Tamil Nadu conducted the first round of WHO STEPS survey in 2020 to assess non-communicable disease (NCD) risk factors. In 2021, subsequently the state launched the Makkalai Thedi Maruthuvam (MTM) initiative to deliver home-based care for individuals with NCDs. To evaluate the effectiveness of the program, we designed a population-based survey in 2023-2024 using electoral booth sampling as a primary sampling unit to assess control rates of hypertension and diabetes among individuals aged 18-69 years using the same WHO STEPS approach. Secondary objective was to estimate the prevalence of behavioural and biological NCD risk factors. A multistage cluster sampling method was used across the Tamil Nadu. A total of 8880 participants were selected from 148 clusters. One eligible adult per household was selected using the KISH method. Data were collected through interviews such as sociodemographic, anthropometric and biological parameters. This survey is the first in Tamil Nadu to use updated electoral data as a sampling frame to estimate the care cascade of the hypertension and diabetes. Although limited by its cross-sectional design and lack of biochemical markers test like HbA1c and cholesterol, the survey offers a practical and scalable model for NCD surveillance in India.•This study used the updated electoral booth data as primary sampling units in the absence of recent census data (India) to ensure the population representativeness.•Comprehensive assessment of hypertension and diabetes care cascade including prevalence, awareness, treatment and control rates among the individual aged 18-69 years.•Designed to evaluate the impact of Makkalai Thedi Maruthuvam (MTM) scheme and support to evidence based NCD intervention in Tamil Nadu.

Latent tuberculosis infection care cascade outcomes in primary care clinics in the tuberculosis epidemiologic studies consortium-III.

The burden of chronic hepatitis B and C in 2022 and progress towards elimination: a global report.

Despite the availability of curative, direct-acting antiviral therapy, hepatitis C virus elimination remains incomplete. Losses across the care cascade continue to limit impact, from initial diagnosis to sustained virologic response. Fewer than 1/3 of individuals ultimately achieve cure. These gaps reflect a delivery system that does not align with the population most affected, many of whom have inconsistent engagement with outpatient care. The emergency department is critical, but underused point of contact, where the burden of undiagnosed and untreated infection is high. This manuscript presents a practical framework for integrating HCV testing and treatment into emergency care within a new United States. It focuses on five domains. Point of care RNA testing allows confirmation of infection during the encounter, reducing delays that contribute to loss to follow up. Treatment initiation is simplified through standardised eligibility criteria and use of pan genomic regimens supported by electronic decision support. A focused safety screen addresses key exclusions, including hepatitis B coinfection, advanced liver disease, renal impairment, and relevant drug interactions. Policy and financial barriers are examined, including prior authorisation requirements, variation of Medicaid coverage, and access to discount pricing programmes. Post treatment follow up is restructured through decentralised approaches such as dried blood spot testing, telemedicine, and linkage to harm reduction services. Implementation will vary across institutions and regions. Regulatory requirements, payer policies, and staffing models remain important constraints. These challenges identify areas for targeted policy reform and prospective study. The emergency department is not traditionally designed for chronic disease management. However, for a curable infection concentrated among patients who rely on episodic care, it may represent the most effective point of intervention.

Adherence to anti-Tuberculosis treatment during the COVID-19 pandemic: a single-centre, retrospective analysis.

Marginalized urban populations experience a high burden of HIV and HCV. We assessed the prevalence and risk factors for both infections and characterized the care cascades in a cohort of vulnerable individuals in Madrid, Spain. We conducted a cross-sectional study (2019-2023) of 4582 individuals via mobile units in high-risk hotspots, offering integrated rapid HIV/HCV testing with point-of-care HCV-RNA confirmation. Multivariable logistic regression identified independent HIV risk factors. HIV prevalence was 6.3% (95% CI: 5.6-7.0). Among people with HIV (PWH), 17.0% of known cases were not receiving antiretroviral therapy; PrEP uptake was zero among HIV-negative individuals. A history of injecting drug use was the primary HIV risk factor (adjusted odds ratio[aOR] 6.6; 95% CI: 4.6-9.5), followed by age >50 years, Spanish origin, and alcohol/benzodiazepine misuse (all P < 0.05). Active HCV prevalence was 5.5% (95% CI: 4.9-6.2); 15.7% in PWH vs 4.8% in people without HIV (P < 0.001). Among confirmed cases, HCV linkage (≥95.2%) and treatment (≥88.6%) were high; however, 16.8% of all antibody-positive individuals (23.2% among PWH) missed confirmatory RNA testing. HIV and HCV remain prevalent, characterized by discontinuities in retention rather than diagnosis. Integrated, low-threshold strategies combining harm reduction with social support are required to address this syndemic.

