Entry Screening Research Articles

Profiles of Sexual Economic Exchanges among Women in Kisumu, Kenya: A Latent Class Analysis.

Sexual economic exchanges, including sex work and transactional sex, have been consistently associated with HIV acquisition among young women in sub-Saharan Africa. Heterogeneity in HIV vulnerability across overlapping types of sexual economic exchange has not been sufficiently explored, limiting appropriate and effective linkage to prevention interventions. From January 2017 to May 2018, cross-sectional data were captured at screening for entry into an HIV incidence cohort in Kisumu, Kenya. Men and women aged 18-35years completed a socio-behavioral questionnaire. Latent class analysis was used to classify sexually active women into discrete groups based on self-identification of occupational sex and other sexual exchanges, including exchange for money, gifts, food, school fees, substances, shelter/rent, and/or clothing. Profiles examined characteristics within and across typologies. Mixed logistic regression models assessed demographic and socio-behavioral characteristics associated with probabilistic class membership. A total of 1063 participants were screened, of whom 536 (50.4%) were sexually active women (median age: 27years [interquartile range 23-30]). Sexual economic exchange was reported by 403 (77.2%) sexually active women, who most commonly reported recent exchange of sex for money (73.9%), gifts (19.6%), food (25.9%), and substances (17.7%); 44.6% reported selling sex as a primary or secondary occupation. Three profiles of sexual economic exchange were identified, each with distinct demographic, behavioral, and occupational characteristics: exchange for money and other necessities (23.3% prevalence), exchange for primarily money (38.2% prevalence), and sex comprising limited or no exchange (38.4% prevalence). In mixture modeling, as compared to limited or no exchange, exchange for money and other necessities, and exchange for primarily money were both associated with increased age, higher number of partners, and partners at least 10years older. Heterogeneous patterns of sexual economic exchange were observed among women in Kenya reflect the different motivations and pathways by which women exchange sex. Female sex workers are often considered a homogeneous group, but these data highlight the need for differentiated services based on the diverse needs of women who engage in sexual economic exchange.

Assessing exit screening of SARS-CoV-2 in Japan: an analysis of the airport screening data of passengers from the United Kingdom, 2020–2022

BackgroundJapan implemented strict border control measures and all incoming passengers were subject to entry screening with reverse transcription–polymerase chain reaction or antigen testing. From late 2020, exit screening within 72 h of departure to Japan also became mandatory. In this study, we evaluated the effectiveness of the exit screening policy in Japan by analyzing airport screening data from October 2020 to April 2022.MethodsIn addition to assessing entry screening data over time of passengers from the United Kingdom, we examined the prevalence of coronavirus disease 2019 (COVID-19) in the United Kingdom based on the Office of National Statistics infection survey. We constructed a statistical model that described entry screening positivity over time using Office of National Statistics prevalence data as the explanatory variable. Ideally, the time-dependent patterns of entry screening and Office of National Statistics prevalence data should resemble each other; however, we found that, sometimes, they were different and regarded the difference to statistically partly reflect the effectiveness of exit screening.ResultsThe average proportion positive in one month before mandatory exit screening was implemented among Japanese passengers was 0.67% (95% confidence interval [CI]: 0.45, 0.98), whereas the proportion positive decreased to 0.49% (95% CI: 0.21, 1.15) in the first month of exit screening. Adjusting for time-dependent prevalence at the origin, we concluded that exit screening contributed to reducing passenger positivity by 59.3% (95% CI: 19.6, 81.3). The overall positivity values among passengers during the Delta and Omicron variant periods were 3.46 times and 1.46 times that during the pre-Delta variant period, respectively.ConclusionsWe used a simplistic statistical model and empirical data from passengers arriving in Japan from the United Kingdom to support that exit screening helped to reduce the proportion positive by 59%. Although the proportion positive later increased considerably and precluded preventing the introduction of imported cases, submitting a certificate for a negative test result contributed to reducing the positivity among travelers.

Diagnostic accuracy of active pulmonary tuberculosis screening during detention admission: a systematic review.

