Vertical Transmission Research Articles

Data fitting and optimal control strategies for HBV acute patient cases in the United States.

Data fitting and optimal control strategies for HBV acute patient cases in the United States.

The Lived Experiences of Ugandan Community Health Workers Engaged in Prevention of Vertical Transmission of HIV and a Capacity-Building Intervention.

To explore the lived experiences of community health workers (CHW) engaged in efforts toward the elimination of vertical transmission (EVT) of HIV and to assess the impact of a capacity-building training intervention. The study consisted of (1) a qualitative assessment of lived experiences of CHWs; (2) a capacity-building training intervention responsive to identified needs; and (3) assessment of the training intervention using pre- and postintervention questionnaires. Focus group discussions and semistructured key informant interviews in addition to CHW training sessions for HIV/EVT were held in 1 rural and 1 semiurban setting in Uganda, based on training materials developed by the World Health Organization and the United States Agency for International Development (USAID). We used standardized pre- and postintervention questionnaires to assess comprehensive knowledge and accepting attitudes toward HIV. Qualitative exploration of the lived experience of 152 CHWs in 10 focus group discussions and 4 key informant interviews revealed several themes: (1) CHWs as bridges between health system and community; (2) CHW assets (tacit knowledge and shared social networks); (3) CHW challenges (stigma, secrecy, and ethical quandaries); (4) favorable community reception; and (5) need for continuing education and reinforcement of skills. In response to identified needs, a capacity-building intervention was designed and implemented with 143 CHWs participating in 10 sessions. The proportion of participants with comprehensive knowledge of HIV increased from 45% to 61% ( P = 0.006), and the proportion endorsing accepting attitudes increased from 63% to 76% ( P = 0.013). CHWs are potentially valuable players in global EVT efforts. Ongoing training is needed to support community-level initiatives.

Familial inheritance of 14q terminal deletion syndrome and review of the literature.

Familial inheritance of 14q terminal deletion syndrome and review of the literature.

MULHERES PORTADORAS DE HIV DIANTE DA MATERNIDADE: DIFICULDADES ENCONTRADAS – UMA REVISÃO BIBLIOGRÁFICA

This article aims to analyze, through a literature review, the main difficulties faced by women with HIV in the context of motherhood. The research seeks to understand the psychosocial, emotional and clinical challenges experienced from the desire to become pregnant to postpartum care, also addressing aspects related to prejudice and access to health services. The methodology adopted consisted of a narrative literature review, with a survey of scientific publications from the last 10 years in the SciELO, LILACS and PubMed databases, using descriptors such as “HIV”, “motherhood”, “HIV-positive women” and “difficulties”. The expected results indicate that, despite advances in the treatment and prevention of vertical transmission of HIV, many women still face social stigma, fear of rejection, insecurity about the baby's health and difficulties in accessing adequate prenatal care. It is concluded that there is a need for greater training of health professionals, expansion of inclusive public policies and educational actions that promote the acceptance and empowerment of women living with HIV during the motherhood process.

‘A teacher by day and a performer by night’: performer-educator identity tensions in a graduate community of practice course

ABSTRACT This article explores how participation in a community of practice course aided negotiation between performer-educator identities among graduate students professionally active as studio teachers. Studio teachers may face isolation due to limited opportunities for professional development and the secluded nature of one-on-one instruction, and overemphasis on vertical knowledge transmission within a master-apprentice model. Often engaged in performing and teaching as part of a broader, portfolio career, studio teachers may face tensions between their performer-educator identities. These tensions in identity may be mitigated through participation in a community of practice. Using a qualitative case study methodology, researchers used questionnaires, reflective assignments, interviews, and non-participant observations to investigate the experiences of 6 participants enrolled in a one-semester graduate course. Themes include the impact of participation in a community of practice, tensions in identity, and alleviation of tensions between identities.

Prevention of vertical transmission of HIV infection in Рerm region: problems and prospects

Objective. To analyze the measures aimed at preventing vertical transmission of HIV infection in Perm Krai for 2020–2024. Materials and methods. The method of statistical analysis of the indicators of the federal state statistical observation forms No. 2 and No. 61 in Perm Krai for 2020–2024, the accounting and reporting forms of the State Budgetary Healthcare Institution "Perm Regional Center for the Prevention and Control of AIDS and Infectious Diseases" and the Ministry of Health of Perm Krai were used. Results. The analysis of official statistics revealed that the main problems are both an inadequate coverage of antiretroviral prophylaxis and insufficient medical supervision of women during pregnancy and after the childbirth. Conclusions. Constant monitoring, improvement of communication between different levels of health care and support for women are the key factors for a successful fight against vertical transmission of HIV.

