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Journal articleLeng T, Kessou L, Heitner J, et al., 2025,
Potential impact and cost-effectiveness of oral HIV pre-exposure prophylaxis for men who have sex with men in Cotonou, Benin: a mathematical modelling study
, The Lancet Global Health, Vol: 13, Pages: E1111-E1121, ISSN: 2214-109XBackground:Oral HIV pre-exposure prophylaxis (PrEP) can effectively reduce HIV incidence. A 2020–21 demonstration project assessed the feasibility and health outcomes of offering oral PrEP to men who have sex with men (MSM) in Cotonou, Benin. We evaluated the epidemiological impact and cost-effectiveness of this project and the potential scale-up of oral HIV PrEP for MSM in Cotonou.Methods:We calibrated an HIV transmission-dynamic model structured by age and risk within a Bayesian framework to MSM-specific HIV prevalence and treatment data, parameterised with project behavioural and cost (including PrEP drug, implementation, and HIV care costs) data. We estimated the impact and cost-effectiveness of the 2020–21 Cotonou demonstration project (PrEP coverage, 5–10% of all MSM who are not living with HIV in Grand Cotonou; and adherence, 13–21% taking at least four of seven required doses [ie, at least four doses per week for daily users and at least four of seven expected doses given reported sexual activity for on-demand users]) and of its potential scale-up over 5 years (from 2022 to 2027), reaching 30% coverage of MSM in Grand Cotonou and with demonstration project adherence levels. We additionally modelled ideal PrEP adherence (100% taking at least four of seven required doses). We estimated the percentage of cumulative new HIV infections averted among participating MSM over 1 year and among all MSM in Grand Cotonou and their female partners over 20 years, and cost-effectiveness as cost per disability-adjusted life-year (DALY) averted over 20 years. Costs and DALYs were discounted 3% annually.Findings:We found that the demonstration project averted an estimated 21·5% (95% uncertainty interval 16·6 to 26·2) of HIV infections among participants over 1 year. With ideal adherence, cases that would be averted increased to 95·2% (90·8 to 98·8). A 5-year PrEP scale-up could avert 3·2% (1·6 to 4
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Journal articleBaggaley RF, Martin CA, Eborall HC, et al., 2025,
Community-based testing of migrants for infectious diseases (COMBAT-ID): observational cohort study measuring the effectiveness of routine testing for infectious diseases among migrants attending primary care
, Eclinicalmedicine, Vol: 84Background: Migrants are at increased risk of chronic infections and have poorer outcomes, being more likely to present late. Early diagnosis and management can reduce morbidity, mortality and onward infection transmission. Methods: We evaluated the effectiveness of an integrated approach to screening migrants for exposure to tuberculosis (TB) with an interferon gamma release assay (IGRA) test, HIV, hepatitis B virus (HBV, using hepatitis B surface antigen testing) and hepatitis C virus (HCV, using antibody testing with confirmatory PCR test) infection when patients first registered with general practices (GPs) in Leicester, UK, using test yields (test positivity rates), numbers of new diagnoses and numbers linked to care. Findings: Of 4004 migrant GP patients referred for testing 2016–2019, test yields were 0.48% (17/3545, 95% CI 0.30–0.77%, HIV), 3.34% (117/3502, 95% CI 2.80–3.99%, HBV), 0.18% (6/3402, 95% CI 0.08–0.38%, HCV) and 19.38% (496/2560, 95% CI 17.89–20.95%, IGRA). Of IGRA-positive patients attending clinic, 7% (31/437) had active TB and 92% (403/437) had latent TB infection. Seventeen (55%) active TB, 397 (99%) latent TB, 71 (61%) HBV, six (35%) HIV and five (83%) HCV infections were new diagnoses. There were high rates of linkage to care for those newly diagnosed. 98% (390/397) of new latent TB patients were offered chemoprophylaxis, of whom 94% (366/390) started treatment and of these, 95% (346/366) completed the course. 100% (6/6), 97% (69/71) and 100% (5/5) of newly HIV-, HBV- and HCV-diagnosed patients attended follow-up, respectively. Interpretation: This first primary care-based combined infection testing programme for recent migrants found high test yields for latent/active TB, HBV and HIV, substantial numbers of new diagnoses for these infections and excellent linkage to care. To influence UK screening guidelines, its cost-effectiveness and acceptability to other primary care settings must be evaluated. Funding: NI
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Journal articleShah A, Kosmidis C, 2025,
