIU)/mL 3 to 7 weeks after the first dose, increasing to 100.1 bIU/mL 3 to 7 weeks after the second dose, and decreasing to 46.9 bIU/mL 16 to 22 weeks after the second dose. The median RBD IgG level 2 to 8 weeks after symptom onset for unvaccinated SARS-CoV-2-infected persons of all disease severities was 411.6 bIU/mL. Common AZD1222 side effects after the first dose were injection site pain, headache, and chills. Most people reported no side effects after the second dose. AZD1222 is widely used across the English-speaking Caribbean, and our study provides evidence for its continued safe and effective use in vaccination programs.
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BACKGROUND: The performance of the Roche Elecsys® Anti-SARS-CoV-2, Abbott Architect SARS-CoV-2 IgM, Abbott Architect SARS-CoV-2 IgG, Euroimmun SARS-CoV-2 IgA, Euroimmun SARS-CoV-2 IgG ELISA, and Trillium IgG/IgM rapid assays was evaluated in Jamaica. METHODS: Diagnostic sensitivities of the assays were assessed by testing serum samples from SARS-CoV-2 PCR-confirmed persons and diagnostic specificity was assessed by testing serum samples collected during 2018-2019 from healthy persons and from persons with antibodies to a wide range of viral infections. RESULTS: Serum samples collected ≥14 days after onset of symptoms, or an initial SARS-CoV-2 RT-PCR positive test for asymptomatics, showed diagnostic sensitivities ranging from 67.9 to 75.0% when including all possible disease severities and increased to 90.0-95.0% when examining those with moderate to critical disease. Grouping moderate to critical disease showed a significant association with a SARS-CoV-2 antibody positive result for all assays. Diagnostic specificity ranged from 96.7 to 100.0%. For all assays examined, SARS-CoV-2 real-time PCR cycle threshold (Ct) values of the initial nasopharyngeal swab sample testing positive were significantly different for samples testing antibody positive versus negative. CONCLUSIONS: These data from a predominantly African descent Caribbean population show comparable diagnostic sensitivities and specificities for all testing platforms assessed and limited utility of these tests for persons with asymptomatic and mild infections.
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Anticorpos Antivirais/sangue , Teste Sorológico para COVID-19/métodos , COVID-19/diagnóstico , SARS-CoV-2/imunologia , COVID-19/sangue , COVID-19/imunologia , Região do Caribe , Ensaio de Imunoadsorção Enzimática , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Jamaica , SARS-CoV-2/isolamento & purificação , Sensibilidade e EspecificidadeRESUMO
AIM: Human papillomavirus (HPV) has been reported to be associated with oral and oropharyngeal cancer. However, little information is available about the epidemiology of oral HPV infection in Jamaica. The purpose of the present study was to assess the prevalence of oral HPV strains using the oral rinse method in HIV and non-HIV Jamaican patients, as well as to determine the association of HPV with sexual practices, smoking, and alcohol use. METHODS: A cross-sectional study was conducted on patients attending The University of the West Indies Mona Dental Polyclinic and the Centre for HIV/AIDS Research and Education Services. Salivary samples were tested through molecular analysis for 37 HPV genotypes using the linear array HPV genotyping test. A survey questionnaire was used to obtain demographic details, smoking history, alcohol practice, sexual practice, and history of HPV testing. RESULTS: The HPV prevalence was 8.65% in 18-64 y olds (N = 104), with a slight female predilection (55%). No high-risk HPV types were found. HPV-84 was the most common type in both HIV and non-HIV patients; 66.7% of HPV-positive participants reported that they had six or more lifetime sexual partners. CONCLUSION: The prevalence of oral HPV was similar to that in other countries. No statistically-significant relationship was observed between the prevalence of HPV and either the number of sexual partners, smoking, or alcohol history. A nationwide study on oral HPV detection might be helpful in developing a HPV vaccination policy in Jamaica.
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Genótipo , Infecções por HIV/complicações , Epidemiologia Molecular , Antissépticos Bucais , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Adolescente , Adulto , Estudos Transversais , DNA Viral/análise , Feminino , Técnicas de Genotipagem , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças da Boca/epidemiologia , Doenças da Boca/virologia , Neoplasias Orofaríngeas , Prevalência , Fatores de Risco , Comportamento Sexual , Fumar , Inquéritos e Questionários , Adulto JovemRESUMO
[This corrects the article DOI: 10.1186/s13756-018-0315-3.].
