Suchergebnisse

The toxicological monographs and monograph addenda contained in this volume were prepared by a WHO Core Assessment Group that met with the FAO Panel of Experts on Pesticide Residues in Food and the Environment in a Joint Meeting on Pesticide Residues (JMPR) in Rome Italy on 9-18 September 2008. Six of the substances evaluated by the WHO Core Assessment Group (azoxystrobin chlorantraniliprole mandipropamid prothioconazole spinetoram and spirotetramat) were evaluated for the first time. Six compounds (buprofezin hexythiazoz flusilazole procymidone profenofos) were re-evaluated within the periodi

A concise assessment of the risks to human health and the environment posed by exposure to 2 2-dichloro-1 1 1-trifluoroethane (HCFC-123) a volatile liquid used as a refrigerant in commercial and industrial air-conditioning installations in gaseous fire extinguishers as a foam-blowing agent and in metal and electronics cleaning. Although HCFC-123 is known to contribute to ozone depletion the significance of its role in global warming is far smaller than that of chlorofluorocarbons and bromofluorocarbons which are being phased out in compliance with the 1987 Montreal Protocol on Substances that

AbstractIntroductionThe HIV Strategy in New South Wales (NSW) Australia aims to virtually eliminate HIV transmission by 2020. We estimated the 2016 HIV diagnosis and care cascade for the state of NSW, with a focus on introducing population‐based data to improve data quality and assess progress towards the UNAIDS 90‐90‐90 targets.MethodsTo estimate the number of people living with diagnosed HIV (PLDHIV) we used NSW data from the Australian National HIV Registry, enhanced by surveillance among people recently diagnosed with HIV to improve migration estimates. The number of undiagnosed PLHIV was estimated using back‐projection modelling by CD4 count at diagnosis. De‐duplicated prescription claims data were obtained from the Australian Pharmaceutical Benefits Scheme (PBS), and were combined with an estimate for those ineligible, to determine the number of PLDHIV on antiretroviral therapy (ART). Data from a clinic network with 87% coverage of PLDHIV in NSW enabled the estimation of the number on ART who had HIV suppression.Results and discussionWe estimated that 10,110 PLHIV resided in NSW in 2016 (range 8400 to 11,720), among whom 9230 (91.3%) were diagnosed, and 8490 (92.0% of those diagnosed) were receiving ART. Among PLDHIV receiving ART, 8020 (94.5%) had suppressed viral load (<200 HIV‐1 RNA copies/mL). Overall, 79.3% of all PLHIV had HIV virological suppression.ConclusionNSW has met each of the UNAIDS 90‐90‐90 targets. The enhanced surveillance methods and data collection systems improved data quality. Measuring and meeting the 90‐90‐90 targets is feasible and could be achieved in comparable parts of the world.

This report prepared by WHO and UNICEF provides water supply and sanitation coverage data for 1990 and 2002 at national regional and global levels and an analysis of trends towards 2015. It is intended as a 'reality check' on how far we have come and where we need to focus next in order to fulfil our commitment towards the water supply and sanitation targets of the Millennium Development Goals.

Winnie Byanyima is the Executive Director of UNAIDS and leads the United Nations' efforts to end the AIDS epidemic by 2030. She is also a longstanding champion of social justice and gender equality having led Uganda's first parliamentary women's caucus where she championed gender equality provisions during her 11 years as an elected member of the Ugandan parliament. To mark World AIDS Day 2020, Nature Communications interviewed Winnie about how the COVID-19 pandemic has impacted the UNAIDS Fast Track targets, the impact of both epidemics on women around the world, and what is next in the fight against HIV.

The toxicological monographs in this volume summarize the safety data on a number of food additives including benzoyl peroxide a-cyclodextrin hexose oxidase from Chondrus crispus expressed in Hansenula polymorpha lutein from Tagetes erecta L. peroxyacid antimicrobial solutions containing 1-hydroxyethylidene-1 1-diphosphonic acid steviol glycosides D-tagatose xynalases from Bacillus subtilis expressed in B. subtilis and zeaxanthins and a natural constituent glycyrrhizinic acid. Monographs on eight groups of related flavouring agents evaluated by the Procedure for the Safety Evaluation of Flavou

The objective of this document is to provide guidance to risk assessors on the use of quantitative toxicokinetic and toxicodynamic data to address interspecies and interindividual differences in dose/concentration-response assessment. Section 1 focuses on the relevance of this guidance in the context of the broader risk assessment paradigm and other initiatives of the International Programme on Chemical Safety (IPCS) project on the Harmonization of Approaches to the Assessment of Risk from Exposure to Chemicals. Technical background material is presented in section 2 followed by generic guidan

In late 2015, the World Health Organization announced new treatment guidelines recommending that anyone who has tested positive for HIV should begin antiretroviral therapy (ART) as soon as possible. In light of this policy, the Government of Namibia included "treat all" in the 2016 National Guidelines for ART, and began nationwide implementation in April 2017. Project SOAR is generating evidence on how the national rollout of the treat all guidelines and decentralization of ART services affect client-level treatment outcomes, quality of ART services, and treatment costs in Namibia. This brief highlights baseline findings that provide a snapshot of ART services delivered by health facilities in northern Namibia during the year prior to the rollout of the treat all guidelines. We also examine ART service outcomes, including 12-month ART patient retention, viral load testing, and viral suppression, to determine the effects of service decentralization during the year preceding the national rollout of Namibia's treat all recommendations.

