Abstractobjectives To describe the sexual and reproductive behaviour of adolescents in sub-Saharan Africa, particularly 15-to 19-year-olds.methods Using DHS ⁄ AIS data (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010), nine indicators of adolescent behaviour and one of adult attitudes towards condom education for adolescents were described for 24 countries. Indicators were disaggregated by gender, urban ⁄ rural residency and educational status, and time trends were described.results Up to 25% of 15-to 19-year-olds reported sex before age 15; this proportion shrank over time in many countries. In most countries, ‡5% of females reported marriage before age 15, and >20% had commenced childbearing. Early sexual debut and childbearing were more common among the least educated and ⁄ or rural females. Reporting of multiple sexual partnerships was more common among males than among females, but decreases over time were more common among males. Urban males and females, and females with higher education, were more likely to report multiple partnerships. Urban youth and those with higher education also reported more condom use. Adult support for condom education for 12-to 14-year-olds has increased over time to 60-65%.conclusions Many 15-to 19-year-olds are at risk of HIV ⁄ STIs and unplanned pregnancies because of multiple partnerships and insufficient condom and other contraceptive use. In many countries, trends are moving in a favourable direction. To better inform prevention programmes in this important area, we recommend routine collection of sexual and reproductive behaviour data for adolescents aged <15 years, expanding the data collected for 15-to 19-year-olds to include detailed information on sexual behaviour within partnerships, and disaggregating data according to sociodemographic variables.keywords sexual behaviour, adolescent, Africa ⁄ epidemiology, review

David Ross and colleagues conduct a follow-up survey of the community-based MEMA kwa Vijana (“Good things for young people”) trial in rural Tanzania to assess the long-term behavioral and biological impact of an adolescent sexual health intervention.

An international outbreak linked to oyster consumption involving a group of over 200 people in Italy and 127 total subjects in 13 smaller clusters in France was analyzed using epidemiological and clinical data and shellfish samples. Environmental information from the oyster-producing area, located in a lagoon in southern France, was collected to investigate the possible events leading to the contamination. Virologic analyses were conducted by reverse transcription-PCR (RT-PCR) using the same primer sets for both clinical and environmental samples. After sequencing, the data were analyzed through the database operated by the scientific network FoodBorne Viruses in Europe. The existence of an international collaboration between laboratories was critical to rapidly connect the data and to fully interpret the results, since it was not obvious that one food could be the link because of the diversity of the several norovirus strains involved in the different cases. It was also demonstrated that heavy rain was responsible for the accidental contamination of seafood, leading to a concentration of up to hundreds of genomic copies per oyster as detected by real-time RT-PCR.

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emphasised that people living with HIV should maintain at least a 30-day supply and ideally a 90-day supply of ART and all other drugs, by mail-order delivery if possible.Community-based organisations have also played an important part in maintaining HIV services. UNAIDS is working with the BaiHuaLin alliance of people living with HIV and other community partners to reach and help those who will run out of antiviral drugs in the near future. 6 Since the lock down of Wuhan on Jan 23, 2020, a community-based organisation (Wuhan TongZhi Center) has dedicated resources to ensure the supply of antiviral drugs and opened a hotline to provide consultations. As of March 31, 2020, this organisation has had more than 5500 consultations with people living with HIV and has helped more than 2664 individuals obtain antiviral drugs. The Thai Red Cross AIDS Research Centre set up a visible platform outside their anonymous clinic with a screening system for every client, providing HIV testing and prevention supplies (eg, condoms, postexposure prophylaxis, and pre-exposure prophylaxis). 9 As COVID-19 continues to spread around the world, many locations are facing the risk of SARS-CoV-2 infection and barriers and challenges for maintaining the HIV care continuum. The situation could be worse in places with weak health-care systems. We recommend that governments, community-based organisations, and interna tional partners should work together to maintain the HIV care continuum during the COVID-19 pandemic, with particular efforts made to ensure timely access to, and to avoid disruption of, routine HIV services.We declare no competing interests. We thank Gifty Marley for proofreading services.