Individuals entering incarceration are at high risk for infectious diseases, other ill conditions, and risky behavior. Typically, the status of active pulmonary tuberculosis (PTB) is not known at the time of admission. Early detection and treatment are essential for effective TB control. So far, no study has compared the diagnostic accuracy of various TB screening tools in detention using a network meta-analysis (NMA). We aimed to investigate the diagnostic accuracy of active PTB screening tests upon detention admission. We searched PubMed, Global Index Medicus, the Cochrane Library electronic databases, and grey literature for publications reporting detention TB entry screening in March 2022 and January 2024. Inclusion was non-restrictive regarding time, language, location, reference standards, or screening tests. Eligible study designs comprised comparative, observational, and diagnostic studies. Publications had to report TB screening of individuals entering confinement and provide data for diagnostic accuracy calculations. The QUADAS-2 tool was designed to assess the quality of primary diagnostic accuracy studies. This systematic review was registered with PROSPERO (CRD42022307863) and conducted without external funding. We screened a total of 2,455 records. Despite extensive searching, no studies met our inclusion criteria. However, we identified evidence revealing key differences in screening algorithm application. In conclusion, more diagnostic accuracy data on TB screening algorithms for detention admission worldwide needs to be collected. We recommend that global TB initiatives set up multi-site studies to investigate the diagnostic accuracy of TB screening on admission in low- and high-prevalence criminal justice systems. Further network meta-analyses of these studies could inform policymakers and public health experts to establish or fine-tune TB control in detention settings.

EP 61 - Implementing Equitable and Efficient Measles Entry Screening to Reduce Exposure Risk

EP 61 - Implementing Equitable and Efficient Measles Entry Screening to Reduce Exposure Risk

Evaluation of the exit screening policy among travelers arriving from Asian and pacific nations

BackgroundThe Japanese government has instituted border control measures against COVID-19, including entry and exit screening of people arriving from overseas. We sought to evaluate the effectiveness of the exit screening policy in Japan in reducing the risk of importing COVID-19 cases among travelers from Asian and Pacific countries.MethodsThe study period was stratified based on the timing of exit screening: (i) the control period (the pre-exit screening period from 25 October 2020 to 16 January 2021), (ii) the time period with the Alpha variant from 17 January to 10 April 2021, and (iii) the time period with the Delta variant from 2 May to 2 October 2021. Incidence data in the countries of origin were used to adjust for the risk of infection among travelers. The positivity rate of entry screening in Japan was compared among the three different study periods, adjusting for the risk of infection in the country of origin.ResultsThe adjusted relative risk of positivity was greatly reduced and substantially below the value of 1 during the Alpha variant period compared with the control period. Although the relative risks increased when comparing the Delta variant period against control, the estimate remained below 1, except for among travelers from India and Myanmar. The relative risk reduction was greatest in high-income countries, with estimates of 100% and 96% risk reduction during the Alpha and Delta variant periods, respectively, followed by upper-middle-income countries with estimates of 90% and 76%, respectively.ConclusionsEven in the presence of the Alpha and Delta variants, exit screening clearly reduced the risk of infection among travelers arriving from Asian and Pacific nations. As the testing relies on the country of origin, the effectiveness varied greatly by the socioeconomic income status and epidemiological situation of those countries. Test standardization and quality assurance may be required in low- and middle-income countries.

Access to quality-assured artemisinin-based combination therapy and associated factors among clients of selected private drug outlets in Uganda