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Background: Antibiotic resistance (ABR) is a serious threat that requires coordinated global intervention to prevent its spread. There is limited data from the English-speaking Caribbean. Methods: As part of a national programme to address antibiotic resistance in Jamaica, a survey of the knowledge, attitudes and antibiotic prescribing practices of Jamaican physicians was conducted using a 32-item self-administered questionnaire. Results: Of the eight hundred physicians targeted, 87% responded. The majority thought the problem of resistance very important globally (82%), less nationally (73%) and even less (53%) in personal practices. Hospital physicians were more likely to consider antibiotic resistance important in their practice compared to those in outpatient practice or both (p < 0.001). Composite knowledge scores were generated and considered good if scored > 80%, average if 60-79% and poor if < 60%. Most had good knowledge of factors preventing resistance (83%) and resistance inducing potential of specific antibiotics (59%), but only average knowledge of factors contributing to resistance (57%). Knowledge of preventative factors was highest in females (p = 0.004), those with postgraduate training (p = 0.001) and those > four years post graduation (p = 0.03). Empiric therapy was often directed by international guidelines and cultures were not routinely done. Limited laboratory and human resources were identified as challenges. Conclusion: Physicians in this study were aware of the problem of ABR, but downplayed its significance nationally and personally. These results will guide a national antibiotic stewardship programme.
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Gestão de Antimicrobianos , Atitude do Pessoal de Saúde , Resistência Microbiana a Medicamentos , Conhecimentos, Atitudes e Prática em Saúde , Médicos/psicologia , Antibacterianos/normas , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/normas , Atitude , Região do Caribe , Estudos Transversais , Prescrições de Medicamentos , Educação Médica , Feminino , Hospitais , Humanos , Jamaica , Masculino , Padrões de Prática Médica , Inquéritos e QuestionáriosRESUMO
Objective. The HIV cascade of care describes the spectrum of engagement in HIV care from diagnosis to viral suppression (VS). The study objective was to develop a baseline HIV cascade of care for new HIV diagnoses in the Bahamas in 2014. Methods. Individuals who were newly diagnosed with HIV in 2014 and known to be alive within a year of that diagnosis were included in the cascade of care (n = 250). Individuals with one CD4 or HIV viral load (VL) measure in 2014 were considered linked to care. Those with at least two CD4 counts in the year were considered retained in care. Eligibility for antiretroviral therapy (ART) was based on having a CD4 count < 350 cells/mm3. ART adherence was defined as filled prescriptions > 11 months/year. VL < 1 000 copies/ml was considered suppressed. Comparisons were made in the cascades by gender and age. Results. Of the 250 persons in the study, 79 of them (32%) were retained in care. Antiretrovirals (ARVs) were prescribed to 116 of the 250 (46%); of those 116, 48 of them (41%) achieved VS. A higher proportion of women achieved VS than did men, but this difference did not reach statistical significance. Similarly, there were differences in VS based on age, but the differences were not statistically significant. Conclusions. In the Bahamas, increased efforts are needed to help people living with HIV to link to and be retained in care. VS may remain suboptimal unless ART is scaled up and adherence interventions are included in measures to improve the treatment cascade.
Objetivo. El proceso continuo de la atención de la infección por el VIH describe el espectro de intervenciones en la atención de la infección, desde el diagnóstico hasta la supresión viral. El objetivo del estudio fue elaborar un proceso continuo de la atención como punto de referencia y comparación para nuevos diagnósticos de infección por el VIH en las Bahamas en el 2014. Métodos. En el proceso continuo de la atención se incluyó a personas con diagnóstico de infección por el VIH en el 2014 y que continuaban vivas a un año del diagnóstico (n = 250). Se consideró vinculadas a la atención a aquellas personas con un recuento de linfocitos CD4 o una medición de la carga viral de VIH en el 2014. Aquellas con al menos dos recuentos de CD4 en el año se consideraron retenidas en la atención. La aptitud para el tratamiento antirretroviral se basó en tener un recuento de CD4 < 350 células/mm3. Se definió adherencia al tratamiento antirretroviral como la entrega de la prescripción >11 meses/año. Se consideró supresión viral a una carga viral de < 1 000 copias/ml. Se hicieron comparaciones en las cascadas por sexo y edad. Resultados. De las 250 personas que participaron en el estudio, 79 (32%) se retuvieron en la atención. Se prescribieron antirretrovirales a 116 de las 250 personas (46%); de estas 116 personas, 48 (41%) lograron la supresión viral. Las mujeres lograron la supresión viral en una proporción mayor que los hombres, pero esta diferencia no fue estadísticamente significativa. Igualmente, se observaron diferencias en la supresión viral según la edad, pero estas tampoco fueron estadísticamente significativas. Conclusiones. En las Bahamas, es necesario incrementar los esfuerzos para ayudar a las personas con infección por el VIH a vincularse y mantenerse en la atención. La supresión viral puede permanecer en niveles subóptimos a menos que se amplíe el tratamiento antirretroviral y se incluyan intervenciones de adherencia terapéutica en las medidas para mejorar el proceso continuo de la atención.
