Monitoring HIV Treatment and the Health Sector Cascade: From Treatment Numbers to Impact

Although not originally part of the MDGs, HIV treatment has been at the center of global HIV reporting since 2003, marked by achievement of the target of 15 million people receiving treatment before 2015 and 18.2 million (16.1–19.0 million) by mid 2016. Monitoring of treatment has been strengthened with harmonized partner reporting and accountability with regular, annual reports. Beyond treatment numbers, increasingly measures of treatment adherence, retention and outcomes have been reported though with varying quality and completeness. However, with the sustainable development goals (SDGs), monitoring treatment is changing in three important ways. First, treatment monitoring is shifting from numbers to coverage and gaps in a cascade of services to achieve universal access. Secondly, this requires greater emphasis on disaggregated, individual level patient and case monitoring systems, which can better support linkage, retention and chronic, long term care. Thirdly, the prevention, testing and treatment cascade with a clear results chain, links treatment numbers to impact, in terms of reduced viral load, mortality and incidence. This agenda will require a greater contribution of routine impact evaluation alongside monitoring, with treatment seen as part of a cascade of services to ensure impact on mortality and incidence. In conclusion, the shift from monitoring treatment numbers to treatment linked to universal access to prevention, testing and treatment and impact on mortality and incidence, will be critical to monitor, evaluate, and improve HIV programs as part of the SDGs.     

Can synthetic urine replace authentic urine to “beat” workplace drug testing?

Synthetic urine (SU), which was primarily utilized by drug testing laboratories as a matrix for quality control preparations, is now commercially sold and can be used to “fool” a positive drug test. To determine if SU can pass as authentic urine, we challenged Army urine drug testing specimen accessioning and testing procedures using eight different commercial SU products. Adulteration (Sciteck AdultaCheck^® 6) and Onsite SU (Synthetic UrineCheck?) test strips were also evaluated. Five of the eight SU were identified by physical observation. All SU products screened negative in the drug immunoassay and additionally passed the specimen validity testing (SVT) as authentic urine. Furthermore, SU was not detected as adulterated with the adulteration test strips (Sciteck AdultaCheck^® 6) but was successfully detected as SU with the On‐site synthetic urine (Synthetic UrineCheck?). To deter SU use, direct observation, as utilized by the military, may be recommended during the collection process.     

Capsule endoscopy capture rate: Has 4 frames-per-second any impact over 2 frames-per-second?

AIM: To compare the current capsule and a new prototype at 2 and 4 frames-per-second, respectively, in terms of clinical and therapeutic impact.METHODS: One hundred patients with an indication for capsule endoscopy were included in the study. All procedures were performed with the new device (SB2₄). After an exhaustive evaluation of the SB2₄ videos, they were then converted to “SB2-like” videos for their evaluation. Findings, frames per finding, and clinical and therapeutic impact derived from video visualization were analyzed. Kappa index for interobserver agreement and χ² and Student’s t tests for qualitative/quantitative variables, respectively, were used. Values of P under 0.05 were considered statistically significant.RESULTS: Eighty-nine out of 100 cases included in the study were ultimately included in the analysis. The SB2₄ videos detected the anatomical landmarks (Z-line and duodenal papilla) and lesions in more patients than the “SB2-like” videos. On the other hand, the SB2₄ videos detected more frames per landmark/lesion than the “SB2-like” videos. However, these differences were not statistically significant (P > 0.05). Both clinical and therapeutic impacts were similar between SB2₄ and “SB2-like” videos (K = 0.954). The time spent by readers was significantly higher for SB2₄ videos visualization (P < 0.05) than for “SB2-like” videos when all images captured by the capsule were considered. However, these differences become non-significant if we only take into account small bowel images (P > 0.05).CONCLUSION: More frames-per-second detect more landmarks, lesions, and frames per landmark/lesion, but is time consuming and has a very low impact on clinical and therapeutic management.     

Association Between Vitamin D Receptor rs731236 (Taq1) Polymorphism and Risk for Restless Legs Syndrome in the Spanish Caucasian Population

Several recent works suggest a possible role of vitamin D deficiency in the etiology or restless legs syndrome (RLS). We analyzed the possible relationship of 2 common single nucleotide polymorphisms (SNPs) in the vitamin D3 receptor (VDR) gene with the risk for RLS.We studied the genotype and allelic variant frequencies of VDR rs2228570 and VDR rs731236 SNPs in 205 RLS patients and 445 healthy controls using a TaqMan essay.The frequencies of the rs731236AA genotype and the allelic variant rs731236A were significantly lower in RLS patients than in controls (P < 0.005 and < 0.01, respectively). Restless legs syndrome patients carrying the allelic variant rs731236G had an earlier age at onset, and those carrying the rs731236GG genotype had higher severity of RLS, although these data disappeared after multivariate analyses. None of the SNPs studied was related with the positivity of family history of RLS.These results suggest a modest, but significant association between VDR rs731236 SNP and the risk for RLS.