Infection In Young People Research Articles

Behavioral aspects and the risk of sexually transmitted infections in young people: a scoping review

Objetivo: mapear os aspectos comportamentais envolvidos no risco de infecções sexualmente transmissíveis entre jovens. Métodos: revisão de escopo com busca nas bases de dados: MEDLINE, LILACS, BDENF, SCOPUS, Web of Science e literatura cinza, utilizando o software Rayyan para seleção do material, seguida de análise por revisores independentes com cegamento ativado. O corpus final foi formado por 299 publicações, que foram submetidas à análise qualiquantitativa. Resultados: foram identificados 43 aspectos comportamentais envolvidos no risco de jovens adquirirem infecções sexualmente transmissíveis. Palavras com mais de 30 aparições determinaram o contexto e a representatividade do corpus textual; a coocorrência de palavras significativas originou seis halos coloridos de palavras que representam os aspectos comportamentais inerentes às infecções sexualmente transmissíveis, de modo intrínseco e extrínseco. Conclusão: os achados mapearam os aspectos comportamentais que contribuem sinergicamente para a conformação de vulnerabilidade de jovens a infecções sexualmente transmissíveis, dentre os quais, uso inconsistente de preservativos, múltiplas parcerias sexuais, consumo de drogas lícitas/ilícitas, iniciação sexual precoce e parcerias sexuais concomitantes. Contribuições para a prática: a identificação de eixos e âmbitos intervencionais apoia e subsidia formulações de intervenções multifocais e medidas efetivas para a prevenção e promoção da saúde acerca das infecções sexualmente transmissíveis na população investigada.

Construção e validação de instrumento para avaliação socioestrutural e comportamental associado à infecção pelo HIV em jovensa

ABSTRACT Objective to construct and validate the content of an instrument for sociostructural and behavioral assessment associated with HIV infection in young people. Method a methodological study developed in two steps: instrument elaboration; and content validity. The items that made up the instrument were selected through a literary review using the Modified Social Ecological Model multilevel domains as a reference, categorized into sociostructural and behavioral components. Content was assessed by experts in two rounds conducted using the Delphi technique, assuming an agreement rate of at least 80%. Results the first version of the instrument contained 52 items, distributed across three domains. In the first round, 19 items (36.5%) had a Content Validity Index lower than 0.80, two items were excluded and the rest were reformulated. In the second round, 2 items were excluded and 3 were incorporated as subitems, totaling 45 items. The Instrument Content Validity Index was 95%. Conclusion and implications for practice experts’ recommendations contributed qualifying the Sociostructural and Behavioral Assessment-HIV instrument, enabling content reorganization. The instrument is valid for identifying socio-structural and behavioral factors associated with HIV infection in young people, with the potential to constitute preventive care planning.

Family-based interventions in youth to prevent HIV/AIDS: A systematic review

Parents are primary sex educators of their teenagers and also function as resources for advice and information about sexual decision-making and partner selection. So far, various family-based programs were carried out to prevent HIV infection in young people; however, their findings are contradictory and inconclusive. Therefore, we carried out the current systematic review to critically review the available literature regarding the role of family-based interventions among young people to prevent HIV infection. The available online databases including ISI Web of Science, Scopus, and PubMed were searched systematically up to November 2022. The risk of bias in the eligible studies was examined by two independent authors using the Cochrane Collaboration Risk of Bias tool. A total of 7 studies including 4952 participants were enrolled in the current study. They were conducted between 2006 and 2020. On the basis of the available literature, family-based HIV prevention interventions seem to be effective in terms of improving HIV/AIDS knowledge and also parent–youth communication. It seems that family-based interventions in youth to prevent HIV/AIDS are effective; however, further well-designed studies are needed to help the researchers reach a firm conclusion on this issue. The current systematic review may be used by investigators for future studies in terms of settings and the selection of educational approaches. Moreover, it strongly suggested that further studies investigating the role of family-based education in the prevention of HIV/AIDS utilize more sample size and also a more robust educational framework.

