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Patients with chronic disease represent an at-risk group in the face of the COVID-19 crisis as they need to regularly monitor their lifestyle and emotional management. Coping with the illness becomes a challenge due to supply problems and lack of access to health care facilities. It is expected these limitations, along with lockdown and social distancing measures, have affected the routine disease management of these patients, being more pronounced in low- and middle-income countries with a flawed health care system. The purpose of this study is to describe a protocol for a randomized controlled trial to test the efficacy of the Adhera® MejoraCare Digital Program, an mHealth intervention aimed at improving the quality of life of patients with chronic diseases during the COVID-19 outbreak in Paraguay. A two-arm randomized controlled trial will be carried out, with repeated measures (baseline, 1-month, 3-month, 6-month, and 12-month) under two conditions: Adhera® MejoraCare Digital Program or waiting list. The primary outcome is a change in the quality of life on the EuroQol 5-Dimensions 3-Levels Questionnaire (EQ-5D-3L). Other secondary outcomes, as the effect on anxiety and health empowerment, will be considered. All participants must be 18 years of age or older and meet the criteria for chronic disease. A total of 96 participants will be recruited (48 per arm). It is expected that the Adhera® MejoraCare Digital Program will show significant improvements in quality of life and emotional distress compared to the waiting list condition. Additionally, it is hypothesized that this intervention will be positively evaluated by the participants in terms of usability and satisfaction. The findings will provide new insights into the viability and efficacy of mHealth solutions for chronic disease management in developing countries and in times of pandemic. ClinicalTrials.gov NCT04659746.

The spread of Chikungunya virus is a major public health concern in the Americas. There were >120,000 cases and 51 deaths in 2023, of which 46 occurred in Paraguay. Using a suite of genomic, phylodynamic, and epidemiologic techniques, we characterized the ongoing large chikungunya epidemic in Paraguay.

Background: As tobacco is the main risk factor for oral cancer, it is important to understand the burden of this disease in light of the Framework Convention on Tobacco Control. For MERCOSUR, tobacco control is a topic of interest. The aim of this study was to describe MPOWER measure scores and to evaluate the trends in lip and oral cavity cancer (LOC) incidence, mortality and Disability-Adjusted Life Years (DALYs), from 2005 to 2021, in MERCOSUR countries. Methods: This is an ecological descriptive study, where the MPOWER measure scores were extracted from the Global Health Observatory of World Health Organization, and the Age-standardized Rates (ASRs) of LOC for MERCOSUR countries were obtained from the Global Burden of Diseases 2021 results tool. The trends of LOC ASRs were obtained using the Prais–Winsten method. Results: Paraguay and Venezuela had lower MPOWER scores over time than Argentina, Brazil and Uruguay. These last three countries showed LOC trends decreasing for most indicators among males, while Paraguay and Venezuela showed increasing trends in incidence for both males and females, and no decreasing trends. Conclusion: This study suggests that MERCOSUR countries with a history of more rigorous MPOWER tobacco control policies are exhibiting decreasing trends in LOC burden.

A licensed chikungunya vaccine now exists; however, it remains unclear whether it could be deployed during outbreaks to reduce the health burden. We used an epidemic in Paraguay as a case study. We conducted a seroprevalence study and used models to reconstruct epidemic transmission dynamics, providing a framework to assess the theoretical impact of a vaccine had it been available. We estimated that 33.0% (95% confidence interval (CI) 30.1–36.0%) of the population became infected during the outbreak. Of these individuals, 6.3% (95% CI 5.8–6.9%) were detected by the surveillance system, with a mean infection fatality ratio of 0.013% (95% CI 0.012–0.014%). A disease-blocking vaccine with 75% efficacy deployed in 40% of individuals aged ≥12 years over a 3-month period would have prevented 34,200 (95% CI 30,900–38,000) cases, representing 23% of all cases, and 73 (95% CI 66–81) deaths. If the vaccine also leads to infection blocking, 88% of cases would have been averted. These findings suggest that the vaccine is an important new tool to control outbreaks. A combination of seroprevalence analyses and modeling indicates that the availability of an infection-blocking CHIKV vaccine would have prevented 88% of cases during an outbreak.