Chronic hepatitis C virus (HCV) infection remains a major cause of liver disease worldwide and requires effective strategies to achieve elimination targets. Taiwan has a substantial HCV burden, with prevalence varying by region; in Changhua County, prevalence was 4.3% before large-scale intervention. In 2019, Changhua launched a county-wide micro-elimination program-the Changhua Integrated Program to Stop Hepatitis C Infection (CHIPS-C)-which combined existing population screening with targeted outreach to higher-risk groups and decentralized delivery of curative direct-acting antiviral (DAA) treatment. Using individual-level data from a population-based cohort, we compared care cascade performance before and after CHIPS-C implementation. The program was associated with increased screening coverage (53.7% to 90.2%) and fewer individuals screened to achieve similar numbers of diagnosed infections. Improvements were driven by streamlined confirmatory testing and coordinated care delivery. Here we show that CHIPS-C substantially increased the adjusted treatment completion rate (83.9% vs 38.7% before implementation). Model-based projections indicate that these gains could reduce HCV-related liver cancer and mortality to levels meeting World Health Organization elimination targets by 2030. These findings demonstrate that integrating risk-based targeting with existing health systems can markedly improve efficiency and outcomes, providing a scalable model for accelerating HCV elimination in diverse settings.

The World Health Organization recommends echocardiographic screening and secondary prophylaxis for rheumatic heart disease (RHD), but evidence on how to implement these interventions within healthcare systems is limited. We report early implementation and clinical outcomes of an RHD program in northern Uganda. From May 2023, the District Health Office in Kitgum trained primary healthcare workers in RHD screening and implemented registry-based secondary antibiotic prophylaxis in public facilities. We analyzed program and registry data through December 31, 2024. Data were obtained from aggregated program reports and individual-level records from the national RHD registry. We developed an RHD care cascade to examine screening uptake and outcomes, including adherence to secondary antibiotic prophylaxis. Adherence was categorized as perfect (100%), near perfect (90%-99%), acceptable (80%-89%), suboptimal (60% to 79%), or poor (<60%). Differences in mean adherence across subgroups were evaluated using 1-way ANOVA and χ2 tests. Time-to-event analysis was conducted to assess the probability of receiving an injection over time since enrollment. Health workers screened about 1% of the district's target population each month. Over 18 months, 25 358 people were screened, including 1213 (4.8%) positive screens and 333 (1.3%) confirmed RHD cases. Among those screened, 16 406 (64%) were female, and 10 746 (42%) and 7333 (28%) were children (aged 5 years-14 years) and adolescents (aged 15 years-24 years), respectively. Of those with positive screens, 972 (80%) received confirmatory echocardiograms. Confirmed cases were relatively young (mean age 28 years), and 224 (67%) were female. Overall, 220 (75%) individuals achieved at least acceptable adherence. Among those who defaulted, 79% did so within 6 months of enrollment. An integrated RHD program in Uganda achieved successful delivery of echocardiographic screening within primary healthcare and acceptable early outcomes. The care cascade framework can be used to monitor similar RHD programs and identify opportunities for improvement.

This study aimed to estimate the national prevalence of type 2 diabetes (T2D), construct a cascade of care for T2D (CoC), and determine the factors associated with prevalence, not previously diagnosed (undiagnosed), and not undergoing medication treatment (untreated). This study analysed cross-sectional data from the 2023 World Health Survey Plus in Cambodia, a nationally representative cross-sectional study of 5271 individuals aged ≥18 years. The survey used a GIS-based multistage sampling for all 24 Cambodian provinces and the capital city. T2D was measured by haemoglobin A1c or was self-reported. Logistic regression was used to examine the association between outcomes of interest and socio-demographic, behavioural, and metabolic factors. The weighted prevalence of T2D was 16.0% (95% CI: 14.2-17.9%), with 58.2% (95% CI: 51.9-64.3%) undiagnosed. Of diagnosed individuals, 32.9% (95% CI: 24.2-42.9%) were untreated with medication, and among treated individuals, 61.5% (95% CI: 47.4-74.5%) had poor glycaemic control. T2D prevalence was higher among older age, urban residency, high socioeconomic status, obesity, and hypertension. The prevalence of undiagnosed T2D was higher among younger individuals, less physically active, and those with no history of hypertension. Higher untreated prevalence was associated with rural residency, young individuals, and lower socioeconomic status. The high prevalence of T2D, of previously undiagnosed and poorly managed T2D, emphasises the need for national policies that strengthen prevention, screening, and equitable access to care through primary healthcare and community-based services in Cambodia.