Dynamic contour tonometer agrees well on average with GAT but the agreement limits are wide. In structurally normal thin corneas DCT may give a more accurate assessment of the true IOP but it does not appear to have any benefit over GAT in thick corneas.

Background Mental health problems are a leading cause of disability in adolescents worldwide. Problem solving is a well-tested mental health intervention in many populations. We aimed to investigate the effectiveness of a brief, transdiagnostic problem-solving intervention for common adolescent mental health problems when delivered by non-specialist school counsellors in New Delhi, India. Methods This randomised trial was done in six government-run schools (three all-boys schools, two all-girls schools, and one coeducational school) that serve low-income communities. We recruited participants from grades 9 to 12 (ages 12-20 years) by selecting students with persistently elevated mental health symptoms accompanied by distress or functional impairment. Clinical eligibility criteria were assessed by research assistants using the Hindi-language version of the Strengths and Difficulties Questionnaire (SDQ), with reference to locally validated borderline cutoff scores of 19 or greater for boys and 20 or greater for girls on the SDQ Total Difficulties scale, an abnormal score of 2 or more on the SDQ Impact scale, and persistence of more than 1 month on the SDQ Chronicity index. Participants were randomly allocated (1:1) to problem solving delivered through a brief (2-3 week) counsellor-led intervention with supporting printed materials (intervention group), or problem solving delivered via printed booklets alone (control group). Primary outcomes were adolescent-reported mental health symptoms (SDQ Total Difficulties scale) and idiographic psychosocial problems (Youth Top Problems [YTP]) at 6 weeks. Primary analyses were done on an intention-to-treat basis at the 6-week endpoint. The trial is registered with ClinicalTrials.gov, NCT03630471. Findings Participants were enrolled between Aug 20, and Dec 4, 2018. 283 eligible adolescents were referred to the trial, and 251 (89%) of these were enrolled (mean age 15•61 years; 174 [69%] boys). 125 participants were allocated to each group (after accounting for one participant in the intervention group who withdrew consent after randomisation). Primary outcome data were available for 245 (98%) participants. At 6 weeks, the mean YTP scores were 3•52 (SD 2•66) in the intervention group and 4•60 (2•75) in the control group (adjusted mean difference-1•01, 95% CI-1•63 to-0•38; adjusted effect size 0•36, 95% CI 0•11 to 0•61; p=0•0015). The mean SDQ Total Difficulties scores were 17•48 (5•45) in the intervention group and 18•33 (5•45) in the control group (-0•86,-2•14 to 0•41; 0•16,-0•09 to 0•41; p=0•18). We observed no adverse events. Interpretation A brief lay counsellor-delivered problem-solving intervention combined with printed booklets seemed to have a modest effect on psychosocial outcomes among adolescents with diverse mental health problems compared with problem-solving booklets alone. This counsellor-delivered intervention might be a suitable first-line intervention in a stepped care approach, which is being evaluated in ongoing studies. Funding Wellcome Trust.

BackgroundWith effective contraceptives available, unplanned pregnancies are preventable and educational interventions have been cited as a promising platform to increase contraceptive use through improving knowledge. However, results from trials of educational interventions have been disappointing. In order to effectively target future interventions, this study aimed to identify risk factors for unplanned pregnancy among young women in Mwanza, Tanzania.MethodsData were analysed from the MEMA kwa Vijiana Trial Long-term Evaluation Survey, a cross-sectional study of 13 814 young adults aged 15–30 years in Mwanza, Tanzania. Potential risk factors for unplanned pregnancy were grouped under three headings: socio-demographic, knowledge of and attitude towards sexual health, and sexual behaviour and contraceptive use. Conditional logistic regression was used to identify predictors of reported unplanned pregnancy among all sexually active women.ResultsIncreasing age, lower educational level, not being currently married, knowing where to access condoms, increasing number of sexual partners and younger reported age at sexual debut were associated with unplanned pregnancy.DiscussionA number of demographic and sexual behaviour risk factors for pregnancy are identified which will help guide future intervention programmes aiming to reduce unplanned pregnancies. This study suggests effective measures to prevent unplanned pregnancies should focus on encouraging girls to stay in school.