Optimal strategies to screen health care workers for COVID-19 in the US: a cost-effectiveness analysis

Background Transmission of SARS-CoV-2 in health care facilities poses a challenge against pandemic control. Health care workers (HCWs) have frequent and high-risk interactions with COVID-19 patients. We undertook a cost-effectiveness analysis to determine optimal testing strategies for screening HCWs to inform strategic decision-making in health care settings. Methods We modeled the number of new infections, quality-adjusted life years lost, and net costs related to six testing strategies including no test. We applied our model to four strata of HCWs, defined by the presence and timing of symptoms. We conducted sensitivity analyses to account for uncertainty in inputs. Results When screening recently symptomatic HCWs, conducting only a PCR test is preferable; it saves costs and improves health outcomes in the first week post-symptom onset, and costs $83,000 per quality-adjusted life year gained in the second week post-symptom onset. When screening HCWs in the late clinical disease stage, none of the testing approaches is cost-effective and thus no testing is preferable, yielding $11 and 0.003 new infections per 10 HCWs. For screening asymptomatic HCWs, antigen testing is preferable to PCR testing due to its lower cost. Conclusions Both PCR and antigen testing are beneficial strategies to identify infected HCWs and reduce transmission of SARS-CoV-2 in health care settings. IgG tests’ value depends on test timing and immunity characteristics, however it is not cost-effective in a low prevalence setting. As the context of the pandemic evolves, our study provides insight to health-care decision makers to keep the health care workforce safe and transmissions low.

Antimicrobial Resistance Following Prolonged Use of Hand Hygiene Products: A Systematic Review

Background: This systematic review aimed to establish whether antimicrobial resistance (AMR) occurs following prolonged use of antimicrobial hand hygiene (HH) products, and, if so, in what magnitude. Methods: Key bibliographic databases were searched to locate items on HH use and AMR development from database inception to December 2020. Records were screened and full texts of all potentially eligible articles were retrieved and checked for inclusion. The following data from the included studies were abstracted: type of HH product used, including the name of antimicrobial agent, study setting, country, study year, duration of use and development of AMR including the organisms involved. Quality assessment was done using the Newcastle-Ottawa Scale (NOS). Results: Of 339 full-text articles assessed for eligibility, only four heterogeneous United States (US) studies conducted in the period between 1986 and 2015 were found eligible, and included. One hospital-based study showed evidence of AMR following long term use of HH products, two studies conducted in household settings showed no evidence of AMR, and another experimental study showed partial evidence of AMR. The overall certainty of the evidence was moderate. Conclusion: Prolonged use of HH products may cause AMR in health care settings, but perhaps not in other settings.

Article 37: Prohibition of Torture, Capital Punishment, and Arbitrary Deprivation of Liberty

Article 37 is inspired by the provisions of the International Covenant on Civil and Political Rights (ICCPR). However, it extends the ICCPR’s provisions to the protection of the children by: (1) imposing the prohibition of life imprisonment for children without the possibility of release; (2) demanding that detention of a child shall be used as a measure of last resort and be imposed for the shortest period of time; and (3) providing to children deprived of liberty the right to maintain contacts with their family members. Article 37 imposes a child-centred understanding of its provisions and rights. These rights extend beyond the ambit of child justice administration to all situations where children may be deprived of liberty, including, for example, child protection settings, health care settings, and immigration settings. This chapter analyses Article 37 rights in accordance with four essential attributes, as enumerated in its four constituent paragraphs: (1) the prohibition in paragraph (a) on torture or ill-treatment, specifically ruling out capital punishment and life imprisonment without parole for minors; (2) the prohibition in paragraph (b) of unlawful and arbitrary deprivations of liberty, insisting that such sanctions are a measure of last resort that must only be imposed for the shortest appropriate period; (3) the limitations on the deprivation of liberty, including the core commitment in paragraph (c) to upholding the child’s inherent dignity and right to be treated with humanity in such circumstances; and (4) the right, in paragraph (d), to minimal due process guarantees which must accompany any child’s deprivation of liberty. While youth criminal justice practice varies greatly from state to state, Articles 37 and 40 have emerged as a codification of global standards set out in the Beijing Rules and a summary prompt to the adoption of guidelines and minimum rules for the protection of children deprived of liberty and the prevention of youth crime. Article 37 should therefore be applied consistently with the recent General Comment no. 24 (2019) on Children’s Rights in the Child Justice System.

Mapping evidence on strengthened and sustained delivery early detection and management of Hypertension and Diabetes among PLWH: a scoping review protocol

ObjectiveThe main review objective of this scoping review is to identify the evidence on the patient outcomes of integrated NCD and HIV services, the type of models used, barriers and facilitators of effective integrated services for early detection and management of hypertension and diabetes in adults PLWH in primary health care settings of Low-income countries. Introduction:Non-communicable diseases (NCDs) raise global public health challenges in all population groups, but the prevalence of hypertension and diabetes is highly rising among people living with HIV (PLWH). This population group requires evidence-based care for early detection and management of hypertension and diabetes. However, there is a lack of evidence regarding the impact of integrated NCD and HIV services on outcomes of PLWH, its feasibility and effectiveness of services provision and the type of models used in strengthened and sustainable services for early detection and management of hypertension and diabetes in primary health care settings. It is necessary to map and models of integrated NCD and HIV services for PLWH and its feasibility and effectiveness as well patient outcomes in a primary health care setting in low-income countries Inclusion criteria: This scoping review will consider studies focusing on the model of integrated Non-communicable and HIV services for adult people living with HIV, including the type of models used, its feasibility, effectiveness and outcome of integrated services in primary health care settings. All published and grey literature will be included in the review. Methods: The search will be carried out using PubMed, MEDLINE with full text via EBSCO host, Google Scholar, Science Direct and Scopus, for a comprehensive search. Using MESH terms, an advanced search will be conducted and also will include grey literature through OpenGrey. This review will be restricted to studies published in English because of the feasibility of translating languages other than English. A three-step search strategy will be used, and the articles identified in the databases will be organised, and the duplicates will be removed. Two independent reviewers will review the titles and abstracts. Full texts will be imported into a bibliographic reference management system. The findings will be presented in tables and descriptive summaries.