Program for Appropriate Technology in Health PATH

Seattle, United States

Program for Appropriate Technology in Health PATH

Seattle, United States
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Gallo M.F.,Centers for Disease Control and Prevention | Kilbourne-Brook M.,Program for Appropriate Technology in Health PATH | Coffey P.S.,Program for Appropriate Technology in Health PATH
Sexual Health | Year: 2012

The female condom remains the sole female-initiated method of dual protection against unintended pregnancy and sexually transmissible infections (STIs), including HIV. We reviewed published data on the effectiveness and acceptability of the female condom for protection against pregnancy and infection. Overall, use of the female condom is low and several barriers hinder the wider adoption of the use of the method. Research on effectiveness has focussed on pregnancy, STIs and biological markers of semen exposure. Although the data available suggest that female condoms (or a mixture of female and male condoms) may provide similar degrees of protection against pregnancy and STIs as do latex male condoms alone, this conclusion has not been demonstrated and thus comparative research is urgently needed. Journal compilation © CSIRO 2012.

Leung J.,Centers for Disease Control and Prevention | Harpaz R.,Centers for Disease Control and Prevention | Molinari N.-A.,Centers for Disease Control and Prevention | Jumaan A.,Centers for Disease Control and Prevention | And 2 more authors.
Clinical Infectious Diseases | Year: 2011

Background: Herpes zoster (HZ) is caused by reactivation of latent varicella zoster virus and is often associated with substantial pain and disability. Baseline incidence of HZ prior to introduction of HZ vaccine is not well described, and it is unclear whether introduction of the varicella vaccination program in 1995 has altered the epidemiology of HZ. We examined trends in the incidence of HZ and impact of varicella vaccination on HZ trends using a large medical claims database. Methods: Medical claims data from the MarketScan ® databases were obtained for 1993-2006. We calculated HZ incidence using all persons with a first outpatient service associated with a 053.xx code (HZ ICD-9 code) as the numerator, and total MarketScan enrollment as the denominator; HZ incidence was stratified by age and sex. We used statewide varicella vaccination coverage in children aged 19-35 months to explore the impact of varicella vaccination on HZ incidence. Results: HZ incidence increased for the entire study period and for all age groups, with greater rates of increase 1993-1996 (P <.001). HZ rates were higher for females than males throughout the study period (P <.001) and for all age groups (P <.001). HZ incidence did not vary by state varicella vaccination coverage. Conclusions: HZ incidence has been increasing from 1993-2006. We found no evidence to attribute the increase to the varicella vaccine program. © The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.

Boyle D.S.,Program for Appropriate Technology in Health Path | Hawkins K.R.,Program for Appropriate Technology in Health Path | Steele M.S.,Program for Appropriate Technology in Health Path | Singhal M.,Program for Appropriate Technology in Health Path | Cheng X.,Lehigh University
Trends in Biotechnology | Year: 2012

A CD4 T-lymphocyte count determines eligibility for antiretroviral therapy (ART) in patients recently diagnosed with HIV and also monitors the efficacy of ART treatment thereafter. ART slows the progression of HIV to AIDS. In the developing world, CD4 tests are often performed in centralized laboratories, typically in urban areas. The expansion of ART programs into rural areas has created a need for rapid CD4 counting because logistical barriers can delay the timely dissemination of test results and affect patient care through delay in intervention or loss of follow-up care. CD4 measurement at the point-of-care (POC) in rural areas could help the facilitation of ART and monitoring of treatment. This review highlights recent technology developments with applications towards determining CD4 counts at the POC. © 2011 Elsevier Ltd.

Frezieres R.G.,California Family Health Council | Walsh T.,California Family Health Council | Kilbourne-Brook M.,Program for Appropriate Technology in Health PATH | Coffey P.S.,Program for Appropriate Technology in Health PATH
Contraception | Year: 2012

Background: Disposable plastic applicators used in microbicide gel studies are expensive and have a negative environmental impact. The SILCS diaphragm is a barrier contraceptive that could offer a reusable delivery system. Study Design: Thirty-six couples in this randomized, cross-over study evaluated single- and double-sided gel delivery from a SILCS diaphragm compared with gel from an applicator. Couples used each gel scenario during two acts of intercourse and completed acceptability questionnaires after each. Results: All three scenarios received favorable ratings for ease of application, acceptability and perceived effectiveness. Both female and male participants tended to rate the gel applicator significantly more favorably than either SILCS gel delivery scenarios for all attributes except messiness/leakage and effectiveness. Additionally, about 60% of female participants and about half of male participants preferred the gel applicator to either of the gel delivery systems using SILCS. The preference for the SILCS scenario for pregnancy protection was statistically significant for both sexes. Male participants were also significantly more likely to prefer the SILCS single-sided delivery system to the gel applicator for protection from sexually transmitted infection. Conclusions: In this study population, participants found the gel applicator to be more acceptable than either single- or double-sided gel delivery from a SILCS diaphragm. Further research of the SILCS as a microbicide delivery system should be implemented to assess its acceptability among study populations that reflect diverse potential user groups such as women and men from both low and high HIV prevalence settings including HIV-positive populations and with and without experience using female barrier methods. © 2012 Elsevier Inc. All rights reserved.