SÍFILIS CONGÊNITA: FATORES DE RISCO, DIAGNÓSTICO PRECOCE E PREVENÇÃO EM GESTANTES E CRIANÇAS

Introduction. Congenital syphilis remains a major public health concern in Brazil and worldwide, representing one of the leading preventable causes of perinatal morbidity and mortality. It is a vertically transmitted infection from the pregnant woman to the fetus, caused by Treponema pallidum, with transmission occurring mainly during pregnancy or at the time of delivery. The absence of timely diagnosis and treatment in the pregnant woman can lead to serious consequences for the newborn, such as prematurity, low birth weight, congenital malformations, deafness, blindness, and even fetal death. Objective. To analyze the main risk factors for congenital syphilis, as well as early diagnostic and prevention strategies during prenatal care, focusing on the protection of maternal and child health.Justification. This study is relevant as it contributes to updating knowledge on the social and clinical determinants involved in the vertical transmission of syphilis, while also emphasizing the importance of effective preventive actions within prenatal care. Methodology. This is a systematic review based on the PRISMA protocol, using the PICO strategy to select articles published between 2020 and 2025 in the LILACS and PubMed databases. Studies addressing maternal risk factors, serological screening strategies, preventive interventions, and neonatal outcomes related to congenital syphilis were included. Results and Discussion. The main factors associated with congenital syphilis were the absence or late initiation of prenatal care, failures in testing and appropriate treatment of the pregnant woman and her sexual partner, low educational level, and social vulnerability. The use of rapid syphilis testing during the initial prenatal consultations, with repetition in subsequent trimesters, proved essential for early diagnosis. Treatment with benzathine penicillin remains the most effective and safest option. Conclusion. The prevention of congenital syphilis requires early identification of maternal cases, appropriate screening during prenatal care, effective treatment of both the pregnant woman and her partner, as well as educational initiatives and public policies aimed at promoting maternal and child health.

Assessing the Risk Factors and Pregnancy Outcomes of Toxoplasmosis Infection

Toxoplasmosis is considered a zoonotic food-borne infection caused by the parasite Toxoplasma gondii. During pregnancy, the Toxoplasma gondii infection is found to contribute to miscarriages, stillbirth, neonatal death, or fetal/neonatal abnormalities via vertical transmission, which increases with gestational age. The current study was conducted to determine the risk factors and pregnancy outcomes of Toxoplasmosis infection among Libyan pregnant women. This study was a case series hospital-based study carried out in the obstetrics and gynecology sectors of Ali Omar Askar Hospital, Alkhadra Hospital, and Alafia Clinic between January 2019 and April 2025. A total of 60 pregnant women who were diagnosed with toxoplasmosis in a multicenter hospital which collected from medical records via a standardized questionnaire. The extracted data underwent analysis and processing via SPSS version 24. A total of 60 pregnant women were included, aged between 30 and 34 years, and accounted for 24(40.0%). The mean age was 29.27±5.210SD. The mean gestational age was 14.52 ± 4.019 SD with the minimum gestational age was 9 weeks while the maximum gestational age was 24 weeks and 58.3% (35) of patients had expressed history of animal contact particularly cat accounted 10.0% (6), 68.3% (41) of patients had received antibiotics therapy with 20.0% (12) had received Spiramycin followed by 18.3% (11) had received Pyrimethamine and 16.7% (10) had received Azithromycin. 28.3% (17) of neonates had expressed jaundice, followed by 25.0% (15) had expressed pneumonitis, 13.3% (8) had expressed skin rash, and 8.3% (5) had expressed hydrocephalus. just 11.7% (7) had expressed chorioretinitis, 10.0% (6) had developed epilepsy, 1.7% (1) had blindness, and 1.7% (1) had strabismus after delivery. statistically significant results were reported on the relationship between neonatal complications and toxoplasmosis outcomes (P-value = 0.041). 46.7% (28) of them had required admission to the neonatal intensive care unit. Several risk factors have been identified linked to toxoplasmosis, such as the middle age group, early gestational age infection exposure, history of animal contact, and early antibiotics therapy. Most patients reported that they received antibiotic therapy, which contributed to a lower rate of fetal and neonatal complications. Therefore, early recognition as well as prompt management of toxoplasmosis is our crucial approach to avoid related adverse perinatal outcomes. Also, effective prenatal counseling and antenatal screening for the high-risk group in toxoplasmosis infection are essential to prevent related perinatal morbidity and mortality.