A multifactorial impact on respiratory morbidity in people of reproductive age and effectiveness of natopherine- and andropherine-containing odorants regarding a non-specific resistance of the nasal mucosa and lowered morbidity of respiratory infections

Prevention of respiratory infections during epidemic periods is an important task of modern health care in Russia and worldwide. One of such approach may rely on use of volatile substances capable of activating nonspecific resistance of the nasal mucosa. Long-term application of synthetic analogues of female pheromones to young males leads to lowered morbidity of respiratory diseases, increased levels of secretory immunoglobulins, as well as decrease peripheral blood of eosinophilia levels in subjects with allergic diseases. Based on this, the aim of the study was set to study an impact of anamnesis factors and indicators reflecting the functioning of nasal mucosal immunity, its nonspecific resistance, on emerging frequent respiratory morbidity; as well as to evaluate effectiveness of natopherine- and andropherine-containing odorants regarding dynamics of such indicators and to reduce incidence of respiratory infections in young subjects. Materials and methods. There were examined 46 apparently healthy boys and girls aged 18 to 22 years. The frequency of respiratory morbidity, anamnesis factors, and the results of non-invasive studies (cytokine concentrations in the nasopharyngeal aspirate and rhinocytograms). Within 30 days, all young subjects were applied to the nasolabial fold synthetic analogues of male (andropherine) and female (natopherine) pheromones (andropherine for young female, natopherine for young male). A re-examination with the above mentioned studies was carried out on day 14 and day 30 of the study. The incidence of respiratory infections was reassessed one year after the onset. Results. The study showed identified a number of predictors and protectors of frequent and long-term respiratory morbidity in young subjects. The predictors of this condition were presented by catamnestics markers of allergic anomalies of the constitution, behavioral factors (smoking), as well as immune indicators of allergy (IL-4) and mucociliary clearance deficiency. A monthly course of odorant applications on the skin of the nasolabial fold using synthetic analogues of male and female pheromones (steranes) has a positive effect both on the nonspecific resistance of the nasal mucosa as well as on the immune parameters. After a month of using steranes, the nasal mucosa is completely decontaminated from coccal microorganisms, and over the next 12 months, the frequency of respiratory infections decreases. This indicates about a prominent clinical effect of the odorants applied.

Results of a Community-Based Screening Program for Chlamydia trachomatis Genital Infection in Young People Aged 18-25 Years.

Introduction and aim Chlamydia trachomatis (CT) cases have increased in the last decade. The aim of the study was to assess the prevalence of CT genital infection in asymptomatic, sexually active young peopleand determine whether a community screening program would be effective in reducing the number of cases. Methods A descriptive cross-sectional studyof consecutive inclusion of asymptomatic people aged 18-25 years between September 2021 and May 2022. Community interventions in high schools, universities, and cultural events were planned to realize the screening.Sociodemographic variables of gender, age, country of origin, and educational level, as well as sexual habits, were recorded for each patient. CT was detected via urine samples. An estimate of the prevalence of CT genital infection and its 95% confidence interval (CI) was made based on the exact binomial distribution, assuming that the sample is representative of the study population. Results A total of 628 subjects participated in the study, of whom 33 had a CT infection, giving a prevalence of 5.2% (95% CI: 3.6%, 7.3%). 93.9% of subjects with CT infection were female (p≤0.019) and 85% of the participants were Spanish nationals. Among vocational training students, the prevalence was 8.1%. Having had four or more sexual partners in the last month and in the previous year was significantly associated with CT infection (p<0.001). Conclusion Screening for CT genital infection in young sexually active women should be implemented in our country, as recommended by the various guidelines.

A qualitative study exploring experiences of the safetxt digital health intervention to reduce sexually transmitted infections in young people in the UK

ObjectivesPeople aged 16–24 are more likely than other age groups to acquire sexually transmitted infections (STI). Safetxt was a randomised controlled trial of a theory-based digital health intervention to reduce...

Prevalence and risk factors of M tuberculosis infection in young people across 14 communities in Zambia and South Africa.