Aspergillus -related lung disease: A wake-up call to navigate complexity in a neglected condition
, Thorax, Vol: 80, Pages: 1-2, ISSN: 0040-6376 -
Journal articleBansi-Matharu L, Moolla H, Citron DT, et al., 2025,
Identifying gaps in the HIV treatment cascade in Africa: a model comparison study
, The Lancet Global Health, Vol: 13, Pages: e1006-e1019, ISSN: 2214-109XBackgroundAlthough HIV incidence has considerably decreased in eastern, central, and southern Africa, new HIV infections continue to be a major public health challenge in the region. We aimed to investigate where in the HIV treatment cascade new transmissions are occurring in Malawi, Zimbabwe, and South Africa (the three countries involved in the Modelling to Inform HIV Programmes in Sub-Saharan Africa project).MethodsIn this model comparison study, we used six well described and independently calibrated HIV transmission dynamics models that have been used to inform HIV policy in Africa (Optima HIV, EMOD, Goals, Thembisa, PopART-IBM, and HIV Synthesis) to estimate and predict the proportion of annual new HIV transmissions attributable to people living with HIV who are undiagnosed, have been diagnosed but have not yet started antiretroviral therapy (ART), are receiving ART, and have interrupted ART in Malawi, Zimbabwe, and South Africa from 2010 to 2040 stratified by the age and sex of the individual acquiring HIV.FindingsDespite the different model structures and underlying assumptions, the six models were well aligned in relation to key HIV epidemic characteristics (including population estimates and HIV prevalence) in each of the three settings. There was, however, considerable variation in the predicted number of new infections, particularly in Malawi and Zimbabwe where this number ranged from fewer than 10 000 new infections to over 30 000 new infections in 2024. Most model results suggested that the mean age of HIV acquisition has been increasing since 2000, with men acquiring HIV at an older age than women in all three settings. All models attributed fewer than 5% of transmissions to individuals who had been diagnosed but had not yet started ART. In Malawi, the proportion of transmissions attributable to undiagnosed people with HIV in 2024 ranged from 33·3% to 75·3% across the models, and transmissions attributable to individuals who had experien
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Journal articleEllis JR, Mutono N, Vasconcelos A, et al., 2025,
How improvements to drug effectiveness impact mass drug administration for control and elimination of schistosomiasis
, Plos Neglected Tropical Diseases, Vol: 19Schistosomiasis affects more than 230 million people worldwide. Control and elimination of this parasitic infection is based on mass drug administration of praziquantel (PZQ), which has been in use for several decades. Because of the limitations of the efficacy of PZQ especially against juvenile worms, and the threat of the emergence of resistance, there is a need to consider alternative formulations or delivery methods, or new drugs that could be more efficacious. We use an individual-based stochastic model of parasite transmission to investigate the effects of possible improvements to drug efficacy. We consider an increase in efficacy compared to PZQ, as well as additional efficacy against the juvenile life stage of schistosome parasites in the human host, and a slow-release formulation that would provide long-lasting efficacy for a period of time following treatment. Analyses suggest a drug with a high efficacy of 99%, or with efficacy lasting 24 weeks after treatment, are the two most effective individual improvements to the drug profile of PZQ. A drug with long lasting efficacy is most beneficial when MDA coverage is low. However, when prevalence of infection has already been reduced to a low level, a high efficacy is the most important factor to accelerate interruption of transmission. Our results indicate that increased efficacy against juvenile worms can only result in modest benefits, but the development of a new drug formulation with higher efficacy against adult worms or long-lasting efficacy would create an improvement to the community impact over the currently used formulation.
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Journal articleLi A, Coffey LL, Mohr EL, et al., 2025,
Role of non-human primate models in accelerating research and developing countermeasures against Zika virus infection
, The Lancet Microbe, Vol: 6, Pages: 101030-101030, ISSN: 2666-5247 -
Journal articleDe Nardi A, Marini G, Dorigatti I, et al., 2025,
Quantifying West Nile virus circulation in the avian host population in Northern Italy.