Cardiac rehabilitation (CR) is an effective but underused secondary prevention strategy. We evaluated where the relative gap in the implementation of CR occurs and characteristics related to CR utilization. We analyzed electronic health records from a large academic health system (2017-2019). We included patients aged ≥18 years, hospitalized with a cardiac event, with an indication for CR. We evaluated crude proportions and used mixed-effects logistic regression to examine the association of characteristics with referral, enrollment (≥1 session), and completion (≥36 sessions), accounting for multiple admissions. Among 4084 patient encounters (mean age: 65.3 ± 14.6 years, 45% female, and 42% Black), 25% were referred, 29% of those referred, enrolled, and 21% of those enrolled, completed CR. We identified characteristics associated with lower CR referral, for example, Black patients (OR = 0.64: 95% CI, 0.50-0.80), female patients (OR = 0.68: 95% CI, 0.56-0.83), and discharge from noncardiology services (eg, OR = 0.07: 95% CI, 0.05-0.10 for general medicine). Post-discharge outpatient visits were associated with higher CR referrals (eg, OR = 1.94: 95% CI, 1.56-2.41 for cardiology follow-up visits). The pattern was largely similar for enrollment and completion, except for higher enrollment for cardiac surgery and lower enrollment for lower-income patients. In the CR care cascade, significant bottlenecks exist at each step, with the narrowest bottleneck noted at the completion stage. We also identified demographic and health system characteristics related to lower CR utilization, which can guide system- and individual-level efforts to promote CR use.

ABSTRACT Indigenous women, two-spirit, transgender, and gender-diverse people in Canada experience disproportionate HIV and sexually transmitted and blood-borne infection (STBBI) inequities shaped by colonial violence and systemic racism. While Indigenous doula work is resurging as reproductive justice, its application to HIV/STBBI prevention and care remains underexplored. We examined how Indigenous HIV/STBBI doula care is envisioned and what competencies are needed to support implementation.This community-based study was guided by an Indigenous Community Guiding Circle of people living with HIV/STBBI and anchored in cultural protocols and ceremony. We conducted 40 in-depth interviews with Indigenous community members living with HIV/STBBI (n = 20), relatives (n = 7), helpers/service providers (n = 8), and Elders/Knowledge Holders (n = 5). Interviews were analyzed using thematic analysis guided by Indigenous storywork principles.Participants described doulas as kin and “helpers” who: (1) provide sustained, nonjudgmental presence across diagnosis, parenting, substance use, and grief; (2) reconnect people to culture, land-based healing, and ceremony; (3) offer peer mentorship rooted in lived experience; (4) deliver practical HIV/STBBI education and stigma reduction; and (5) enact structural advocacy across healthcare, justice, housing, and child welfare systems.Indigenous HIV/STBBI doula care offers a culturally grounded, peer-led model with potential to strengthen engagement across the HIV/STBBI care cascade.

Chronic hepatitis B (CHB) affects the lives of up to 1.89 million people in the United States. The aim of this study was to assess the CHB treatment rates at a tertiary medical system in Los Angeles. We conducted a retrospective analysis of all adult patients with CHB across the entire UCLA database from 2013 to 2023. Based on the ALT and HBV DNA, as well as diagnosis of cirrhosis by ICD-9/10 codes, we determined the number of patients who were eligible for antiviral therapy per AASLD guidelines. Based on this information, we determined the treatment rate of CHB. In the study period, there were 3,384 patients with positive HBsAg. 511 of these patients had HBV-related cirrhosis. Moreover, 429 of 511 cirrhotic patients were on therapy (84%). Of the 2873 non-cirrhotic patients, only 51 patients met treatment criteria per AASLD guidelines. Of these patients, only 37 were started on therapy. However, a total of 1255 patients were on antiviral therapy (37.1%). In addition, 789 (23.3%) patients were on antiviral therapy who did not meet treatment criteria. From 2013 to 2023, the CHB care cascade at UCLA yielded a total treatment rate of 13.8%. Treatment rates of cirrhosis patients were much higher (84.0%). Significantly more patients than were otherwise eligible received treatment. This can potentially be explained by a considerable number of patients being started on treatment prior to being referred to and seen in the UCLA system and/or provider knowledge of treatment thresholds.