From 2018-2021 the TB Reduction through Expanded Antiretroviral Treatment and TB Screening (TREATS) project took place in 21 Zambian and South African communities. The TREATS Incidence of TB Infection Cohort Study was conducted in adolescents and young people (AYP), aged 15-24 years in 14 communities. We describe the baseline prevalence and risk factors of Mycobacterium tuberculosis (M. tuberculosis) infection among this cohort and explore the quantitative QFT-Plus interferon gamma (IFN-γ) responses. A random sample of approximately 300 AYP per community were recruited and information on TB/HIV risk factors, TB symptoms and social mixing patterns collected. QuantiFERON TB Gold Plus assay (QFT-Plus) was used to detect M. tuberculosis infection, following manufacturer's instructions. Logistic regression was used to determine factors associated with infection. 5577 eligible AYP were invited to participate across both countries, with 4648 enrolled. QFT-Plus results were available for 4529: 2552(Zambia) and 1977(South Africa). Overall, 47.6% (2156/4529) AYP had positive QFT-Plus results, the prevalence of infection in South Africa being twice that in Zambia (64.7% (1280/1977) vs 34.3% (867/2552) p<0.001). Infection was associated with age, household contact with TB and alcohol in Zambia but showed no associations in South Africa. The antigen tube differential (TB2-TB1>0.6 IU/ml) of the assay at baseline showed no evidence of association with recent TB exposure. The high prevalence of infection in AYP warrants urgent action to address TB control, especially in South Africa. Further research is required to delineate antigen tube responses of the QFT-Plus assay more precisely to fully realise the benefit of the additional TB2 tube in high TB/HIV burden settings.

Using a Geosocial Networking App to Investigate New HIV Infections and Related Risk Factors Among Student and Nonstudent Men Who Have Sex With Men in Chengdu, China: Open Cohort Study.

In China, condomless sex among men who have sex with men (MSM) is the primary route of HIV infection in young people. Chengdu is a hotspot for reported HIV cases among young people nationwide. Extensive use of geosocial networking (GSN) smartphone apps has dramatically changed the pattern of sexual behavior among young MSM (YMSM). However, data on HIV incidence and the risk behavior of YMSM using the GSN app are still obscure. This study aims to analyze and understand the HIV incidence and its risk factors among YMSM using GSN apps in Chengdu, China. An open cohort study was conducted among YMSM aged 18-24 years through a gay GSN smartphone app in Chengdu, China, from July 2018 to December 2020. Every participant completed a web-based questionnaire on sociodemographic characteristics, sexual behaviors, and other related statuses; made a reservation for a web-based HIV testing; and then voluntarily got tested at the designated testing site. At least one additional HIV test was taken via the app during the study period, and participants were evaluated at the end of the study or at the time of HIV seroconversion. By dividing the sum of the observed HIV seroconversions by the observed person-years, HIV incidence was calculated and compared between the student and nonstudent MSM. Univariate and multivariate (Cox proportional hazards regression) analyses were used to discuss the risk factors for new HIV infections. In the study cohort, 24 seroconversions occurred among 625 YMSM who took at least two HIV tests through the app during the study period, contributing to 505 observed person-years. The HIV incidence rate per 100 person-years was 4.75 (95% CI 2.89-6.61) among all MSM, 3.60 (95% CI 1.27-5.93) among student MSM, and 5.88 (95% CI 2.97-8.79) among nonstudent MSM. In addition, the HIV incidence per 100 person-years was 11.11 (95% CI 4.49-17.73) among those who had resided in the area for 6 months or less and 7.14 (95% CI 1.52-12.77) among those with senior high school or less education. Two or more sexual partners (adjusted hazards ratio [HR] 3.63, 95% CI 1.08-12.23) in the preceding 6 months was a risk factor for new HIV infections. Consistent condom use for anal sex (adjusted HR 0.38, 95% CI 0.16-0.88) and insertive anal sex only (adjusted HR 0.10, 95% CI 0.01-0.75) in the preceding 6 months were protective factors for new HIV infections. The rate of new HIV infections among YMSM who actively used GSN smartphone apps was high, especially among migrant nonstudent MSM. Targeted interventions on GSN smartphone apps should be implemented to provide demand-adapted prevention and services to reduce the threat of HIV.

Course of Lower Respiratory Tract Infection in Young People Treated at the Military Hospital of Smolensk Garrison with Detected Mycoplasma pneumoniae Carrying a Macrolide-Resistant Mutation in 23S rRNA Gene.