Major I.,Queen's University of Belfast | Boyd P.,Queen's University of Belfast | Kilbourne-Brook M.,Program for Appropriate Technology in Health PATH | Saxon G.,Program for Appropriate Technology in Health PATH | And 2 more authors.
Contraception | Year: 2013

Background: There is considerable interest in developing new multipurpose prevention technologies to address women's reproductive health needs. This study describes an innovative barrier contraceptive device - based on the SILCS diaphragm - that also provides long-term controlled release of the lead candidate anti-HIV microbicide dapivirine. Study Design: Diaphragm devices comprising various dapivirine-loaded polymer spring cores overmolded with a nonmedicated silicone elastomer sheath were fabricated by injection molding processes. In vitro release testing, thermal analysis and mechanical characterization were performed on the devices. Results: A diaphragm device containing a polyoxymethylene spring core loaded with 10% w/w dapivirine provided continuous and controlled release of dapivirine over a 6-month period, with a mean in vitro daily release rate of 174 mcg/day. The mechanical properties of the new diaphragm were closely matched to the SILCS diaphragm. Conclusions: The study demonstrates proof of concept for a dapivirine-releasing diaphragm with daily release quantities potentially capable of preventing HIV transmission. In discontinuous clinical use, release of dapivirine may be readily extended over 1 or more years. © 2013 Elsevier Inc. All rights reserved.

Baingana R.,Makerere University | Matovu-Kasozi D.,Makerere University | Garrett D.,Program for Appropriate Technology in Health PATH
Public Health Nutrition | Year: 2013

Objective To improve estimates of vitamin A deficiency in children of pre-school age in the 2006 Uganda Demographic and Health Survey (UDHS 2006). Design A cross-sectional study in which dried blood spot samples were analysed for C-reactive protein (CRP). Retinol-binding protein (RBP) had previously been analysed using a commercial enzyme immunoassay. Setting A population-based study in Uganda. Subjects A systematically selected subset of the dried blood spot samples collected from children aged 6-59 months for UDHS 2006. Children were categorized into 'normal CRP' (Group A) and 'raised CRP' (Group B) using a CRP cut-off of 5 mg/l. A correction factor was calculated to adjust the Group B RBP values for the influence of the acute-phase response. Results Geometric mean CRP was 6·2 (95 % CI 5·5, 7·0) mg/l, 1·6 (95 % CI 1·5, 1·8) mg/l and 17·9 (95 % CI 16·4, 19·6) mg/l in all children, in Group A and in Group B, respectively. Geometric mean RBP in all children, in Group A and in Group B was 1·18 (95 % CI 1·14, 1·22) μmol/l, 1·26 (95 % CI 1·20, 1·33) μmol/l and 1·12 (95 % CI 1·07, 1·17) μmol/l, respectively, before correction. Correction increased mean RBP in Group B to 1·26 (95 % CI 1·21, 1·31) μmol/l. The prevalence of vitamin A deficiency (RBP < 0·825 μmol/l) reduced from 18·4 % (95 % CI 17·2, 23·0 %) to 13·9 % (95 % CI 11·3, 16·5 %). Conclusions Correcting for the acute-phase response significantly reduced the prevalence of vitamin A deficiency; thus, the acute-phase response should be considered when vitamin A status is assessed using RBP in order to improve population-level estimates of vitamin A deficiency. Copyright © The Authors 2012.

Chi R.-C.,Veterans Affairs Puget Sound Health Care System | Rock M.T.,Vanderbilt University | Neuzil K.M.,University of Washington | Neuzil K.M.,Program for Appropriate Technology in Health PATH
Clinical Infectious Diseases | Year: 2010