BackgroundMalaria treatment in sub-Saharan Africa is faced with challenges including unreliable supply of efficacious agents, substandard medicines coupled with high price of artemisinin-based combinations. This affects access to effective treatment increasing risk of malaria parasite resistance development and adverse drug events. This study investigated access to quality-assured artemisinin-based combination therapy (QAACT) medicines among clients of selected private drug-outlets in Uganda.MethodsThis was a cross sectional study where exit interviews were conducted among clients of private drug outlets in low and high malaria transmission settings in Uganda. This study adapted the World Health Organization/Health Action International (WHO/HAI) standardized criteria. Data was collected using a validated questionnaire. Data entry screen with checks was created in Epi-data ver 4.2 software and data entered in duplicate. Data was transferred to STATA ver 14.0 and cleaned prior to analysis. The analysis was done at 95% level of significance.ResultsA total of 1114 exit interviews were conducted among systematically sampled drug outlet clients. Over half, 54.9% (611/1114) of the participants were males. Majority, 97.2% (1083/1114) purchased an artemisinin-based combination anti-malarial. Most, 55.5% (618/1114) of the participants had a laboratory diagnosis of malaria. Majority, 77.9% (868/1114) of the participants obtained anti-malarial agents without a prescription. Less than a third, 27.7% (309/1114) of the participants obtained a QAACT. Of the participants who obtained QAACT, more than half 56.9% (173/309) reported finding the medicine expensive. The predictors of accessing a QAACT anti-malarial among drug outlet clients include type of drug outlet visited (aPR = 0.74; 95%CI 0.6, 0.91), not obtaining full dose (3-day treatment) of ACT (aPR = 0.49; 95%CI 0.33, 0.73), not finding the ACT expensive (aPR = 1.24; 95%CI 1.03, 1.49), post-primary education (aPR = 1.29; 95%CI 1.07,1.56), business occupation (aPR = 1.24; 95%CI 1.02,1.50) and not having a prescription (aPR = 0.76; 95%CI 0.63, 0.92).ConclusionLess than a third of the private drug outlet clients obtained a QAACT for management of malaria symptoms. Individuals who did not find artemisinin-based combinations to be expensive were more likely to obtain a QAACT anti-malarial. The Ministry of Health needs to conduct regular surveillance to monitor accessibility of QAACT anti-malarial agents under the current private sector copayment mechanism.

Reconstructing the COVID-19 incidence in India using airport screening data in Japan.

A major epidemic of COVID-19 caused by the Delta variant (B.1.617.2) occurred in India from March to July 2021, resulting in 19 million documented cases. Given the limited healthcare and testing capacities, the actual number of infections is likely to have been greater than reported, and several modelling studies and excess mortality research indicate that this epidemic involved substantial morbidity and mortality. To estimate the incidence during this epidemic, we used border entry screening data in Japan to estimate the daily incidence and cumulative incidence of COVID-19 infection in India. Analysing the results of mandatory testing among non-Japanese passengers entering Japan from India, we calculated the prevalence and then backcalculated the incidence in India from February 28 to July 3, 2021. The estimated number of infections ranged from 448 to 576 million people, indicating that 31.8% (95% confidence interval (CI): 26.1, 37.7) - 40.9% (95% CI: 33.5, 48.4) of the population in India had experienced COVID-19 infection from February 28 to July 3, 2021. In addition to obtaining cumulative incidence that was consistent with published estimates, we showed that the actual incidence of COVID-19 infection during the 2021 epidemic in India was approximately 30 times greater than that based on documented cases, giving a crude infection fatality risk of 0.47%. Adjusting for test-negative certificate before departure, the quality control of which was partly questionable, the cumulative incidence can potentially be up to 2.3-2.6 times greater than abovementioned estimates. Our estimate of approximately 32-41% cumulative infection risk from February 28 to July 3, 2021 is roughly consistent with other published estimates, and they can potentially be greater, given an exit screening before departure. The present study results suggest the potential utility of border entry screening data to backcalculate the incidence in countries with limited surveillance capacity owing to a major surge in infections.

Correlation of SARS-CoV-2 in Wastewater and Individual Testing Results in a Jail, Atlanta, Georgia, USA.

Institution-level wastewater-based surveillance was implemented during the COVID-19 pandemic, including in carceral facilities. We examined the relationship between COVID-19 diagnostic test results of residents in a jail in Atlanta, Georgia, USA (average population ≈2,700), and quantitative reverse transcription PCR signal for SARS-CoV-2 in weekly wastewater samples collected during October 2021‒May 2022. The jail offered residents rapid antigen testing at entry and periodic mass screenings by reverse transcription PCR of self-collected nasal swab specimens. We aggregated individual test data, calculated the Spearman correlation coefficient, and performed logistic regression to examine the relationship between strength of SARS-CoV-2 PCR signal (cycle threshold value) in wastewater and percentage of jail population that tested positive for COVID-19. Of 13,745 nasal specimens collected, 3.9% were COVID-positive (range 0%-29.5% per week). We observed a strong inverse correlation between diagnostic test positivity and cycle threshold value (r=-0.67; p<0.01). Wastewater-based surveillance represents an effective strategy for jailwide surveillance of COVID-19.