Human Papillomavirus Persistence, Recurrence, and Incidence in Early Childhood.

Little is known on the vertical transmission of human papillomavirus (HPV) and on the dynamics of HPV among children. Our objective was to determine the risk of HPV recurrence, persistence, and incidence over 2 years of age among children born to HPV-positive mothers. We conducted the HERITAGE study among pregnant women recruited between 2010 and 2016 in Canada. HPV DNA testing was done on vaginal samples collected during the first and third trimesters of pregnancy, and on conjunctival, oral, pharyngeal, and genital samples collected in children from birth and at every 3-6 months up to 2 years. We estimated the probability of HPV vertical transmission, and of HPV recurrence, persistence, and incidence among children during follow-up. Time to clear HPV among children was estimated using Kaplan-Meier technique. Among the 422 women with HPV during pregnancy, 390 carried pregnancy to term, and 395 children were born alive including twins/triplets. HPV vertical transmission was estimated at 7.3% (95% confidence interval [CI], 5.0%-10.4%) with a genotype concordance of 85.2%. During the entire follow-up, we observed 91 HPV detections (among 51 children) including 2 recurrent and 1 persistent. Incident genotypes occurred in 26 of the 270 (9.6%) children with valid HPV testing during follow-up. Most HPV infections detected in children cleared with a mean time of 3.9 months (95% CI, 3.6-4.2 months). HPV vertical transmission and incident HPV occasionally occur during infancy, but the risk of persistence or recurrence is overall very low.

Transmission investigation of Mycoplasma synoviae in Chinese indigenous chickens.

Mycoplasma synoviae (MS) induces avian synovitis, presenting with tendon inflammation, and respiratory distress, ultimately compromising poultry health and farm productivity. To investigate the epidemiological characteristics of MS in Chinese indigenous chickens, a comprehensive study was conducted on chicken flocks from three breeder farms in Jiangsu, China. A total of 113 batches of chicken flocks were screened using real-time polymerase chain reaction (qPCR). Among 3,284 choanal cleft swab samples collected from chickens aged 2 to over 25 weeks, 1,695 tested positive for MS. Notably, the MS-positive rate increased significantly in chickens aged 8 to 25 weeks. Interestingly, none of the chicken embryo samples (0/322) and only two one-day-old chickens (2/927) tested positive for MS infection. In contrast, Mycoplasma gallisepticum (MG) infection was more prevalent, particularly in unhatched embryos (158/294), primarily due to air sac contamination. All offspring from MS-positive parent flocks aged 27 to 38 weeks tested negative for MS. To further explore the influence of the breeding environment, chickens from the same batch were raised either in breeder farms or isolators for 17 weeks. Chickens housed in breeder farms exhibited MS nucleic acid and antibody positivity from 9 to 17 weeks, whereas those raised in isolators remained MS-free throughout the study. These findings indicate that vertical transmission of MS in Chinese indigenous chickens is rare, with horizontal transmission being the predominant mode of spread.

Epizootic hemorrhagic disease virus oral infection affects midge reproduction and is vertically transmitted to offspring in Culicoides sonorensis