Deaths from AIDS (1 500 000 in 2013) have been falling more slowly than anticipated with improved access to antiretroviral therapy. Opportunistic infections account for most AIDS-related mortality, with a median age of death in the mid-30s. About 360 000 (24%) of AIDS deaths are attributed to tuberculosis. Fungal infections deaths in AIDS were estimated at more than 700 000 deaths (47%) annually. Rapid diagnostic tools and antifungal agents are available for these diseases and would likely have a major impact in reducing deaths. Scenarios for reduction of avoidable deaths were constructed based on published outcomes of the real-life impact of diagnostics and generic antifungal drugs to 2020. Annual deaths could fall for cryptococcal disease by 70 000, Pneumocystis pneumonia by 162 500, disseminated histoplasmosis by 48 000 and chronic pulmonary aspergillosis by 33 500, with approximately 60% coverage of diagnostics and antifungal agents; a total of .1 000 000 lives saved over 5 years. If factored in with the 90–90–90 campaign rollout and its effect, AIDS deaths could fall to 426 000 annually by 2020, with further reductions possible with increased coverage. Action could and should be taken by donors, national and international public health agencies, NGOs and governments to achieve the UNAIDS mortality reduction target, by scaling up capability to detect and treat fungal disease in AIDS. This article is part of the themed issue 'Tackling emerging fungal threats to animal health, food security and ecosystem resilience'.

AbstractIntroductionAchieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90‐90‐90 progress by age, 15–49 (as a comparison) and 50+ years, with further analyses among 50+ (55–59, 60–64, 65+ vs. 50–54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe).MethodsUsing data from nationally representative Population‐based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90‐90‐90 targets. Country‐specific Poisson regression models examined 90‐90‐90 variation among OPLWH age strata.ResultsAnalyses included 24,826 HIV‐positive individuals (15–49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15–49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15–49, women were more likely to achieve 90‐90‐90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country‐specific 90‐90‐90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum.ConclusionsWhile OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV‐positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH <50. Findings support expanded HIV testing, prevention and treatment services to meet ongoing OPLWH health needs in SSA.

This publication constitutes a comprehensive report drawing attention to important human rights issues that migration poses for health policy-makers. These issues include the magnitude of and reasons for migration; migrating health professionals and the brain drain ; forced migration and its health implications; detaining and screening at the borders; health and human rights issues of migrants once in the host country; the most vulnerable categories of migrants. International Migration Health and Human Rights also examines important topical developments including emerging infectious diseases s

AbstractIntroduction: HIV‐infected individuals on first‐line antiretroviral therapy (ART) in resource‐limited settings who do not achieve the last "90" (viral suppression) enter a complex care cascade: enhanced adherence counselling (EAC), repetition of viral load (VL) and switch to second‐line ART aiming to achieve resuppression. This study describes the "failure cascade" in patients in Lesotho.Methods: Patients aged ≥16 years on first‐line ART at 10 facilities in rural Lesotho received a first‐time VL in June 2014. Those with VL ≥80 copies/mL were included in a cohort. The care cascade was assessed at four points: attendance of EAC, result of follow‐up VL after EAC, switch to second‐line in case of sustained unsuppressed VL and outcome 18 months after the initial unsuppressed VL. Multivariate logistic regression was used to assess predictors of being retained in care with viral resuppression at follow‐up.Results: Out of 1563 patients who underwent first‐time VL, 138 (8.8%) had unsuppressed VL in June 2014. Out of these, 124 (90%) attended EAC and 116 (84%) had follow‐up VL (4 died, 2 transferred out, 11 lost, 5 switched to second‐line before follow‐up VL). Among the 116 with follow‐up VL, 36 (31%) achieved resuppression. Out of the 80 with sustained unsuppressed VL, 58 were switched to second‐line, the remaining continued first line. At 18 months' follow‐up in December 2015, out of the initially 138 with unsuppressed VL, 56 (41%) were in care and virally suppressed, 37 (27%) were in care with unsuppressed VL and the remaining 45 (33%) were lost, dead, transferred to another clinic or without documented VL. Achieving viral resuppression after EAC (adjusted odds ratio (aOR): 5.02; 95% confidence interval: 1.14–22.09; p = 0.033) and being switched to second‐line in case of sustained viremia after EAC (aOR: 7.17; 1.90–27.04; p = 0.004) were associated with being retained in care and virally suppressed at 18 months of follow‐up. Age, gender, education, time on ART and level of VL were not associated.Conclusions: In this study in rural Lesotho, outcomes along the "failure cascade" were poor. To improve outcomes in this vulnerable patient group who fails the last "90", programmes need to focus on timely EAC and switch to second line for cases with continuous viremia despite EAC.