Tuberculosis in HIV programmes in lower-income countries: practices and risk factors

BACKGROUND: Tuberculosis (TB) is a common diagnosis in human immunodeficiency virus (HIV) infected patients on antiretroviral treatment (ART). OBJECTIVE: To describe TB-related practices in ART programmes in lower-income countries and identify risk factors for TB in the first year of ART. METHODS: Programme characteristics were assessed using standardised electronic questionnaire. Patient data from 2003 to 2008 were analysed and incidence rate ratios (IRRs) calculated using Poisson regression models. RESULTS: Fifteen ART programmes in 12 countries in Africa, South America and Asia were included. Chest X-ray, sputum microscopy and culture were available free of charge in respectively 13 (86.7%), 14 (93.3%) and eight (53.3%) programmes. Eight sites (53.3%) used directly observed treatment and five (33.3%) routinely administered isoniazid preventive treatment (IPT). A total of 19 413 patients aged ≥16 years contributed 13 227 person-years of follow-up; 1081 new TB events were diagnosed. Risk factors included CD4 cell count (>350 cells/μl vs. <25 cells/μl, adjusted IRR 0.46, 95%CI 0.33–0.64, P < 0.0001), sex (women vs. men, adjusted IRR 0.77, 95%CI 0.68–0.88, P = 0.0001) and use of IPT (IRR 0.24, 95%CI 0.19–0.31, P < 0.0001). CONCLUSIONS: Diagnostic capacity and practices vary widely across ART programmes. IPT prevented TB, but was used in few programmes. More efforts are needed to reduce the burden of TB in HIV co-infected patients in lower income countries.

Predictors of vaginal practices for sex and hygiene in KwaZulu-Natal, South Africa: findings of a household survey and qualitative inquiry

Vaginal practices in sub-Saharan Africa may increase HIV transmission and have important implications for development of microbicides and future HIV prevention technologies. It remains unclear which women undertake vaginal practices and what factors predict prevalence, practice type and choice of products. Using cross-sectional data from mixed research methods, we identify factors associated with vaginal practices among women in KwaZulu-Natal, South Africa. Data were gathered through focus group discussions, in-depth and key-informant interviews, followed by a province-wide, multi-stage cluster household survey, using structured questionnaires in face-to-face interviews with 867 women. This paper details six types of vaginal practices, which--despite their individual distinctiveness and diverse motivations--may be clustered into two broad groups: those undertaken for purposes of 'hygiene' (genital washing, douching and application) and those for 'sexual motivations' (application, insertion, ingestion and incisions). Multivariate analysis found significant associations between 'hygiene' practices and media access, religiosity and transactional sex. 'Sexual' practices were associated with partner concurrency, religiosity and use of injectable hormonal contraceptives. Future interventions relating to vaginal practices as well as microbicides need to reflect this characterisation of practices as sexual- and/or hygiene-related.

Success in Offshoring of Application Development – Does Culture Matter?

Recently, offshoring of information systems (IS) services to external vendors has seen considerable growth. Outsourcing to vendors in foreign countries brings about unique challenges which need to be understood and managed effectively. This paper explores cultural differences in IS offshoring arrangements involving German client organizations that outsource application development activities to Indian vendors. For this purpose, a research framework is developed based on both theoretical considerations and specific empirical observations from multiple case studies. The goal is to (1) explore the nature of cultural differences in offshoring arrangements in depth and to (2) analyze the relationship between those cultural differences and offshoring success. Based on the case findings, implications and practices for the management of offshore development projects are outlined.

The invention of democratic parliamentary practices in the Helvetic Republic

In this book, leading historians of the French, Batavian, Helvetic, Cisalpine, and Neapolitan revolutions bridge the gap between the historiographies of the so-called Sister Republics and explore political culture as a set of discourses or political practices. Parliamentary practices, the comparability of "universal" political concepts, late-eighteenth-century Republicanism, the relationship between press and politics, and the interaction between the Sister Republics and France are all examined from a comparative, transnational perspective.