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HIV , Continuidade da Assistência ao Paciente , Bahamas , Continuidade da Assistência ao Paciente , HIVRESUMO
ABSTRACT Objective The HIV cascade of care describes the spectrum of engagement in HIV care from diagnosis to viral suppression (VS). The study objective was to develop a baseline HIV cascade of care for new HIV diagnoses in the Bahamas in 2014. Methods Individuals who were newly diagnosed with HIV in 2014 and known to be alive within a year of that diagnosis were included in the cascade of care (n = 250). Individuals with one CD4 or HIV viral load (VL) measure in 2014 were considered linked to care. Those with at least two CD4 counts in the year were considered retained in care. Eligibility for antiretroviral therapy (ART) was based on having a CD4 count < 350 cells/mm3. ART adherence was defined as filled prescriptions > 11 months/year. VL < 1 000 copies/ml was considered suppressed. Comparisons were made in the cascades by gender and age. Results Of the 250 persons in the study, 79 of them (32%) were retained in care. Antiretrovirals (ARVs) were prescribed to 116 of the 250 (46%); of those 116, 48 of them (41%) achieved VS. A higher proportion of women achieved VS than did men, but this difference did not reach statistical significance. Similarly, there were differences in VS based on age, but the differences were not statistically significant. Conclusions In the Bahamas, increased efforts are needed to help people living with HIV to link to and be retained in care. VS may remain suboptimal unless ART is scaled up and adherence interventions are included in measures to improve the treatment cascade.
RESUMEN Objetivo El proceso continuo de la atención de la infección por el VIH describe el espectro de intervenciones en la atención de la infección, desde el diagnóstico hasta la supresión viral. El objetivo del estudio fue elaborar un proceso continuo de la atención como punto de referencia y comparación para nuevos diagnósticos de infección por el VIH en las Bahamas en el 2014. Métodos En el proceso continuo de la atención se incluyó a personas con diagnóstico de infección por el VIH en el 2014 y que continuaban vivas a un año del diagnóstico (n = 250). Se consideró vinculadas a la atención a aquellas personas con un recuento de linfocitos CD4 o una medición de la carga viral de VIH en el 2014. Aquellas con al menos dos recuentos de CD4 en el año se consideraron retenidas en la atención. La aptitud para el tratamiento antirretroviral se basó en tener un recuento de CD4 < 350 células/mm3. Se definió adherencia al tratamiento antirretroviral como la entrega de la prescripción >11 meses/año. Se consideró supresión viral a una carga viral de < 1 000 copias/ml. Se hicieron comparaciones en las cascadas por sexo y edad. Resultados De las 250 personas que participaron en el estudio, 79 (32%) se retuvieron en la atención. Se prescribieron antirretrovirales a 116 de las 250 personas (46%); de estas 116 personas, 48 (41%) lograron la supresión viral. Las mujeres lograron la supresión viral en una proporción mayor que los hombres, pero esta diferencia no fue estadísticamente significativa. Igualmente, se observaron diferencias en la supresión viral según la edad, pero estas tampoco fueron estadísticamente significativas. Conclusiones En las Bahamas, es necesario incrementar los esfuerzos para ayudar a las personas con infección por el VIH a vincularse y mantenerse en la atención. La supresión viral puede permanecer en niveles subóptimos a menos que se amplíe el tratamiento antirretroviral y se incluyan intervenciones de adherencia terapéutica en las medidas para mejorar el proceso continuo de la atención.
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Infecções por HIV/diagnóstico , Contagem de Linfócito CD4 , Continuidade da Assistência ao Paciente , Fármacos Anti-HIV/uso terapêutico , Carga Viral , BahamasRESUMO
OBJECTIVE: The HIV cascade of care describes the spectrum of engagement in HIV care from diagnosis to viral suppression (VS). The study objective was to develop a baseline HIV cascade of care for new HIV diagnoses in the Bahamas in 2014. METHODS: Individuals who were newly diagnosed with HIV in 2014 and known to be alive within a year of that diagnosis were included in the cascade of care (n = 250). Individuals with one CD4 or HIV viral load (VL) measure in 2014 were considered linked to care. Those with at least two CD4 counts in the year were considered retained in care. Eligibility for antiretroviral therapy (ART) was based on having a CD4 count < 350 cells/mm3. ART adherence was defined as filled prescriptions > 11 months/year. VL < 1 000 copies/ml was considered suppressed. Comparisons were made in the cascades by gender and age. RESULTS: Of the 250 persons in the study, 79 of them (32%) were retained in care. Antiretrovirals (ARVs) were prescribed to 116 of the 250 (46%); of those 116, 48 of them (41%) achieved VS. A higher proportion of women achieved VS than did men, but this difference did not reach statistical significance. Similarly, there were differences in VS based on age, but the differences were not statistically significant. CONCLUSIONS: In the Bahamas, increased efforts are needed to help people living with HIV to link to and be retained in care. VS may remain suboptimal unless ART is scaled up and adherence interventions are included in measures to improve the treatment cascade.