We evaluated the effect of macrolide-resistant mutations in the Mycoplasma pneumoniae 23S rRNA gene on the severity of lower respiratory tract infections in immunocompetent young adults treated at the Smolensk Military Hospital between 25 October 2017, and 17 November 2021. All analyzed cases represented a non-severe infection of the lower respiratory tract: 44 case histories with community-acquired pneumonia and 20 cases with acute bronchitis. The presence of mutations in the gene 23S rRNA of M. pneumoniae was determined with standard Sanger sequencing. The macrolide-resistant genotype was found in 4/44 (9.1%) of the samples of the patients with pneumonia and in 3/20 (15%) of the samples of the patients with acute bronchitis. The analyzed cases with identified M. pneumoniae carrying a mutation in the 23S rRNA gene did not show any differences in the clinical presentation in terms of disease severity caused by M. pneumoniae with the wild-type (WT) phenotype.

A systematic review of the prevalence of selected sexually transmitted infections in young people in Latin America.

ABSTRACTObjective.To estimate the burden of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Treponema pallidum (TP), and human papillomavirus (HPV) infections among people aged 10 to 25 in Latin America and the Caribbean.Methods.The MEDLINE, EMBASE, and LILACS databases were searched, as well as documents from regional organizations or national health Institutions. Population-based studies that reported prevalence or incidence of CT, NG, TP, and HPV detected through confirmatory tests in adolescents and young people were included. Two reviewers independently selected studies and extracted data. The quality of studies was assessed using the Newcastle–Ottawa Scale. Pooled estimators were calculated in cases where heterogeneity was <70%; when not feasible, prevalence ranges were reported.Results.Out of a total of 3 583 references, 15 prevalence studies complied with the inclusion criteria. Due to substantial heterogeneity (>70%), it was not possible to pool frequency estimators. Among the general population, the prevalence of CT infection ranged between 2.1% and 30.1% (9 studies, 5 670 participants); for NG, prevalence ranged between 0% and 2.9% (8 studies, 5 855 participants); for TP, prevalence varied between 0% and 0.7% (3 studies, 11 208 participants), and for HPV infection, prevalence ranged between 25.1% and 55.6% (8 studies, 3 831 participants).Conclusions.Reliable, population-based data on sexually transmitted infections (STIs) in adolescents and youth in Latin America and the Caribbean are limited. Additional studies are needed to better understand the burden of STIs in this population. However, given the substantial prevalence of STIs detected, countries need public health policies for prevention, early diagnosis, and treatment of STIs in young people.

Online self-sampling kits for human immunodeficiency virus and other sexually transmitted infections: Feasibility, positivity rates, and factors associated with infections in France.

Men who have sex with men are increasingly diagnosed with sexually transmitted infections (STI) in France. To address this situation, quarterly screening for HIV combined with hepatitis B (HBV) and hepatitis C (HCV), as well as annual screening for C.trachomatis (CT) and N.gonorrhoeae (NG) are recommended. The MemoDepistages program offered an at-home screening solution for these infections. This study describes the feasibility of this screening process, the rate of positive test results, and the factors associated with positivity. Participants were recruited online. Laboratories verified the quantity and quality of the samples. Logistic regression was used to determine the associated factors for infection. Overall, 1556 out of 1908 (81.6%) blood samples were tested for at least HIV. A total of eight participants (0.5%) were newly diagnosed with HIV and four with HCV (0.3%). No new infection was confirmed for HBV. Overall positivity was 9.3% for CT and 9.6% for NG. The highest positivity was reported in rectal swabs for CT (7.3%) and in pharyngeal swabs for NG (7.2%). Factors associated with extragenital CT/NG were age under 30 years (for pharyngeal and rectal infections) and having at least 10 partners in the past 6 months (p<0.001) (for pharyngeal infections only). The self-sampling kit for multiple STIs can perform comprehensive tests and identify new infections in young people, especially in extragenital sites.