, Infect Dis Model, Vol: 10, Pages: 375-386West Nile virus (WNV) is one of the most threatening mosquito-borne pathogens in Italy where hundreds of human cases were recorded during the last decade. Here, we estimated the WNV incidence in the avian population in the Emilia-Romagna region through a modelling framework which enabled us to eventually assess the fraction of birds that present anti-WNV antibodies at the end of each epidemiological season. We fitted an SIR model to ornithological data, consisting of 18,989 specimens belonging to Corvidae species collected between 2013 and 2022: every year from May to November birds are captured or shot and tested for WNV genome presence. We found that the incidence peaks between mid-July and late August, infected corvids seem on average 17% more likely to be captured with respect to susceptible ones and seroprevalence was estimated to be larger than other years at the end of 2018, consistent with the anomalous number of recorded human infections. Thanks to our modelling study we quantified WNV infection dynamics in the corvid community, which is still poorly investigated despite its importance for the virus circulation. To the best of our knowledge, this is among the first studies providing quantitative information on infection and immunity in the bird population, yielding new important insights on WNV transmission dynamics.
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Journal articlePeeling RW, Fongwen NT, Guzman MG, et al., 2025,
Specimen and data sharing to advance research and development on Zika virus
, The Lancet Microbe, Vol: 6, Pages: 101057-101057, ISSN: 2666-5247 -
Journal articleDuchêne DA, Chowdhury A-A, Yang J, et al., 2025,
Drivers of avian genomic change revealed by evolutionary rate decomposition
, Nature, Vol: 641, Pages: 1208-1216, ISSN: 0028-0836Modern birds have diversified into a striking array of forms, behaviours and ecological roles. Analyses of molecular evolutionary rates can reveal the links between genomic and phenotypic change1,2,3,4, but disentangling the drivers of rate variation at the whole-genome scale has been difficult. Using comprehensive estimates of traits and evolutionary rates across a family-level phylogeny of birds5,6, we find that genome-wide mutation rates across lineages are predominantly explained by clutch size and generation length, whereas rate variation across genes is driven by the content of guanine and cytosine. Here, to find the subsets of genes and lineages that dominate evolutionary rate variation in birds, we estimated the influence of individual lineages on decomposed axes of gene-specific evolutionary rates. We find that most of the rate variation occurs along recent branches of the tree, associated with present-day families of birds. Additional tests on axes of rate variation show rapid changes in microchromosomes immediately after the Cretaceous–Palaeogene transition. These apparent pulses of evolution are consistent with major changes in the genetic machineries for meiosis, heart performance, and RNA splicing, surveillance and translation, and correlate with the ecological diversity reflected in increased tarsus length. Collectively, our analyses paint a nuanced picture of avian evolution, revealing that the ancestors of the most diverse lineages of birds underwent major genomic changes related to mutation, gene usage and niche expansion in the early Palaeogene period.
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Journal articlePapadopoulou E, Sykes DL, Goeminne P, et al., 2025,
Patients’ perspectives on antimicrobial resistance in chronic respiratory disease: an AMR-Lung – European Lung Foundation global patient survey
, ERJ Open Research, ISSN: 2312-0541Background:Antimicrobial resistance (AMR) represents a significant global health threat, particularly for people with chronic respiratory diseases. However, their experiences, knowledge, priorities and concerns have not been comprehensively assessed. This study aimed to gauge patients’ perspectives of AMR burden in chronic respiratory disease.Methods:An anonymous web-based patient survey was developed by AMR-Lung ERS Clinical Research Collaboration and members from the European Lung Foundation patient advisory groups, consisting of 39 questions, translated into 20 languages and held online over a 2-month period. Multivariable logistic regression analyses were used to explore disease-specific burden and factors potentially affecting AMR across different healthcare settings.Results:Among 2012 respondents from 57 countries on all 6 continents, 30.7% recalled having an AMR-associated infection, while 12.6% perceived their last antimicrobial course as ineffective. 30.5% received long-term prophylactic antimicrobials, with 44.6% of them recalling an AMR-associated infection. 17.6% reported antimicrobial use without medical prescription, while 9.5% perceived prescriptions as delayed. Respondents recognised mostly their healthcare professionals as an information source regarding AMR, but 27% were unaware of AMR prior to the survey. Patients from high-income countries were more likely to be knowledgeable about AMR, and less inclined to use antimicrobials without prescription and to perceive them as ineffective. Respondents overwhelmingly viewed AMR as a personal (76.4%) and global (79.6%) threat.Conclusions:This global large-scale survey ascertains for the first time the high AMR burden from the perspective of people with chronic respiratory diseases, accentuating the need to promote AMR awareness, judicious antimicrobial use, and accessibility to quality healthcare.
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