Opioid use disorder (OUD) is a major cause of death and disability among Medicaid beneficiaries. Understanding progress on engaging Medicaid beneficiaries in effective treatment is vital for reducing burden. To examine changes over time and state variation in rates of OUD diagnosis, receipt of medications for OUD (MOUD), MOUD continuity, and OUD-related hospitalization or emergency department (ED) visits among Medicaid beneficiaries. This repeated cross-sectional study used 2018-2023 Medicaid claims data for measurement years 2019 to 2023. The study included non-dual eligible Medicaid beneficiaries aged 18 to 64 years residing in 47 states and the District of Columbia. The data analyses were performed between July 1 and December 11, 2025. Medicaid coverage. The main outcome was the percentage of Medicaid beneficiaries with (1) an OUD diagnosis, (2) MOUD, (3) MOUD continuity for at least 180 days, and (4) OUD-related hospitalization or emergency department visit. Among 126 430 422 Medicaid beneficiary-year observations (aged 35-64 years range, 47.7%-52.3%; female range, 59.5%-61.2%), the percentage diagnosed with OUD declined from 4.2% in measurement year 2019 to 3.6% in measurement year 2023 and declined in 34 states. The percentage of all Medicaid beneficiaries with OUD who received MOUD increased from 60.0% to 69.1% and increased in 45 states. The percentage of Medicaid beneficiaries who continued MOUD for at least 180 days decreased from 62.6% to 57.6% and decreased in 29 states. The percentage of beneficiaries with OUD who had an OUD-related hospitalization or ED visit decreased from 10.9% to 10.6% but increased in 31 states. This cross-sectional study found a substantial increase in the percentage of individuals with OUD who received MOUD among almost all states. The increase in MOUD use may have contributed to reductions in overdose deaths, but more research is needed.

Risk of tuberculosis incidence and the tuberculosis infection care cascade among older adults in eastern China: A population-based cohort study.

To evaluate factors associated with positive LTBI screening among HCWs and predictors of treatment initiation and completion across hospital sites in Ireland. Multicentre retrospective cohort study. Five hospital sites in Ireland. N = 755 healthcare workers (HCWs). Evaluation of latent tuberculosis infection (LTBI) by interferon gamma release assay in HCWs from high-incidence countries during 2023, identified via occupational health records. IGRA positivity rates, linkage to treatment and treatment outcomes were recorded. Demographic and occupational factors associated with these outcomes were investigated. There were n = 755 HCWs from high-incidence TB countries identified via occupational health records eligible for LTBI screening. 719 underwent IGRA testing, of whom 93 (13%) were positive. Age > 50 was associated with IGRA positivity (OR 5.71; 95% CI 1.79-18.17; P = .003). In addition to these n = 93 HCWs, two additional sites provided treatment outcomes for n = 164 HCWs, and a further n = 58 IGRA-positive HCWs were referred to Site 1. Among these 313 IGRA-positive HCWs, 50% initiated therapy, with substantial variation across sites (27%-88%). Multivariable analysis showed study site, but not demographic factors, predicted treatment initiation (P < .001). Common reasons for non-initiation included treatment refusal and non-attendance. Treatment completion was high (82%) and was not associated with study site. LTBI prevalence among HCWs in Ireland was lower than international estimates. While treatment initiation was low, completion was high. Treatment initiation varied by site, driven by institutional rather than individual factors. A standardised national programmatic approach is needed for HCWs within the LTBI cascade of care.