Epizootic hemorrhagic disease virus (EHDV: Reoviridae: Orbivirus) is a Culicoides-borne pathogen that affects a variety of ruminants, causing significant economic losses and/or ecological impacts in animal agriculture/wildlife populations worldwide. In this study, we examined the effect of EHDV serotype-2 oral infection on the survival and reproduction of Culicoides sonorensis Wirth and Jones (a confirmed vector of EHDV in North America), and the potential vertical transmission of EHDV-2 (from infected female to its offspring) in this midge species. Culicoides sonorensis females were fed on defibrinated bovine blood mixed with EHDV-2 (5.5 log10 PFU/ml) or without EHDV-2 (control). Adult survival/longevity, oviposition rates, number of eggs deposited, egg hatch rates (fertility), larval survival, larval stage duration, eclosion rates, and sex-ratios of the progeny were recorded and compared between the two groups. In addition, the progeny (eggs and F1 generation adults) of EHDV-2 fed females were processed for viral detection through RT-qPCR and plaque assays. Survival/longevity of the blood-fed adults, oviposition rates, number of eggs deposited, larval stage duration, eclosion rates, and sex-ratios were not significantly different between the two groups. However, egg hatch rates were significantly lower in the EHDV-2 fed group (35.8 ± 5.2%) than the control group (74.5 ± 6.8%), but larval survival rates were higher in the EHDV-2 fed group (59.8 ± 4.9%) compared to the control group (34.1 ± 6.5%). EHDV-2 (Ct < 35) was detected in the eggs (3.4%, 1/29 females tested, Ct = 22.1 [4.9 log10 PFUe/ml]) and F1 adult progeny (1.7%, 1/58 adults tested, Ct = 23.5 [4.5 log10 PFUe/ml]) of the orally exposed females through RT-qPCR as well as through plaque assays. Our findings suggest that EHDV-2 infection has no major impact on C. sonorensis survival/longevity or oviposition but has a significant negative effect on midge fecundity/fertility. Our study also provides evidence for the vertical transmission of EHDV-2 from an infected adult female to its offspring in C. sonorensis. However, salivary transmission of EHDV-2 from the vertically infected progeny and its significance in the epidemiology of hemorrhagic disease are currently unknown and remain to be examined in further studies. Overall, these findings collectively indicate that Orbivirus infection can negatively affect vector reproduction, and that vertical transmission is a probable mechanism of overwintering of EHDV in North America.

Hepatitis C virus testing in infants, a move to early screening by HCV RNA at 2 months of age

Abstract In the last decade, hepatitis C virus (HCV) has become a curable chronic viral infection, with excellent treatment and streamlined diagnostic testing. Canada and many other countries have adopted national elimination targets; however, reaching these goals will require changes in the way care is provided. Standard of care HCV treatment is all-oral daily medication for 8 or 12 weeks and all provinces in Canada have mechanisms for public coverage. Unfortunately, vertical transmission continues to be the predominant reason for paediatric infection, but if diagnosed, children can be treated as young as 3 years old. Early paediatric diagnosis and cure are of the utmost importance to prevent complications such as adverse mental health outcomes and advanced liver disease early in life. One major barrier to paediatric diagnosis and cure is poor antibody screening uptake, as low as 23% by 18 months among children born to positive persons. In the United States, a landmark study showed a temporal decrease in screening rates from 91% at 2 months to 59% at 18 months. As such, the American Association for Study of the Liver/Infectious Disease Society of America, and very recently, the Centres for Disease Control and Prevention, now recommend screening by all children born to positive person for HCV RNA at 2-6 months of age. While antibody testing could still be completed at 18 months to determine serostatus, understanding if a child has active infection in infancy supports early linkage to care and decreases paediatric loss to follow-up.

(In)coherence between Chagas disease policy and the experiences of those affected in Mexico: The need for a transdisciplinary approach.

Chagas disease, caused by the parasite Trypanosoma cruzi, remains a significant public health challenge in México, symbolizing systemic neglect in healthcare. Despite longstanding efforts to control its transmission, there are critical gaps in the alignment of public health policies with the lived experiences of affected individuals. This study examines these dissonances by analyzing qualitative interviews with 61 individuals diagnosed with T. cruzi and reviewing relevant Mexican public health regulations, including national standards and action programs. Findings reveal that most diagnoses occur incidentally, such as during blood donation or vector control campaigns, with minimal active case detection at the primary healthcare level. Affected individuals often encounter insufficient follow-up care, significant barriers to treatment, and misinformation that exacerbates psychological distress. Among the 14 participants who received etiological treatment, access was frequently due to individual persistence rather than systemic support, highlighting inequities in healthcare delivery. Additionally, structural barriers, including economic constraints and insufficient local healthcare infrastructure, further limit access to timely diagnosis and treatment, particularly in rural areas. Policy gaps include the absence of universal T. cruzi testing for pregnant individuals, lack of vertical transmission prevention strategies, and inadequate communication between healthcare providers and patients. Current public health initiatives disproportionately prioritize vector control and blood bank screening, neglecting the broader social and economic challenges faced by those already diagnosed. The study underscores the urgent need for a transdisciplinary approach to Chagas disease management in México, integrating biomedical, sociocultural, and policy perspectives. Recommendations include implementing universal prenatal screening for T. cruzi, enhancing health communication strategies, reframing Chagas as a manageable condition to reduce stigma, and improving follow-up care protocols. Addressing these challenges requires intersectoral collaboration and an inclusive approach that values the lived experiences of affected communities. By bridging the gap between policy and practice, this research contributes to the development of holistic strategies that not only control Chagas disease transmission but also improve the quality of life for those already impacted. These insights are essential for informing public health reforms in México and other endemic regions, advancing equity and effectiveness in neglected tropical disease management.

