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Background: The importance of immunization for child survival underscores the need to eliminate immunization inequalities. Few existing studies of inequalities use approaches that view the challenges and potential solutions from the perspective of caregivers. This study aimed to identify barriers and context-appropriate solutions by engaging deeply with caregivers, community members, health workers, and other health system actors through participatory action research, intersectionality, and human-centered design lenses. Methods: This study was conducted in the Demographic Republic of Congo, Mozambique and Nigeria. Rapid qualitative research was followed by co-creation workshops with study participants to identify solutions. We analyzed the data using the UNICEF Journey to Health and Immunization Framework. Results: Caregivers of zero-dose and under-immunized children faced multiple intersecting and interacting barriers related to gender, poverty, geographic access, and service experience. Immunization programs were not aligned with needs of the most vulnerable due to the sub-optimal implementation of pro-equity strategies, such as outreach vaccination. Caregivers and communities identified feasible solutions through co-creation workshops and this approach should be used whenever possible to inform local planning. Conclusions: Policymakers and managers can integrate HCD and intersectionality mindsets into existing planning and assessment processes, and focus on overcoming root causes of sub-optimal implementation.

IntroductionIn May 2023, when the WHO declared that COVID-19 was no longer a public health emergency of international concern, countries began considering transitioning from the emergency phase to routine provision of COVID-19 vaccination. This paper presents the experience of seven countries with integrating COVID-19 vaccination into other health services and health system functions.MethodsData collection took place between August 2023 and April 2024 in Benin, Ethiopia, Ghana, India (Tamil Nadu State), Liberia, Mozambique and Nigeria using key informant interviews and focus group discussions. Interviewees included national and subnational representatives from across the Ministry of Health, COVID-19 task forces, civil society organisations and partners. Focus group discussions were conducted with health workers.ResultsWhile demand for vaccination was low at the time of data collection, six of seven countries had started integrating or planned to integrate COVID-19 vaccination with other health services. Relatively high integration was reported for certain health system functions such as supply chain, while others such as information systems were less integrated. The immunisation programme served as lead on integrating COVID-19 vaccination, but coordinating across other health programmes was a major challenge. Nearly all assessment countries relied on external funding for COVID-19 vaccines; none had plans to self-procure COVID-19 vaccines when external funding ends.ConclusionThis article highlights challenges such as a lack of cross-programmatic coordination with clear roles and accountability mechanisms, absence of a clear strategy for sustainable procurement of COVID-19 vaccines, infodemics, as well as considerations countries face in transitioning from emergency response to a more routine approach to COVID-19 vaccination. Opportunities exist to focus COVID-19 vaccination integration efforts in a way that sets the stage for a strengthened life course approach to immunisation; lessons for future emergencies include designing for integration earlier to ensure systems and processes built are leveraged postemergency.

Hepatitis C is a virus affecting millions worldwide and is a major health risk. With the potentially severe adverse event profile of the current backbone of therapy, interferon, there is an impetus to discover interferon free treatment regimens. With the development of new oral direct acting antivirals, interferon free regimens may be available in the next few years. This article discusses some of the preliminary data from interferon free studies.

BackgroundChronic hepatitis C (CHC) is traditionally treated in the outpatient setting. Despite the excellent tolerability, shortened treatment duration, and high cure rates of newer direct-acting antivirals (DAAs), many vulnerable patients remain untreated due to issues with linkage to care.AimsThis study sought to reframe and establish the hospital admission as a unique opportunity to initiate antiviral treatment for patients with CHC, particularly those with psychosocial or linkage to care issues.MethodsPatients with untreated CHC were identified either on the Psychiatry or Med/Surg wards at the Veterans Affairs Palo Alto Health Care System (VAPAHCS). If found to be appropriate for treatment initiation, patients were started on antivirals during their hospitalization and followed closely while inpatient and after discharge to assess for sustained virologic response (SVR), treatment tolerability, and treatment completion.ResultsOverall, 36% (23) of potential treatment candidates were initiated on DAA treatment during their hospitalization. Of these patients, 91.3% had documented treatment completion with an intention-to-treat and modified intention-to-treat SVR rate of 91.3% and 100%, respectively.ConclusionsWe establish the hospital admission as a valuable opportunity for HCV treatment initiation, yielding excellent treatment outcomes in those who would not otherwise be treated and achieved a modified intention-to-treat response rate of 100%.

Hepatitis B is a DNA virus affecting hundreds of millions of individuals worldwide. As the clinical sequelae of cirrhosis and hepatocellular cancer are increasingly recognized to be related to viral levels, the impetus increases to offer treatment to those previously not treated. With the development of more robust antivirals with reasonable safety profiles, long-term treatment is becoming more common. The oral nucleos(t)ide analogs have become the preferred first-line therapies for most genotypes of hepatitis B. Five are now available, all with different potencies and resistance profiles. Long-term data spanning several years are now available for most compounds in this arena. This article focuses on the common natural variants and those secondary to nucleos(t)ide therapy, as well as diagnostic methods to detect resistance.

In a phase 2 trial, 10-mg bulevirtide plus pegylated interferon alfa-2a was superior to bulevirtide alone with regard to an undetectable HDV RNA level 24 weeks after the end of treatment in patients with chronic hepatitis D.