Background Opportunistic infections (OIs) are common causes of mortality among people living with HIV (PLHIV). We determined prevalence and 30-day mortality due to histoplasmosis, cryptococcosis, and TB in PLHIV with advanced HIV disease (AHD). Methods PLHIV 18 years and older, with a CD4 + T-cell count of less than 350 cells/mm3 newly diagnosed with HIV infection or re-engaged in care after being without ART for more than 90 days (Group A). The second group included symptomatic PLHIV regardless of ART status or CD4 + T-cell count (Group B); all followed for 30 days. Detection of Histoplasma Ag (HisAg) in urine was done by enzyme immunoassay (EIA), Cryptococcus antigen (CrAg) was detected in serum and cerebrospinal fluid (CSF) specimens by lateral flow assay (LFA), and lipoarabinomannan (LAM) detection in urine was by LFA (TB LAM) and in sputum by GeneXpert for diagnosis of Mycobacterium infections. Results From August 2021 to June 2022, 491 PLHIV were enrolled; 482 (98%) had a CD4 + T-cell result, and 381 patients (79%) were classified with AHD according to CD4 + T-cell count (< 200 CD4/mm 3 ). Frequency of an OI was 38% ( n  = 145/381). Antigen test positivity rate was 16% (72/467) for TB-LAM, 9% (43/464) for HisAg, and 11% (51/484) for CrAg. Twenty-one of 34 (62%) patients receiving CSF CrAg tests were positive, confirming meningitis. Significant differences in 30-day mortality were observed in patients with an OI (16%) vs. no OI (7%) ( p  = 0.002). Mortality was highest in patients with histoplasmosis (25%), co-infection (22%), cryptococcosis (18% overall; 19% for cryptococcal meningitis), and TB (10%). Conclusions TB and fungal OIs, including co-infection, were common in PLHIV in Paraguay and had high associated mortality. Laboratories and health facilities need access to CD4 + T-cell testing and rapid diagnostic assays.

Recent rises in incident tuberculosis (TB) cases in Paraguay and the increasing concentration of TB within prisons highlight the urgency of targeting strategies to interrupt transmission and prevent new infections. However, whether specific cities or carceral institutions play a disproportionate role in transmission remains unknown. We conducted prospective genomic surveillance, sequencing 471  Mycobacterium tuberculosis complex genomes, from inside and outside prisons in Paraguay’s two largest urban areas, Asunción and Ciudad del Este, from 2016 to 2021. We found genomic evidence of frequent recent transmission within prisons and transmission linkages spanning prisons and surrounding populations. We identified a signal of frequent M. tuberculosis spread between urban areas and marked recent population size expansion of the three largest genomic transmission clusters. Together, our findings highlight the urgency of strengthening TB control programs to reduce transmission risk within prisons in Paraguay, where incidence was 70 times that outside prisons in 2021. To role that carceral institutions play in Mycobacterium tuberculosis transmission remains somewhat unknown. Authors perform a prospective genomic surveillance study, to assess transmission dynamics in prisons and surrounding communities in Paraguay.

We aimed to determine the prevalence of depression, anxiety, and stress in university students in Paraguay during the COVID-19 pandemic. A cross-sectional study was conducted among 293 students from four universities in Paraguay in 2021. The DASS-21 mental health scale was used to measure the outcomes (depression, anxiety, and stress) and evaluate their association with socio-educational variables. A total of 77.1% of the participants were women and 136 (46.4%) were between 21 and 25 years old. The prevalence of depression, anxiety, and stress was 74.7%, 87.4%, and 57%, respectively. We found that being a woman and studying at a public university was positively associated with depression, anxiety, and stress. Receiving COVID-19 training increases the prevalence of mental health problems. In conclusion, high levels of anxiety, depression, and stress were found in university students during the COVID-19 pandemic. Being a woman, studying at a public university, and receiving training on COVID-19 were factors associated with a higher prevalence of presenting all the mental health problems evaluated. Furthermore, students aged 31 and over had a higher prevalence of depression and stress.