A-361 Implementation of a Fit-for-purpose Point of Care Quality Assurance Program

Abstract Background All individuals should have equitable access to accurate and timely testing for infectious diseases. Point of care testing (PoCT) has been developed to support populations having limited access to laboratory-based testing. Unlike laboratory-based testing, PoCT is often performed by non-laboratory staff and outside the jurisdiction of regulatory frameworks. Under these conditions, quality assurance (QA) of PoCT is often lacking; inaccurate testing can go undetected, leading to poor patient outcomes. A fit-for-purpose QA program was developed to monitor the quality of PoCT for infectious disease testing, particularly in low-middle income countries and in testing outside the laboratory regulatory environment. Methods In collaboration with the World Health Organization (WHO), the National Serology Reference Laboratory (NRL) reviewed the barriers to participation in QA programs experienced by PoCT sites. Using this information, NRL developed a QA model specifically designed for PoCT for infectious disease. In collaboration with Foundation for Innovative and New Diagnostics (FIND, Geneva, Switzerland), Kirby Institute (Sydney, Australia) and Flinders University (Adelaide, Australia), NRL implemented the PoCT QA model across Africa, Asia, and remote regional Australia. The model consists of competency panels (CP - one positive and one negative sample) and external quality assessment (EQA) panels. The EQA panels contain five samples. Whereas the test site knows the reactivity of the CP samples, the EQA samples are tested blinded. Both panels use inactivated samples that are stable at ambient temperature. The model uses streamlined logistics channels, with data collection and analysis using smartphone technology and QR codes. NRL designed a method for randomizing the identity of EQA sample vials so test sites can test QA panels ad hoc, and not be limited to specific test event dates. A range of support material such as pictorial instructions for use, virtual training events and on-line videos were produced to support test sites. Results More than 100 test sites from 14 countries have participated in the NRL PoCT QA programs. The model is designed so data is collected by test sites scanning QR codes and entering results directly into a data entry screen. The NRL PoCT QA program removed barriers to participation by offering sample types that are inactivated and stable at ambient temperature for extended periods of time, removing the need for dry ice shipping. The program is cost effective making it accessible to low- and middle-income countries. Data is collected using novel smartphone technology, facilitating results to be entered into a central database for immediate analysis. Testing of the QA samples can be done at any time, avoiding set test events. Conclusion Implementation of a fit-for-purpose PoCT QA for infectious disease testing removes the barriers to participation and facilitates the monitoring of testing over time. Any deficiencies in testing can be detected and addressed rapidly, ensuring that accurate test results are reported, and the population protected.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

ABUAD online and hard copy application admission as well as steps on how to Apply for Direct entry (DE) and Post-UTME screening. It also contains the Afe Babalola University, ABUAD Application form download link as well as its online application where necessary.

“You can get a couple of ramen noodle packs for a BusparⓇ“: A qualitative examination of medication access, policy, and procedures in southern jails

BackgroundJails in the United States are required to provide health care to the over 10 million people entering jails each year, a significant portion of whom need medications. Yet little is known about the processes by which medications are prescribed, obtained, and administered to incarcerated persons in jails. ObjectiveTo describe medication access, policy, and procedures in jails. MethodsSemi-structured interviews were conducted with administrators and health workers from 34 jails (of 125 contacted) across 5 states in the southeastern United States. The interview guide covered all aspects of healthcare in jails from entry to release; however, the present study focused on responses relating to medications. Interviews were thematically coded using a combination of deductive and inductive coding guided by the research objective. ResultsFour processes described medication use chronologically from intake to release: jail entry and health screening, pharmacy and medication protocols, protocols specific to medication dispensing and administration, and medications at release. Many jails had procedures for using medications brought from home, though some declined to use these medications. Medication decision-making in jails was primarily performed by contracted healthcare providers, and most medications were obtained from contract pharmacies. Almost all jails banned narcotics; however, other medication restrictions varied by jail. Most jails charged a copay for medications. Participants discussed various privacy practices related to medication distribution, as well as approaches to diversion prevention including “crushing and floating” medications. Finally, the pre-release medication management process included transition planning that ranged from no planning to sending additional prescriptions to the patient's pharmacy. ConclusionsMedication access, protocols, and procedures in jails varies considerably, and there is a need for further adoption of existing standards and guidelines for the use of medications in jails, such as the Assess, Plan, Identify, and Coordinate (APIC) model of community re-entry.