Knowledge, Attitudes, and Practices toward Chagas Disease: A Cross-Sectional Survey of Bolivians in the Gran Chaco and Latin American Migrants in London.

Understanding the at-risk population's perception of Chagas disease is essential for its effective prevention and control. A cross-sectional survey of knowledge, attitudes, and practices toward Chagas disease was conducted with Bolivians in a highly endemic region of Bolivia and Latin American migrants in London. In total, 175 participants completed the survey: 100 Bolivians in a highly endemic village in Santa Cruz, Bolivia and 75 Latin American migrants in London (of whom 31 were from Bolivia). All participants from the endemic village and all Bolivian migrants in London knew of Chagas disease, whereas only 25% of other Latin American migrants had heard of it (P <0.001). In London, Bolivians had more knowledge of Chagas disease than those from other Chagas-endemic countries. In Bolivia only, better understanding of Chagas disease was associated with educational attainment. Only 4% of participants overall were aware of the risk of vertical transmission. Few Latin American migrants in London had previously been tested for Chagas disease, and most were not aware of how to access testing. Migration and level of endemicity may shape individuals' understanding of as well as attitudes and practices toward Chagas disease. A better understanding of these factors can guide effective prevention and control program development in both endemic and non-endemic settings.

Transmission of the human respiratory microbiome and antibiotic resistance genes in healthy populations

BackgroundThe human microbiome is transmissible between individuals, including pathogens and commensals with metabolic and immune-modulating effects, which could influence susceptibility, severity, and outcomes of both infection and non-infection diseases. However, limited studies of respiratory microbiome transmission within populations have been conducted. Herein, we performed species- and strain-level metagenomic analyses on oropharyngeal (OP) swabs from 1046 healthy urban dwellers across 13 districts, including 111 households with at least two cohabitants, to elucidate the transmission dynamics of the respiratory microbiome within households and communities.ResultsWe found that geographic districts accounted for the greatest variation in the OP microbiome, with unrelated individuals from the same district showing greater microbiome similarity and higher strain-sharing rates than those from different districts. Cohabitants, especially spouses and siblings, exhibited similar microbial abundances and shared more strains, with 16.7% (IQR 0.0–33.3%) of strains shared among cohabitants, compared to 0.0% (IQR 0.0–11.1%) in non-cohabiting pairs (p < 0.05). Both respiratory commensals and opportunistic pathogens were shared among cohabitants. In contrast, no evidence of vertical transmission was detected between mother–offspring pairs. Additionally, the OP microbiome contained diverse antibiotic resistance genes (ARGs), with 15.0% linked to mobile genetic elements (MGEs) or plasmids; the flanking sequences of these ARGs were more conserved across species than those of non-MGE-associated ARGs, suggesting horizontal transfer of ARGs among respiratory microorganisms.ConclusionsIn summary, we characterized the transmissible nature of the OP microbiome and the risk of ARG dissemination among respiratory microorganisms. These findings underscore the role of respiratory microbes and ARGs exchange in shaping the microbiome of healthy populations and emphasize their relevance to public health strategies for respiratory health management.4cQW6ZzqCyCYGmEdL1A8oiVideo