BackgroundBulevirtide (BLV) is approved in Europe for the treatment of chronic hepatitis D (CHD). Optimal BLV monotherapy duration for CHD is unknown). This analysis evaluated BLV monotherapy in pts without VR after 24W.MethodsResults from pts who completed BLV monotherapy for 96W in the Phase 3 (MYR301) and Phase 2 (MYR204) studies were included. NR and PR were defined as HDV RNA declines of <1 log10 IU/mL and ≥1 but <2 log10 IU/mL, respectively. Rates of biochemical response (alanine aminotransferase [ALT] within normal limits [WNL]) were compared.ResultsAt W24, 65% pts had VR (58% with ALT WNL), 24% had PR (56% with ALT WNL), and 11% had NR (13% with ALT WNL) (IDDF2024-ABS-0269 Table 1).Abstract IDDF2024-ABS-0269 Table 1Shift Table for Virologic Response at Week 24 vs Responses at Weeks 48 and 96 BLV 2mg (N = 47) BLV 10mg (N = 94) BLV 2mg + 10mg (N = 141) Week 24 HDV RNA Week 24 HDV RNA Week 24 HDV RNA VR PR NR VR PR NR VR PR NR N = 25 N =12 N =10 N = 67 N = 22 N = 5 N = 92 N = 34 N = 15 W48 HDV RNA Responder, [ALT WNL ] 23 (92%) 11 (92) , [8] 1 (10%) , [0] 60 (90%) 12 (55%) , [9] 2 (40%) , [0] 83 (90%) 23 (68%) , [17] 3 (20%) , [0] Partial Responder, [ALT WNL ] 2 (8%) 0, [0] 1 (10%) , [1] 6 (9%) 6 (27%) , [3] 0, [0] 8 (9%) 6 (18%) , [3] 1 (7%) , [1] Non-responder, [ALT WNL ] 0 1 (8%) , [0] 8 (80%) , [1] 1 (1%) 4 (18%) , [2] 3 (60%) , [1] 1 (1%) 5 (15%) , [2] 11 (73%) , [2] W96 HDV RNA Responder, [ALT WNL ] 23 (92%) 11 (92%) , [10] 3 (30%) , [1] 60 (90%) 14 (64%) , [9] 4 (80%) [1] 83 (90%) 25 (74%) , [19] 7 (47%) , [2] Partial Responder, [ALT WNL ] 2 (8%) 0, [0] 3 (30%) , [1] 5 (7%) 5 (23%) , [4] 0, [0] 7 (8%) 5 (15%) , [4] 3 (20%) , [1] Non-responder, [ALT WNL ] 0 1 (8%) , [0] 4 (40%) , [1] 2 (3%) 3 (14%) , [1] 1 (20%) , [0] 2 (2%) 4 (12%) , [1] 5 (33%) , [1]Data expressed as n (%) or nOf 49 with W24 NR or PR, the mean BL HDV RNA was similar whether NR, PR, or VR at W96. Median BL U/L ALT was higher in pts with NR (138) vs VR (79) and PR (95) at W96. Of 34 PR pts at W24, 74% had VR, and 71% had ALT WNL by W96. Of the 15 NR pts at W24, 47% had VR, and 27% had ALT WNL by W96. A higher proportion of NR at W24 achieved VR at W96 among those receiving BLV 10mg (80%) vs BLV 2mg (30%).The mean log10 IU/mL HDV RNA decline in those NR/PR at W24 was 3.6, −1.4, and −0.2 for VR, PR, and NR at W96. Median W96 U/L ALT change in those NR/PR at W24 was −48, −42, and −67, respectively. Among all NR at W96, ALT declined >50% from BL in 7/11. (IDDF2024-ABS-0269 Table 2)Abstract IDDF2024-ABS-0269 Table 2Progression of ALT & HDV RNA Among Those Who Were NR or PR at Week 24 Virologic Response Achieved at Week 96 Time Point VR at W96 N = 32 PR at W96 N = 8 NR at W96 N = 9 ALT (U/L), Median (Q1, Q3) Baseline 79 (53,113) 95 (56 , 150) 138 (112 , 196) W24 36 (31 , 50) 43 (34,108) 47 (40 , 78) W48 32 (27 , 43) 41 (29 , 57) 71 (45 , 75) W96 31 (24 , 46) 38 (30 , 72) 75 (64 , 91) Change at W96 -48 (-73 , - 12) -42 (-83 , - 6) -67 (-102 , - 33) HDV RNA (log10 IU/mL), mean (SD) Baseline 5.0 (1.5) 5.3 (1.5) 4.6 (1.8) W24 3.6 (1.3) 4.2 (1.8) 3.6 (1.8) W48 2.5 (1.5) 4.0 (2.2) 4.0 (1.8) W96 1.5 (0.9) 3.9 (1.7) 4.4 (1.7) Change W96 -3.6 (1.1) -1.4 (0.3) -0.2 (0.7)Abbreviations: NR, non-responder; PR, partial responder; VR, virologic responderConclusionsOf 49 pts without VR at W24, the majority with PR and nearly half with NR were able to achieve VR at W96. ALT improved in all viral-response groups, including those with NR.

The Tanzania Private Health Sector Assessment provides information on the size, location and characteristics of non-state health service providers in Tanzania. It also identifies challenges and opportunities for the Government of Tanzania and International Community to leverage the potential of these providers to achieve.