Emerging and re-emerging viral diseases, predisposing risk factors, and implications of international travel: a call for action for increasing vigilance and imposing restrictions under the current threats of recently emerging multiple Omicron subvariants.

Emerging and re-emerging viral diseases, predisposing risk factors, and implications of international travel: a call for action for increasing vigilance and imposing restrictions under the current threats of recently emerging multiple Omicron subvariants.

The analysis of the characteristics of imported COVID-19 cases from January to April in 2020: a cross-sectional study.

Since the first case reported in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused an outbreak of coronavirus disease 2019 (COVID-19) worldwide. The global case count continued to rise and the WHO declared a Public Health Emergency of International Concern (PHEIC), causing a growing risk of imported COVID-19 infection. This study aimed to provide descriptive and quantitative epidemiological characteristics of imported COVID-19 cases in China. This cross-sectional study examined all imported COVID-19 cases in Mainland China from 22 January to 21 April 2020. Ratios, Median and percentile were used for descriptive analysis. Spearman's correlation analysis was performed between daily new imported cases in Mainland China and the country of origin. The chi-square test was used to evaluate the difference between home quarantine and compulsory centralized quarantine on native transmission. A total of 1,610 cases of COVID-19 were imported from 49 countries to 27 provincial administrative regions in China; 79.8% were from European countries and the United States of America (the USA). Before 29 March 2020, the imported cases were mainly from the USA (27.7%) and United Kingdom (UK; 42.6%). After 29 March 2020, the daily newly imported cases from Russia rapidly grew. After 12 April 2020, the number of daily newly imported cases gradually decreased and remained at a low level (12±7 cases per day). Airport entry was encouraged, and ground border crossing was limited. Among the 1,610 cases, 54.0% were in the asymptomatic incubation period on arrival in Mainland China. The transmissions by imported COVID-19 were gradually and effectively curbed in Mainland China, despite a disproportionally high number of cases worldwide. Entry screening measures must be implemented universally to all inbound travelers at a point of entry or targeted to specific travel routes or to specific travelers. Compulsory centralized quarantine should be recommended in the prevention of the imported COVID-19 epidemic.

Care of refugee children and adolescents with chronic diseases and disabilities

Kinder und Jugendliche mit chronischen Erkrankungen und Behinderungen auf der Flucht gehören zu den besonders schutzbedürftigen Personen, da ihre Gesundheit und ihre Entwicklungschancen erheblich gefährdet sind. In diesem Beitrag werden Herausforderungen und Möglichkeiten in der Versorgung dieser Patient*innengruppe aus der Perspektive verschiedener Versorgungsbereiche beschrieben: Erstaufnahmestelle, Öffentlicher Gesundheitsdienst (ÖGD), niedergelassene Kinder- und Jugendärzt*innen, sozialpädiatrische Zentren und Selbsthilfe. Den Ausgangspunkt bildet eine Darstellung der Rechte auf eine optimale Gesundheitsversorgung, die sich aus der UN-Behindertenrechtskonvention und der UN-Kinderrechtskonvention ableiten lässt. Dabei wird deutlich, dass für Kinder- und Jugendliche im Status als Asylbewerber*innen systematische Lücken in der Erkennung und Versorgung chronischer Erkrankungen, Behinderungen und Förderbedarfe bestehen. Eine Erweiterung der „Gesundheitsuntersuchung“ nach der Ankunft, die bisher auf die Erkennung übertragbarer Erkrankungen fokussiert, ist wichtig und notwendig, um individuelle Bedarfe zu identifizieren und die Datenlage für diese Gruppe zu verbessern. Auch eine Stärkung der Schuleingangsuntersuchung durch den ÖGD insbesondere für ältere Kinder, die als Quereinsteiger*innen die Schule besuchen, könnte die Versorgung flächendeckend deutlich verbessern. Im Kontrast zu diesen Defiziten, die Veränderungen auf der politischen Ebene erfordern, gibt es insbesondere in lokalen Kontexten innovative Versorgungsangebote, wie z. B. Kindersprechstunden in Erstaufnahmestellen, vielfältiges ehrenamtliches Engagement oder die Nutzung sozialer Medien in der Selbsthilfe, die exemplarisch vorgestellt werden.