A survey of paediatric HIV programmatic and clinical management practices in Asia and sub-Saharan Africa--the International epidemiologic Databases to Evaluate AIDS (IeDEA)

INTRODUCTION There are limited data on paediatric HIV care and treatment programmes in low-resource settings. METHODS A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap). RESULTS A total of 64,552 children were under care at 63 clinics (AP, N=10; CA, N=4; EA, N=29; SA, N=10; WA, N=10). Most were in urban settings (N=41, 65%) and received funding from governments (N=51, 81%), PEPFAR (N=34, 54%), and/or the Global Fund (N=15, 24%). The majority were combined adult-paediatric clinics (N=36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N=56) had access to DNA PCR for infant diagnosis. African (N=40/53) but not Asian sites recommended exclusive breastfeeding up until 4-6 months. Regular laboratory monitoring included CD4 (N=60, 95%), and viral load (N=24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N=52, 83%) and outreach worker home visits to trace children lost to follow-up (N=45, 71%) were common. CONCLUSIONS In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented.

Commentary of GATS Article IX : Business Practices

Commentary of Article IX of the General Agreement on Trade in Services (GATS) on business practices, including a textual analysis of the provision, as well as an examination of the pertinent WTO case law and of other related international and regional rules and practices.

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.

Heterogeneity in testing practices for infections during pregnancy: national survey across Switzerland.

QUESTION Detection and treatment of infections during pregnancy are important for both maternal and child health. The objective of this study was to describe testing practices and adherence to current national guidelines in Switzerland. METHODS We invited all registered practicing obstetricians and gynaecologists in Switzerland to complete an anonymous web-based questionnaire about strategies for testing for 14 infections during pregnancy. We conducted a descriptive analysis according to demographic characteristics. RESULTS Of 1138 invited clinicians, 537 (47.2%) responded and 520 (45.6%) were eligible as they are currently caring for pregnant women. Nearly all eligible respondents tested all pregnant women for group B streptococcus (98.0%), hepatitis B virus (HBV) (96.5%) and human immunodeficiency virus (HIV) (94.7%), in accordance with national guidelines. Although testing for toxoplasmosis is not recommended, 24.1% of respondents tested all women and 32.9% tested at the request of the patient. Hospital doctors were more likely not to test for toxoplasmosis than doctors working in private practice (odds ratio [OR] 2.52, 95% confidence interval [CI] 1.04-6.13, p = 0.04). Only 80.4% of respondents tested all women for syphilis. There were regional differences in testing for some infections. The proportion of clinicians testing all women for HIV, HBV and syphilis was lower in Eastern Switzerland and the Zurich region (69.4% and 61.2%, respectively) than in other regions (range 77.1-88.1%, p <0.001). Most respondents (74.5%) said they would appreciate national guidelines about testing for infections during pregnancy. CONCLUSIONS Testing practices for infections in pregnant women vary widely in Switzerland. More extensive national guidelines could improve consistency of testing practices.