Chronic delta hepatitis: from discovery to new treatments

Introduction. Hepatitis delta virus (HDV) is a small, defective RNA virus that is related more to plant viroids than to other human pathogens. &#x0D; Material and methods. Nearly 50 research articles from various sources were reviewed and a comprehensive analysis was done regarding various parameters concerning HDV. Articles published over a period of 30 years were selected based on their experimental and statistical relevance to HDV. This review gives a brief insight into epidemiology, genetics, clinical evolution and treatment of chronic hepatitis delta.&#x0D; Results. Chronic hepatitis delta remains a major cause of morbidity in Eastern European countries and the Mediterranean region. At the same time, there is a resurgence of HBV and HDV infection in young people (under the age of 50) in Western Europe, as a consequence of the intra-familial and sexual mode of acquisition among immigrants from Eastern Europe, the Mediterranean region and from countries of the former Soviet Union, Africa high burdened regions of Asia and South America. Prevalence among IVDU was found to be higher especially in western european countries and other regions of low HDV prevalence. Chronic delta viral hepatitis is a dynamic, progressive process. A direct cytopathic pattern of liver tissue damage was also observed, especially in the presence of HDV genotype 3. Chronic hepatitis D is reported to progress to cirrhosis and hepatocellular cancer, and this trend is greater the higher the level of HDV viremia at the time of presentation.&#x0D; Conclusions. Flaws in screening and on-time diagnosis still remain due to the insufficient research and data available. While still not classified as a carcinogen by IARC, our review ends up in support of the notion that HDV infection increases the chances and fastens the pathogenic processes leading to HCC.

Factors associated with sexually transmitted infection/HIV diagnosis among a predominantly university population in Brazil.

In Brazil, the increasing prevalence of HIV infection in young people makes it critical to know its distribution in university communities. In this cross-sectional study, we evaluated the impact of STI/HIV testing campaigns on university campuses from 2013 to 2017. The participants took part in rapid testing for HIV, syphilis, hepatitis B and C, and counseling sessions. A total of 2691 people participated in the campaigns. Of these, 79.4% were single, and 50.3% were women. The median age was 24years old, and 77.9% of participants had ≥12years of formal education. Most reported having unprotected sex in the last year (87.4%). The positivity rates for HIV, syphilis, hepatitis B virus, and hepatitis C virus were 0.56%, 1.20%, 0.19%, and 0.11%, respectively. The characteristics associated with HIV infection were being men who have sex with men (MSM) (aOR = 12.06; 95% CI = 3.83-37.99) and having <12years of schooling (aOR = 3.28; 95% CI = 1.03-10.38). Factors associated with syphilis seropositivity were older age (aOR = 1.06; 95% CI = 1.03-1.09), multiple partners (aOR = 2.44; 95% CI = 1.08-5.50), and being MSM (aOR = 5.40; 95% CI = 2.49-11.72). Positivity for hepatitis B tended to decrease with the years of testing (p = 0.023) and for hepatitis C to increase with age (p = 0.035). Our study observed a high vulnerability to HIV and syphilis infection in a university community, which needs an early prevention strategy, including regular testing, continuing sexual education, easy access to condoms, and pre- and postexposure HIV prophylaxis.

4. “I Knew That My Dad Was Going to Find Out”: Dismantling Barriers and Transforming The Future of Prep Uptake In Black and Latinx Sexual Gender Minority Youth (BLSGMY)

Pre-exposure prophylaxis (PrEP) has the potential to transform HIV prevention in BLSGMY. Yet, uptake among BLSGMY remains low. Engagement in the HIV prevention cascade early is critical to reducing the burden of new infections in young people. In order to transform engagement in PrEP prevention in BLSGMY, healthcare providers and others involved in increasing access and direct care to PrEP will need to better understand and address the barriers of PrEP uptake. We sought to understand barriers, using an ecological framework, to PrEP uptake among BLSGMY at risk for or recently (last 5 years) diagnosed with HIV.

