Publications by authors named "Adrian D Smith"

Objectives: This study aimed to develop and validate a clinical score for the prediction of critical care entrance in children with dengue.

Methods: We conducted a retrospective cohort study using admissions from January 2019 to August 2021, at Hospital Infantil Napoleón Franco Pareja, in Cartagena, Colombia. We included all children 18 years or younger, with a positive immunoglobulin M or nonstructural protein 1 laboratory test and admitted for follow-up at the emergency department.

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  • A study in Kenya assessed the prevalence of pre-treatment HIV drug resistance (HIVDR) among various groups, including MSM, PWID, FSWs, heterosexuals, and children, revealing that children had the highest resistance at 41.3%.
  • The analysis covered HIV-1 sequences collected from 1986 to 2020, identifying a concerning increase in pre-treatment HIVDR from 6.9% before 2005 to 24.2% from 2016-2020, particularly among HETs, who saw fluctuations in their resistance rates.
  • The research identified 32 transmission clusters with shared mutations, indicating ongoing transmission, particularly in a notable cluster of MSM with the K103N mutation,
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Objective: We carried out a study to estimate the vaccine effectiveness (VE) of homologous vaccination schedules against COVID-19, using data from mandatory information systems from Bogota, Colombia.

Methods: A test-negative case-control study in adults from Bogota (Colombia), between March 1st of 2021 and February 25th of 2022. We assess VE among symptomatic COVID-19 cases during the Mul, Delta, and Omicron predominance periods in Bogota, with controls matched by sex, age (±5 years), and date of testing (±7 days), using a case:control ratio of 1:1.

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Background: We aim to estimate the magnitude of the reduction in pneumococcal pneumonia and meningitis mortality after the mass introduction of pneumococcal conjugate vaccine (PCV)7 and PCV13 in children in the United States.

Methods: We assessed the trends in mortality rates from pneumococcal pneumonia and meningitis, in the United States between 1994 and 2017. We fitted an interrupted time-series negative binomial regression model (adjusted by trend, seasonality, PCV7/PCV13 coverage, and H.

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  • - The study investigates the fatalities of Indonesian healthcare workers (HCWs) due to COVID-19 from March 2020 to July 2021, revealing at least 1,545 deaths among HCWs, primarily affecting physicians, nurses, and midwives.
  • - The mortality rate for HCWs was significantly higher compared to the general population, with a rate of 1.707 deaths per 1,000 HCWs and a risk ratio of 4.92, suggesting HCWs faced nearly five times the mortality risk.
  • - The majority of deceased HCWs were aged 40 to 59, with a median age of 50, and many had pre-existing health conditions; the report highlights the urgent need for systematic
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  • The study evaluated the effectiveness of two rapid diagnostic tests (RDTs) for syphilis (Bioline and Determine) specifically in people living with HIV (PLWH) in Cali, Colombia.
  • A total of 244 participants were studied, revealing high sensitivity for Bioline and variability in Determine's performance based on sample type and ART status.
  • Despite the overall excellent performance of the RDTs for screening syphilis in PLWH, concerns were noted regarding the lower sensitivity of Determine on capillary blood compared to serum samples.
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  • In February 2021, Colombia launched a mass COVID-19 vaccination campaign using primarily the BNT162b2 (Pfizer) and CoronaVac vaccines, targeting individuals over 40 years old in a high-transmission area.
  • The study tracked 796,072 insured individuals and assessed the vaccines' effectiveness in preventing symptomatic COVID-19, hospitalizations, critical care admissions, and deaths from March to August 2021.
  • Findings indicated that while CoronaVac showed limited effectiveness for those over 80, it significantly reduced severe outcomes for individuals aged 40-79, and BNT162b2 was effective across all age groups above 40, though its effectiveness decreased for those 80 and older.
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  • In Kenya, key populations like men who have sex with men, people who inject drugs, and female sex workers significantly impact the transmission of HIV-1 within the broader heterosexual population, but data on their transmission dynamics is limited.
  • A study analyzed 4058 HIV-1 sequences from various risk groups and regions, revealing that 89% of transmissions occur within the same risk group, with 11% from mixing between groups.
  • The research indicates that low-prevalence regions and key populations mainly act as sinks for HIV-1 transmission, suggesting that both key populations and the general epidemic need targeted intervention strategies.
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HIV-1 transmission dynamics involving men who have sex with men (MSM) in Africa are not well understood. We investigated the rates of HIV-1 transmission between MSM across three regions in Kenya: Coast, Nairobi, and Nyanza. We analyzed 372 HIV-1 partial sequences sampled during 2006-2019 from MSM in Coast ( = 178, 47.