Tenofovir Alafenamide Therapy Throughout Pregnancy in Mothers With Hepatitis B

ABSTRACTBackgroundMothers with chronic hepatitis B and advanced fibrosis may require antiviral therapy throughout pregnancy. Current guidelines recommend tenofovir disoproxil fumarate (TDF), which is unsuitable for mothers at risk of renal dysfunction or decreased bone mineral density.AimsThis study aimed to evaluate the safety of tenofovir alafenamide (TAF) therapy during pregnancy.MethodsMothers with chronic hepatitis B treated with TAF or no therapy were retrospectively enrolled and categorised into three groups: (A) TAF‐first trimester, (B) TAF‐late trimester and (C) no treatment. Propensity score matching was applied to create comparable groups. Primary assessments included serious adverse events up to postpartum week 28, while secondary assessments examined predictors of such events and vertical transmission rates.ResultsAmong 284 mothers, 160 were selected. No significant differences were observed in foetal loss, low birth weight, preterm delivery or congenital abnormalities between groups A and B, or between groups A and C. Other adverse events were similar across groups, except for a higher incidence of gestational diabetes in the TAF‐first trimester group. In vitro fertilisation was identified as the sole predictor of serious events. No infants were reported with hepatitis B virus infection at 28 weeks postpartum.ConclusionsThis study suggests that TAF treatment throughout pregnancy is safe for mothers with chronic hepatitis B and their infants. TAF therapy represents a viable treatment option for these mothers.

Examining the Possibility of Maladaptive Cultural Evolution through Oblique Transmission

As one of the prerequisites for maladaptive cultural evolution, oblique transmission has drawn attention. However, even though maladaptive cultural evolution could occur if children choose oblique transmission frequently, can oblique transmission be selected by children in the course of genetic evolution? In addressing the question above, in this study, we conducted agent-based simulations focusing on the evolution of “oblique transmission bias,” the tendency of children to choose oblique transmission when they can choose between oblique and vertical transmission. At first, we analyzed how the oblique transmission bias evolves by comparing models with two cultural traits versus five traits, manipulating the probability of environmental changes and the strength of natural selection, respectively. As a result, the oblique transmission rate evolved under limited conditions. Second, we conducted simulations under the setting of the oblique transmission rates as exogenous variables; maladaptive cultural evolution did not occur because of oblique transmission when oblique transmission bias is as strong as one evolved in the previous simulation. In addition, we show that if maladaptive culture is more likely to be imitated by children, maladaptive cultural evolution occurs.

Co-evolution of pathogen-host interactions with vertical transmission can produce bistable outcomes.

Co-evolution of pathogen-host interactions with vertical transmission can produce bistable outcomes.

Facilitators, barriers and service availability for delivering integrated care for the triple elimination of HIV, syphilis and hepatitis B vertical transmission in Uganda: a multi-site explanatory mixed methods study

BackgroundElimination of vertical transmission of HIV, syphilis and hepatitis B is part of the global aspiration to end the three infections as public health threats by 2030. Whereas global and national policy guidelines recommend integration of screening, prevention and treatment for the three infections in maternal and child health (MCH) service delivery points, progress has been slow. We aimed to explore the health system factors that facilitate and hinder optimal integration of triple elimination services within the MCH platforms.MethodsThis was a cross-sectional, explanatory mixed methods multi-site study implemented in two regions of Uganda, conducted in July – August 2024. Firstly, we used an observation checklist to assess for the availability of services and commodities required for provision of triple elimination care at 20 health facilities (two regional referral hospitals, two general hospitals, two specialized outpatient TASO clinics, five HCIVs, eight HCIIIs and one HCII), and computed a percentage service and commodity availability score for each site, and average for the sites. We then used findings from this assessment to guide open-ended probing during key informant interviews and focus group discussions among ten key informants and 43 focus group discussion participants. Interviews and discussions were recorded, transcribed verbatim, and then analysed manually. We categorized responses as either facilitators or barriers and extracted quotes, by theme, based on the World Health Organization’s health systems building blocks framework.ResultsThe average percentage score of service and commodity availability was 61.8% (range: 46.4–78.6%) in Acholi region and 66.1% (range: 53.6–78.6%) in Teso region. We found that presence of trained focal persons, district accountability fora, routine data collection and utilization, and availability of motivated community health workers facilitated triple elimination service integration. Key barriers included limited district health team engagement, frequent stock-outs of diagnostic and treatment commodities, health personnel shortages and high reporting burden.ConclusionsHealth facility service readiness and availability percentage scores differed across facilities and between the two regions. Several health system factors facilitate integrated service provision for elimination of HIV, syphilis and hepatitis B vertical transmission. This integration is, however, constrained by a number of health system barriers. Further implementation research could contribute to addressing the various health system constraints and adoption of strategies for service integration tailored to site contexts.

Should I stay or should I go: transmission trade-offs in phages and plasmids.

Should I stay or should I go: transmission trade-offs in phages and plasmids.