Enfermedad COVID-19 en adultos jóvenes mexicanos hospitalizados

Introduction: The literature suggests that the behavior of SARS-CoV-2 infection in young people is different. COVID-19 has been reported to be less frequent and less severe yet the evidence remains contrasting. This study had the objective of describing the COVID-19 disease in hospitalized Mexican youth. Material and methods: A retrospective study was carried out in 102 patients with COVID-19 admitted to the National Institute of Respiratory Diseases Ismael Cosio Villegas and the ISSEMyM Toluca State of Mexico Medical Center in the period from March to May 2020. They were classified according to age, 51 patients in the group of young adults <35 years and 51 adults older than 35 years. The clinical characteristics between the groups and their association with decreased severity of illness and death were compared. Results: In the group of young people (<35 years) the saturation of O2 at admission was 86% IQR (74-91). 66% (n = 34) presented lymphopenia on admission. The percentage of obesity in young people was similar to that of adults (43% versus 41%). The degree of severity was mild in 27.5% (n = 14), moderate in 45% (n = 23) and severe/critical in 27.5% (n = 14). This group also presented lower degrees of tachypnea, severity of COVID-19 and lethality due to SARS-CoV-2 infection when compared to adults (15% versus 45% p <0.05). At hospital admission, D-dimer values were lower in this group (0.69 versus 1.01 µg/mL) and serum albumin was higher (3.77 versus 3.3 mg/dL) compared with the values in adults. The neutrophil/lymphocyte ratio and platelets/lymphocytes were found as possible predictive biomarkers of deterioration by COVID-19 with an OR of 8.03 and 3.6, respectively. Conclusion: Young adults with COVID-19 who warrant hospitalization have a high percentage of obesity. They have a higher amount of initial albumin, and lower levels of D-dimer with symptoms that are frequently mild-moderate on admission and less lethal compared to hospitalized adult patients. © 2021, Instituto Nacional de Enfermedades Respiratorias. All rights reserved.

Healthcare provider and service user perspectives on STI risk reduction interventions for young people and MSM in the UK

ObjectiveBehavioural interventions have been shown to reduce sexual behaviours associated with increased risk of sexually transmitted infections in young people (<25 years) and men who have sex with men (MSM)...

Predictors of Epstein-Barr virus serostatus in young people in England

BackgroundEpstein-Barr virus (EBV) is an important human pathogen which causes lifelong infection of > 90% people globally and is linked to infectious mononucleosis (arising from infection in the later teenage years) and several types of cancer. Vaccines against EBV are in development. In order to determine the most cost-effective public health strategy for vaccine deployment, setting-specific data on the age at EBV acquisition and risk factors for early infection are required. Such data are also important to inform mathematical models of EBV transmission that can determine the required target product profile of vaccine characteristics. We thus aimed to examine risk factors for EBV infection in young people in England, in order to improve our understanding of EBV epidemiology and guide future vaccination strategies.MethodsThe Health Survey for England (HSE) is an annual, cross-sectional representative survey of households in England during which data are collected via questionnaires and blood samples. We randomly selected individuals who participated in the HSE 2002, aiming for 25 participants of each sex in each single year age group from 11 to 24 years. Stored samples were tested for EBV and cytomegalovirus (CMV) antibodies. We undertook descriptive and regression analyses of EBV seroprevalence and risk factors for infection.ResultsDemographic data and serostatus were available for 732 individuals. EBV seroprevalence was strongly associated with age, increasing from 60.4% in 11–14 year olds throughout adolescence (68.6% in 15–18 year olds) and stabilising by early adulthood (93.0% in those aged 22–24 years). In univariable and multivariable logistic regression models, ethnicity was associated with serostatus (adjusted odds ratio for seropositivity among individuals of other ethnicity versus white individuals 2.33 [95% confidence interval 1.13–4.78]). Smoking was less strongly associated with EBV seropositivity.ConclusionsBy the age of 11 years, EBV infection is present in over half the population, although age is not the only factor associated with serostatus. Knowledge of the distribution of infection in the UK population is critical for determining future vaccination policies, e.g. comparing general versus selectively targeted vaccination strategies.

Sexually transmitted infections in young people and factors associated with HIV coinfection: an observational study in a large city

ObjectivesYoung people are a critical target group for sexually transmitted infections (STI) surveillance due to their particular behavioural and social related vulnerability. The aim of this study was to describe...

Association between severe drought and HIV prevention and care behaviors in Lesotho: A population-based survey 2016-2017.