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  • The study examines how programs that integrate HIV and TB treatment in sub-Saharan Africa influence access to antiretroviral therapy (ART) for co-infected patients, highlighting that uptake remains low despite these integrations.
  • A systematic review was conducted, analyzing data from 27 studies, revealing that the overall ART uptake was only 53%, with significant variability between different studies.
  • Key barriers to ART uptake identified included stigma, low income, and limited healthcare resources, while enablers involved effective management of supply chains and supportive health systems.
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Men who have sex with men (MSM) in Kenya bear a heavy burden of HIV/STIs and are a priority population in the national HIV/AIDS response, yet remain criminalised and stigmatised within society. HIV pre-exposure prophylaxis (PrEP) offers an opportunity to significantly impact the HIV epidemic, as does the concept of U = U, whereby those who are living with HIV and on treatment are uninfectious when their viral load has been suppressed so as to be undetectable. However, the value of such innovations will not be realised without sufficient understanding of, and respect for, the sexual health service provision needs of MSM.

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Background: Our aim was to study the association between case rates and reductions in urban mobility in state capitals of Colombia.

Methods: We designed an ecological time-series study to correlate the Colombian incidence rate with reductions in mobility trends of retail stores.

Results: The meta-analysis of β coefficients describing the association between case rates and reductions in mobility trends of retail stores resulted in a mean estimate of 0.

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Background: Transgender people are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide, and culturally competent prevention and treatment services are often unavailable or inaccessible. Despite recent improvements in national HIV responses for many key populations in east Africa, evidence of effective responses informed by transgender sexual health needs is sparse. We aimed to assess gender identity among men and transgender people who have sex with men in Kenya, and to explore its associations with sexual health-related outcomes, risk behaviours, and uptake of HIV prevention and care interventions.

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Introduction: There is little published literature about gay, bisexual and other men who have sex with men and transgender individuals (MSM and TG)'s use of social media in sub-Saharan Africa, despite repressive social and/or criminalizing contexts that limit access to physical HIV prevention. We sought to describe MSM and TG's online socializing in Nairobi and Johannesburg, identifying the characteristics of those socializing online and those not, in order to inform the development of research and health promotion in online environments.

Methods: Respondent-driven sampling surveys were conducted in 2017 in Nairobi (n = 618) and Johannesburg (n = 301) with those reporting current male gender identity or male sex assigned at birth and sex with a man in the last 12 months.

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Introduction: Men who have sex with men and transgender individuals (MSM/TG) carry a disproportionately high burden of HIV, including in South Africa. However, there are few empirical population-representative estimates of viral suppression and the HIV care cascade including HIV testing among this population, nor of factors associated with these outcomes.

Methods: We conducted a respondent driven sampling (RDS) survey among 301 MSM/TG in Johannesburg in 2017.

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Background: Influenza is a common cause of severe respiratory illness, but risk factors for hospitalisation in low income settings with a high HIV prevalence are not well described. We aimed to assess risk factors associated with influenza-associated severe acute respiratory illness (SARI) hospitalisation in South Africa.

Methods: We conducted a case-population study using data on risk conditions in patients hospitalised with SARI and the national prevalence of these conditions.

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Objective: African men who have sex with men often sell sex to men, and MSM who sell sex (MSM-SW) often also have female partners. We compared sexual risk behaviour of MSM-SW who were sexually active with female partners (bisexual MSW) to MSM-SW with only male partners (exclusive MSW).

Design: Descriptive behavioural study

Methods: : A novel, validated daily event and partner diary self-completed by 82 MSM who sold sex over a follow-up period of 42 days with weekly review.

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Background: Violence toward MSM and female sex workers (FSW) is associated with HIV risk, and its prevention is prioritized in international HIV/AIDS policy.

Methods: Sociodemographic and behavioural data derived from HIV risk and follow-up cohorts including MSM and FSW in coastal Kenya between 2005 and 2014 was used to estimate the risk of rape, physical assault and verbal abuse, and to assess associations between first occurrence of assault with individual and recent behavioural factors.

Results: Incidence of first reported rape was similar for MSM [3.

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  • Men who have sex with men (MSM) in Kenya are recognized as a vulnerable group at high risk for HIV due to social stigma and limited access to sexual health services.
  • A study involving 26 self-identified MSM in Malindi revealed four main themes influencing their sexual identities and decision-making: conflict between the concepts of 'homosexuality' and 'African identity,' gender stereotypes regarding sexual roles, socioeconomic constraints on personal choices, and the commercialization of non-normative sexualities.
  • The findings suggest that addressing LGBTQ+ sexual health and HIV risks requires a deeper understanding of the sociocultural factors impacting this community, which should inform future health interventions and public health programs.
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  • A training program for healthcare providers in Kenya showed promise in reducing prejudice and improving care for MSM two years later.
  • Recommendations from the study included expanding sensitivity training, creating guidelines for infections, advocating for supportive policies, and incorporating MSM data into national HIV reporting frameworks.
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Background: Influenza and respiratory syncytial virus (RSV) infection are common causes of lower respiratory tract illness. Data on their burden in low and middle-income settings and from Africa are scarce. We aimed to estimate age-specific rates of hospitalization attributable to influenza and RSV among patients attending private hospitals in South Africa during 2007-2012.

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