In 2008, the global urban population surpassed the rural population and by 2050 more than 6 billion will be living in urban centres. A growing body of research has reported on poor health outcomes among the urban poor but not much is known about HIV prevalence among this group. A survey of nearly 3000 men and women was conducted in two Nairobi slums in Kenya between 2006 and 2007, where respondents were tested for HIV status. In addition, data from the 2008/2009 Kenya Demographic and Health Survey were used to compare HIV prevalence between slum residents and those living in other urban and rural areas. The results showed strong intra-urban differences. HIV was 12% among slum residents compared with 5% and 6% among non-slum urban and rural residents, respectively. Generally, men had lower HIV prevalence than women although in the slums the gap was narrower. Among women, sexual experience before the age of 15 compared with after 19 years was associated with 62% higher odds of being HIV positive. There was ethnic variation in patterns of HIV infection although the effect depended on the current place of residence.

Background Insecticide-treated mosquito nets (ITNs) are one of the most effective tools for preventing malaria in sub-Saharan Africa. Objective This study examined knowledge, attitude, and practice on the use of ITNs in the prevention of malaria among pregnant women and guardians of children under five in the Democratic Republic of the Congo. Methods A total of 5,138 pregnant women and guardians of children under five were interviewed. Results The majority of participants (>80%) knew the signs and symptoms of malaria; 81.6% reported having an ITN in the household, but 78.4% reported using it the night before the interview. Only 71.4% of pregnant women used ITN the night compared to 68.2% of children under five. In the Logistic Regression model, women who believed that it is normal to use ITNs were 1.9 times more likely to use it than those who did not (OR: 1.930); women who were confident in their abilities to use ITNs were 1.9 times more likely than those who were not confident (OR: 1.915); and women who had a good attitude towards ITNs were also more likely to use ITNs compared to those who did not (OR: 1.529). Conclusion New and innovative evidence-based behavior change interventions are needed to increase the utilization of ITNs among vulnerable groups.

To assess potential barriers to seeking human immunodeficiency virus (HIV) testing among adults in the United States, data from the 1998 National Health Interview Survey (NHIS) were analyzed. The NHIS is a multistage cluster survey of the United States noninstitutionalized civilian population ages 18 years or older. The 1998 NHIS survey was conducted using the computer-assisted personal interview. Of a nationally representative sample (n = 32,440) of the U.S. noninstitutionalized civilian population, 21,410 (66%) have never been tested for HIV, 9,728 (30%) have been tested, and 1302 (4%) did not complete the survey or refused to answer the question. Among individuals who completed the survey, men (odds ratio [OR]: 1.08, 95% confidence interval [CI] = 1.04, 1,22), individuals ages 50 years or older (OR: 4.01, 95% CI = 3.16, 5.08), or 18-19 years (OR: 2.12, 95% CI = 1.71, 2.63), those who had "up to 11 grade" level of education (OR: 2.16, 95% CI = 1.74, 2.63), those who lived in nonmetropolitan areas (OR: 1.21, 95% CI = 1.14, 1.28), or lived in the Midwest (1.34, 95% CI = 1.24, 1.43) were significantly more likely than their counterparts to have not sought HIV testing. Among individuals who have never been tested for HIV, 58% had no particular reason, 38% felt they were not at risk of contracting HIV, whereas less than 1% feared adverse consequences. The high proportion of adults who never tested for HIV after two decades of HIV epidemic underscores the need for new approaches to fight the spread of HIV infection in the United States.

This study analyzed factors associated with human immunodeficiency virus (HIV) infection among persons ages 50 years or older at HIV diagnosis and examined differences in morbidity and survival between them and those ages 13 to 49 years. HIV-infected persons reported to the Michigan HIV/AIDS registry between January 1990 and October 2000 were analyzed. Of 12,614 HIV-infected persons selected, 938 (7.4%) were ages 50 years or older at HIV diagnosis. Persons ages 50 years or older at HIV diagnosis were twice as likely to be male (odds ratio [OR]: 1.9) than female. They were slightly at higher risk of contracting HIV through blood products (OR: 1.53) or heterosexual contact (OR: 1.24) than through injection drug use, but the difference was not statistically significant. They were twice as likely to report unknown HIV risk (OR: 1.8) than injection drug use and were significantly less likely to be men who have sex with men (OR: 0.64) than injection drug users. The prevalence of selected acquired immune deficiency syndrome (AIDS)-defining conditions was similar between the two age groups. However, HIV dementia was more commonly diagnosed among older persons, whereas disseminated Mycobacterium avium was less commonly diagnosed in this age group. The overall mean survival was significantly shorter among persons ages 50 years or older (73.5 months [standard deviation (SD)]: 2.21 compared with their counterparts [112.3 months (SD: 0.77)], even after adjusting for CD4 count at HIV diagnosis. Older persons appeared to have contracted HIV through heterosexual contact, blood products, or injection drug use and to have a short survival. This age group should no longer be overlooked.

The current Ebolavirus disease (EVD) outbreak in the provinces of North Kivu and Ituri is the tenth outbreak affecting the Democratic Republic of Congo (DRC); the first outbreak occurring in a war context, and the second most deadly Ebolavirus outbreak on record following the 2014 outbreak in West Africa. The DRC government's response consisted of applying a package of interventions including detection and rapid isolation of cases, contact tracing, population mapping, and identification of high-risk areas to inform a coordinated effort. The coordinated effort was to screen, ring vaccinate, and conduct laboratory diagnoses using GeneXpert (Cepheid) polymerase chain reaction. The effort also included ensuring safe and dignified burials and promoting risk communication, community engagement, and social mobilization. Following the adoption of the “Monitored Emergency Use of Unregistered Products Protocol,” a randomized controlled trial of four investigational treatments (mAb114, ZMapp, and REGN-EB3 and Remdesivir) was carried out with all consenting patients with laboratory-confirmed EVD. REGN-EB3 and mAb114 showed promise as treatments for EVD. In addition, one investigational vaccine (rVSV-ZEBOV-GP) was used first, followed by a second prophylactic vaccine (Ad26.ZEBOV/MVA-BN-Filo) to reinforce the prevention. Although the provision of clinical supportive care remains the cornerstone of EVD outbreak management, the DRC response faced daunting challenges including general insecurity, violence and community resistance, appalling poverty, and entrenched distrust of authority. Ebolavirus remains a public health threat. A fully curative treatment is unlikely to be a game-changer given the settings of transmission, zoonotic nature, limits of effectiveness of any therapeutic intervention, and timing of presentation.