BackgroundA previous analysis of the impact of drought in Africa on HIV demonstrated an 11% greater prevalence in HIV-endemic rural areas attributable to local rainfall shocks. The Lesotho Population-Based HIV Impact Assessment (LePHIA) was conducted after the severe drought of 2014–2016, allowing for reevaluation of this relationship in a setting of expanded antiretroviral coverage.Methods and findingsLePHIA selected a nationally representative sample between November 2016 and May 2017. All adults aged 15–59 years in randomly selected households were invited to complete an interview and HIV testing, with one woman per household eligible to answer questions on their experience of sexual violence. Deviations in rainfall for May 2014–June 2016 were estimated using precipitation data from Climate Hazards Group InfraRed Precipitation with Station Data (CHIRPS), with drought defined as <15% of the average rainfall from 1981 to 2016. The association between drought and risk behaviors as well as HIV-related outcomes was assessed using logistic regression, incorporating complex survey weights. Analyses were stratified by age, sex, and geography (urban versus rural). All of Lesotho suffered from reduced rainfall, with regions receiving 1%–36% of their historical rainfall. Of the 12,887 interviewed participants, 93.5% (12,052) lived in areas that experienced drought, with the majority in rural areas (7,281 versus 4,771 in urban areas). Of the 835 adults living in areas without drought, 520 were in rural areas and 315 in urban. Among females 15–19 years old, living in a rural drought area was associated with early sexual debut (odds ratio [OR] 3.11, 95% confidence interval [CI] 1.43–6.74, p = 0.004), and higher HIV prevalence (OR 2.77, 95% CI 1.19–6.47, p = 0.02). It was also associated with lower educational attainment in rural females ages 15–24 years (OR 0.44, 95% CI 0.25–0.78, p = 0.005). Multivariable analysis adjusting for household wealth and sexual behavior showed that experiencing drought increased the odds of HIV infection among females 15–24 years old (adjusted OR [aOR] 1.80, 95% CI 0.96–3.39, p = 0.07), although this was not statistically significant. Migration was associated with 2-fold higher odds of HIV infection in young people (aOR 2.06, 95% CI 1.25–3.40, p = 0.006). The study was limited by the extensiveness of the drought and the small number of participants in the comparison group.ConclusionsDrought in Lesotho was associated with higher HIV prevalence in girls 15–19 years old in rural areas and with lower educational attainment and riskier sexual behavior in rural females 15–24 years old. Policy-makers may consider adopting potential mechanisms to mitigate the impact of income shock from natural disasters on populations vulnerable to HIV transmission.

Epidemiology and natural history of hepatitis C virus infection among children and young people

Chronic hepatitis C virus (HCV) infection is a global health burden. Although HCV infection rarely contributes to morbidity during childhood, most HCV-infected children develop chronic HCV with a lifetime risk of liver disease. Little is known about the development of long-term liver disease and the effect of treatment in patients infected with HCV in childhood. This study was a retrospective review of patients infected with HCV in childhood enrolled in HCV Research UK. A total of 1,049 patients were identified and included. The main routes of infection were intravenous drug use (53%), blood product exposure (24%) and perinatal infection (11%). Liver disease developed in 32% of patients, a median of 33 years after infection, irrespective of the mode of infection. Therefore, patients with perinatal exposure developed cirrhosis at an earlier age than the rest of the risk groups. The incidence of hepatocellular carcinoma (HCC) was 5%, liver transplant 4% and death occurred in 3%. Overall, 663 patients were treated (55% with interferon/pegylated interferon and 40% with direct-acting antivirals). Sustained virological response (SVR) was achieved in 406 (75%). There was a higher mortality rate among patients without SVR vs. those with SVR (5% vs. 1%, p = 0.003). Treatment was more effective in patients without cirrhosis and disease progression was less frequent (13%) than in patients with cirrhosis at the time of therapy (28%) p < 0.001. Patients with cirrhosis were more likely to develop HCC, require liver transplantation, or die. HCV infection in young people causes significant liver disease, which can now be prevented with antiviral therapy. Early treatment, especially before development of cirrhosis is essential. Detection of HCV should be aimed at relevant risk groups and antiviral therapy should be made available in childhood to prevent long-term liver disease and spread of HCV. Chronic hepatitis C virus (HCV) infection is a global health problem, which can now be treated with potent direct-acting antiviral drugs. This study demonstrates that HCV infection in childhood causes serious liver disease in 32% of patients, a median of 33 years after infection, irrespective of age, mode and route of infection. Disease outcomes were better in patients treated before the development of advanced liver disease. Antiviral therapy should be made available in childhood to prevent long-term liver disease and the spread of HCV.