Tuberculosis in Pediatric Antiretroviral Therapy Programs in Low- and Middle-Income Countries: Diagnosis and Screening Practices.

BACKGROUND The global burden of childhood tuberculosis (TB) is estimated to be 0.5 million new cases per year. Human immunodeficiency virus (HIV)-infected children are at high risk for TB. Diagnosis of TB in HIV-infected children remains a major challenge. METHODS We describe TB diagnosis and screening practices of pediatric antiretroviral treatment (ART) programs in Africa, Asia, the Caribbean, and Central and South America. We used web-based questionnaires to collect data on ART programs and patients seen from March to July 2012. Forty-three ART programs treating children in 23 countries participated in the study. RESULTS Sputum microscopy and chest Radiograph were available at all programs, mycobacterial culture in 40 (93%) sites, gastric aspiration in 27 (63%), induced sputum in 23 (54%), and Xpert MTB/RIF in 16 (37%) sites. Screening practices to exclude active TB before starting ART included contact history in 41 sites (84%), symptom screening in 38 (88%), and chest Radiograph in 34 sites (79%). The use of diagnostic tools was examined among 146 children diagnosed with TB during the study period. Chest Radiograph was used in 125 (86%) children, sputum microscopy in 76 (52%), induced sputum microscopy in 38 (26%), gastric aspirate microscopy in 35 (24%), culture in 25 (17%), and Xpert MTB/RIF in 11 (8%) children. CONCLUSIONS Induced sputum and Xpert MTB/RIF were infrequently available to diagnose childhood TB, and screening was largely based on symptom identification. There is an urgent need to improve the capacity of ART programs in low- and middle-income countries to exclude and diagnose TB in HIV-infected children.

Mobilities, Entanglements, Transformations. Outline of a Research Project on Pottery Practices in Neolithic Wetland Sites of the Swiss Plateau

A large number of later Neolithic sites (3900–3500BC) in Switzerland, Southern Germany and Eastern France offer outstandingly well preserved archaeological materials from cultural layers. Due to the wide use of dendrochronology, settlement remains and artefact assemblages can now be placed into a precise and fixed chronological framework, thus presenting a unique case within prehistoric archaeology. In earlier research, chronological and regional units were constructed on the basis of pottery. These spacial and temporal units of typical pottery sets were understood as Neolithic cultures, as culturally more or less homogenous entities connected with (ethnic) identities. Today, with a larger data corpus of excavated settlements at hand, we can begin to understand that this period of the past was in fact characterised by a multitude of cultural entanglements and transformations. This is indicated by the occurrence of local and non-local pottery styles in one and the same settlement: for example typically local Cortaillod pottery is found together with NMB-styled pottery in settlements at Lake Neuchâtel or Michelsberg pottery is regularly occurring in settlements at Lake Constance where Pfyn pottery style is the typical local one. These and many more examples show that there must have been complex entanglements of social ties expanding between Eastern France, Southern Germany and the Swiss Plateau. Given these circumstances the former notions of Neolithic culture should be critically revised. Therefore, in late 2014, the Prehistoric Archaeology Department at the Archaeological Institute of University of Berne started a four-year research project funded by Swiss National Science Foundation in late 2014: ‘Mobilities, Entanglements and Transformations in Neolithic Societies of the Swiss Plateau (3900-3500 BC)’. It’s objective is to address the topic sketched above by adopting a mixed methods research (MMR)-design combining qualitative and quantitative approaches from archaeology and archaeometry. The approach is theoretically based on Pierre Bourdieu’s reflexive sociology and his concept of habitus but includes further concepts of practice theories. By shifting the focus to the movement of people, ideas and things – to pottery production practices in contexts of mobility – a deeper understanding of the transformative capacities of encounters can be achieved. This opens the path for new insights of Neolithic societies including social, cultural and economic dynamics that were underestimated in former research.