Background. Influenza vaccine immunogenicity is suboptimal in older persons. Intradermal (ID) vaccination may be a promising alternative to intramuscular (IM) vaccination. Methods. This randomized trial compared the immunogenicity of 60% dose ID influenza vaccination to standard IM vaccination of full-dose or 60% dose vaccine. Pre- and postvaccination measurements in the hemagglutination inhibition antibody titer were compared. Participants who received reduced-dose vaccine were revaccinated with full-dose IM vaccine. Results. 257 healthy adults aged 2≥65 years received 1 of the following trivalent inactivated influenza vaccines: standard-dose (15 μg each of 3 hemagglutinin vaccine antigens in 0.5 mL) IM injection, reduced-dose (9 μg, 0.3 mL) IM injection, reduced-dose (9 μg, 0.3 mL) ID injection, or 2 reduced-dose (4.5 μg, 0.15 mL) ID injections. Respective seroprotection rates were 65.6%, 57.8%, 68.9%, and 67.2% against A/H1N1; 76.6%, 75.0%, 75.4%, and 75.0% against A/H3N2; and 26.6%, 17.2%, 16.4%, and 25.0% against influenza B. Subsequent full-dose IM vaccination of participants randomized to reduced-dose vaccine by either IM or ID routes did not improve seroprotection rates. Local reactions of redness, swelling, and itching were significantly more frequent among recipients of ID injections. Conclusion. Influenza vaccine at 60% dose by either IM or ID route elicited antibody responses generally similar to full-dose IM vaccination among healthy elderly persons ( identifier: NCT00504231). © 2010 by the Infectious Diseases Society of America. All rights reserved.

Weigl B.H.,Program for Appropriate Technology in Health PATH | Neogi T.,University of Washington | McGuire H.,Program for Appropriate Technology in Health PATH
Journal of Laboratory Automation | Year: 2014

The emergence of point-of-care (POC) diagnostics specifically designed for low-resource settings coupled with the rapid increase in need for routine care of patients with chronic diseases should prompt reconsideration of how health care can be delivered most beneficially and cost-effectively in developing countries. Bolstering support for primary care to provide rapid and appropriate integrated acute and chronic care treatment may be a possible solution. POC diagnostics can empower local and primary care providers and enable them to make better clinical decisions. This article explores the opportunity for POC diagnostics to strengthen primary care and chronic disease diagnosis and management in a low-resource setting (LRS) to deliver appropriate, consistent, and integrated care. We analyze the requirements of resource-appropriate chronic disease care, the characteristics of POC diagnostics in LRS versus the developed world, the many roles of diagnostics in the care continuum in LRS, and the process and economics of developing LRS-compatible POC diagnostics. © 2013 Society for Laboratory Automation and Screening.

Hickling J.K.,Working in Tandem Ltd | Jones K.R.,Working in Tandem Ltd | Friede M.,World Health Organization | Zehrung D.,Program for Appropriate Technology in Health PATH | And 2 more authors.
Bulletin of the World Health Organization | Year: 2011

Delivery of vaccine antigens to the dermis and/or epidermis of human skin (i.e. intradermal delivery) might be more efficient than injection into the muscle or subcutaneous tissue, thereby reducing the volumes of antigen. This is known as dose-sparing and has been demonstrated in clinical trials with some, but not all, vaccines. Dose-sparing could be beneficial to immunization programmes by potentially reducing the costs of purchase, distribution and storage of vaccines; increasing vaccine availability and effectiveness. The data obtained with intradermal delivery of some vaccines are encouraging and warrant further study and development; however significant gaps in knowledge and operational challenges such as reformulation, optimizing vaccine presentation and development of novel devices to aid intradermal vaccine delivery need to be addressed. Modelling of the costs and potential savings resulting from intradermal delivery should be done to provide realistic expectations of the potential benefits and to support cases for investment. Implementation and uptake of intradermal vaccine delivery requires further research and development, which depends upon collaboration between multiple stakeholders in the field of vaccination.

Mugisha E.,Program for Appropriate Technology in Health PATH | Van Rensburg G.H.,University of South Africa | Potgieter E.,University of South Africa
AIDS Research and Treatment | Year: 2011

Despite the usefulness of VCT service as an entry point to prevention for the HIV-uninfected people and care, treatment and support for those who test HIV positive, VCT service remains poorly utilized among the fishing communities. The aim of the study was to identify factors influencing VCT service delivery and utilisation among fishing communities in Uganda and consequently, formulated a strategic framework for improving VCT service delivery and utilisation in the fishing communities. The study followed a 3-phased approach, collecting and analyzing quantitative data from Kasenyi fishing community under phase I, collecting and analyzing qualitative data from hospital managers and VCT counselors in phases II and III, respectively. Results indicate that VCT services delivery and utilisation is affected by factors at government (macro) level, the institution (meso) level, and at the individual (micro) level. Based on this, a strategic framework was designed, expected to increase VCT service availability, accessibility, and acceptability if applied. The researcher recommends the use of this useful tool in the design of VCT programs. © 2011 E. Mugisha et al.

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