Asthma is a common chronic disease responsible for a considerable disease burden in China and around the world. Despite its burden, there is substantial unmet need for asthma care, including screening, diagnosis, treatment, and management. Symptom-based screening for asthma could support identification of undiagnosed asthma patients, as well as reference to higher-level hospitals for formal diagnoses and treatment. This study focuses on identifying suspected asthma patients and encouraging them to seek formal diagnoses and treatment. This approach aligns with the novel concept of population medicine, which aims to maximize overall population health rather than focusing on individual patients within the health system. We are conducting a two-arm population-based stratified clustered randomized controlled trial (cRCT) to evaluate the effectiveness of a population medicine multimorbidity intervention package. The intervention integrates community screening, chronic disease management, patient education, digital follow-up, and team-based care. The trial is being implemented in Xishui County, Guizhou Province, a mountainous low-resource county in Southwestern China, covering 26 townships and more than 300,000 permanent residents. We considered each of the 26 townships in Xishui County as a cluster and stratified them into large and small townships based on population size. Townships with an above-average population were designated as "large," and those with a below-average population were designated as "small." We randomized the same number of residents in each township stratum (large and small) to undergo the European Community Respiratory Health Survey (ECRHS) for identifying suspected asthma patients. Individuals identified as suspected asthma patients were considered study participants and subsequently enrolled in the intervention or control arm. All participants in the intervention arm are followed for one year, with one telephone follow-up at month three and in-person follow-ups at months six and 12, while participants in the control arm are followed only at baseline and 12months. Primary outcomes include the number of chronic conditions controlled, whether the participant received lung function testing, and Asthma Control Test (ACT) score. In addition, we are evaluating 42 secondary outcomes covering physiological and functional indicators such as lung function, health-related quality of life, mental health, behavioral risk factors, healthcare utilization, productivity loss, knowledge of asthma and chronic obstructive pulmonary disease (COPD), and care cascade indicators for asthma and other chronic diseases. This cRCT has been featured as an important case study in the Lancet Commission on Investing in Health report to evaluate the effectiveness of the integrated intervention package on priority conditions. The trial was designed under population medicine principles, with an aim providing holistic care and enhancing the overall health status of suspected asthma patients. The results of the trial will inform the next generation of multimorbidity management and population medicine practices among global health authorities and practitioners. ClinicalTrials.gov Identifier: NCT06457009. Registered on June 7, 2024.

Strengthening the hepatitis B care cascade to prevent vertical transmission in Africa: a call to empower midwives.

The Evolving HIV Landscape in Central and Eastern Europe: Progress, Gaps, and Future Directions-Part I.

Variation in cardiovascular care completion is well documented. However, less is known about differences originating from earlier, intermediate stages such as ordering or scheduling of testing or referrals, despite their role as key prerequisites for care access. To examine the care cascades for coronary artery disease (CAD) after emergency department (ED) visits and to identify the specific stages at which variation emerges for CAD testing and cardiology referrals. This was a retrospective cohort study using data and metadata from electronic health records from a large multicenter health system. Participants were adult patients with established primary care and no history of ischemic heart disease or cardiology care who presented to an ED from January 1, 2020, to June 30, 2022, and underwent a troponin test, a proxy for clinically suspected myocardial ischemia. Variation in cardiovascular follow-up care (CAD testing and cardiology referrals) was identified and analyzed. Analyses were restricted to patients with above-median electrocardiogram (ECG)-derived ischemia risk scores to enrich for higher likelihood of benefit from cardiovascular follow-up. Receipt of an order for CAD testing (stress tests, coronary computed tomography angiography) or cardiology referral, scheduling of the service, and completion within 6 months. Outcomes were compared by insurance type, race and ethnicity, language, and sex using multivariable logistic regression adjusted for demographic characteristics, clinical factors, and ECG-derived cardiovascular risk. Among 16 475 patients with an ED visit (median [IQR] age, 67.4 [54.9-77.9] years; 36% female and 64% male individuals) and elevated cardiovascular risk, marked variation in follow-up care emerged. Compared to commercially insured patients, those with Medicare dual or disabled coverage had lower adjusted odds of completing CAD testing (adjusted odds ratio [aOR], 0.45; 95% CI, 0.36-0.56) and cardiology referrals (aOR, 0.47; 95% CI, 0.39-0.57); similar patterns were seen for Medicaid coverage. Patients whose primary language was not English were less likely to complete either service (CAD testing aOR, 0.77; 95% CI, 0.61-0.98; referral aOR, 0.75, 95% CI, 0.61-0.92), and female patients had lower adjusted odds of completing CAD testing (aOR, 0.86; 95% CI, 0.77- 0.96). Adjusted differences by race and ethnicity were modest. Variation was primarily associated with ordering differences and with additional scheduling barriers for select groups. Once scheduled, completion rates exceeded 75%, without differences between groups. This retrospective cohort study found that among patients who visited the ED with elevated ischemic risk, attrition in follow-up care was concentrated early in care cascades and most pronounced among those with noncommercial health insurance. This stepwise analytic framework offers a novel, reproducible approach for health systems to identify where and for whom care gaps arise, which can enable targeted interventions to improve equity and efficiency.

Tuberculosis active case-finding among Afghan refugees in Pakistan: Care cascade, characteristics and treatment outcomes.