Hepatitis B virus (HBV) and Hepatitis C virus (HCV) remain major global health challenges, together accounting for approximately 1.1 million deaths annually and representing leading causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma. In Paraguay, the true burden remains poorly defined, hindering effective public health planning toward the WHO’s 2030 elimination goal. This cross-sectional study aimed to establish a comprehensive, nationally representative epidemiological baseline among blood donors. We prospectively analyzed 85,811 blood donor samples. Screening involved chemiluminescent immunoassays for anti-HBc, HBsAg, and anti-HCV, followed by confirmatory Nucleic Acid Amplification Testing (NAT) for HBV-DNA and HCV-RNA. The age-standardized seroprevalences were: 1.66% for anti-HBc, 0.079% for HBsAg, and 0.261% for anti-HCV. However, significant regional variations were noted, with anti-HBc prevalence ranging from 0.70% to 3.86% ( p  < 0.001). Anti-HBc also increased with age (0.27% in < 20 years to 3.10% in > 50 years). Critically, no HBV markers were detected in donors born after the national 2003 vaccination program. Only 1 of 229 anti-HCV reactive samples was HCV-RNA detectable. While low overall seroprevalence confirms blood safety standards, pronounced regional disparities require targeted public health interventions focused on specific epidemiological hotspots. The absence of HBV markers in the post-vaccination cohort provides strong evidence of the national immunization program’s success, offering an invaluable baseline for future elimination strategies.

Background Bovine leukemia virus (BLV) is a member of retroviridae family, together with human T cell leukemia virus types 1 and 2 (HTLV-1 and -2) belonging to the genes deltaretrovirus , and infects cattle worldwide. Previous studies have classified the env sequences of BLV provirus from different geographic locations into eight genetic groups. To investigate the genetic variability of BLV in South America, we performed phylogenetic analyses of whole genome and partial env gp51 sequences of BLV strains isolated from Peru, Paraguay and Bolivia, for which no the molecular characteristics of BLV have previously been published, and discovered a novel BLV genotype, genotype-9, in Bolivia. Results In Peru and Paraguay, 42.3 % (139/328) and over 50 % (76/139) of samples, respectively, were BLV positive. In Bolivia, the BLV infection rate was up to 30 % (156/507) at the individual level. In Argentina, 325/420 samples were BLV positive, with a BLV prevalence of 77.4 % at the individual level and up to 90.9 % at herd level. By contrast, relatively few BLV positive samples were detected in Chile, with a maximum of 29.1 % BLV infection at the individual level. We performed phylogenetic analyses using two different approaches, maximum likelihood (ML) tree and Bayesian inference, using 35 distinct partial env gp51 sequences from BLV strains isolated from Peru, Paraguay, and Bolivia, and 74 known BLV strains, representing eight different BLV genotypes from various geographical locations worldwide. The results indicated that Peruvian and Paraguayan BLV strains were grouped into genotypes-1, -2, and -6, while those from Bolivia were clustered into genotypes-1, -2, and -6, and a new genotype, genotype-9. Interestingly, these results were confirmed using ML phylogenetic analysis of whole genome sequences obtained by next generation sequencing of 25 BLV strains, assigned to four different genotypes (genotypes-1, -2, -6, and -9) from Peru, Paraguay, and Bolivia. Comparative analyses of complete genome sequences clearly showed some specific substitutions, in both structural and non-structural BLV genes, distinguishing the novel genotype-9 from known genotypes. Conclusions Our results demonstrate widespread BLV infection in South American cattle and the existence of a new BLV genotype-9 in Bolivia. We conclude that at least seven BLV genotypes (genotypes-1, -2, -4, -5, -6, -7, and -9) are circulating in South America.

Dengue fever has been endemic in Paraguay since 2009 and is a major cause of public-health-management-related burdens. However, Paraguay still lacks information on the association between climate factors and dengue fever. We aimed to investigate the association between climatic factors and dengue fever in Asuncion. Cumulative dengue cases from January 2014 to December 2020 were extracted weekly, and new cases and incidence rates of dengue fever were calculated. Climate factor data were aggregated weekly, associations between dengue cases and climate factors were analyzed, and variables were selected to construct our model. A generalized additive model was used, and the best model was selected based on Akaike information criteria. Piecewise regression analyses were performed for non-linear climate factors. Wind and relative humidity were negatively associated with dengue cases, and minimum temperature was positively associated with dengue cases when the temperature was less than 21.3 °C and negatively associated with dengue when greater than 21.3 °C. Additional studies on dengue fever in Asuncion and other cities are needed to better understand dengue fever.