Eight provinces and territories are currently experiencing syphilis outbreaks, with increases in incidence rates particularly in western Canada and Nunavut. 1,2 From 2009 to 2018, the number of infectious syphilis cases in Canada increased substantially, from 1584 to 6311 (4.7 to 17.0 per 100 000 population). Increased rates have been observed among women and people reporting heterosexual sex, with ongoing outbreaks among men who have sex with men. Cases of neurosyphilis will continue to occur, given this national resurgence of syphilis. 2
BACKGROUND: The HIV care cascade is an indicators-framework used to assess achievement of HIV clinical targets including HIV diagnosis, HIV care initiation and retention, initiation of antiretroviral therapy, and attainment of viral suppression for people living with HIV. METHODS: The HIV Care Cascade Research Development Team at the CIHR Canadian HIV Trials Network Clinical Care and Management Core hosted a two-day virtual workshop to present HIV care cascade data collected nationally from local and provincial clinical settings and national cohort studies. The article summarizes the workshop presentations including the indicators used and available findings and presents the discussed challenges and recommendations. RESULTS: Identified challenges included (1) inconsistent HIV care cascade indicator definitions, (2) variability between the use of nested UNAIDS’s targets and HIV care cascade indicators, (3) variable analytic approaches based on differing data sources, (4) reporting difficulties in some regions due to a lack of integration across data platforms, (5) lack of robust data on the first stage of the care cascade at the sub-national level, and (6) inability to integrate key socio-demographic data to estimate population-specific care cascade shortfalls. CONCLUSION: There were four recommendations: standardization of HIV care cascade indicators and analyses, additional funding for HIV care cascade data collection, database maintenance, and analyses at all levels, qualitative interviews and case studies characterizing the stories behind the care cascade findings, and employing targeted positive-action programs to increase engagement of key populations in each HIV care cascade stage.
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Percutaneous drainage of the lesions showed pus, with gramnegative bacilli in both the aspirate and blood cultures. The bacterial colonies were visibly mucoid and later identified as Klebsiella pneumoniae, susceptible to ceftriaxone and ciprofloxacin. The string test, which is a quick screening method providing phenotypic evidence of hypermucoviscous strains of K. pneumoniae, showed strings measuring greater than 5 mm in length (Figure 1). 1 Genetic testing later confirmed the presence of magA and rmpA genes, which encode virulence factors responsible for the K1 capsular polysaccharide serotype and mucoid phenotype, respectively. 1,2 After partial drainage of the abscesses and one week of treatment with ceftriaxone, the patient was discharged home. He received 11 weeks of oral ciprofloxacin until clinical and radiographic resolution of the abscesses was shown.Pyogenic liver abscesses are typically polymicrobial and due to underlying biliary tract pathology; albeit 20%-40% of cases are considered cryptogenic. 2 Hypervirulent (hypermucoviscous) phenotypes of K. pneumoniae are an emerging cause of pyogenic liver abscess and can be associated with impaired glucose tolerance. 3 Although initially described in the mid-1980s in Taiwan, these hypervirulent strains of K. pneumoniae are increasingly recognized as a monomicrobial cause of cryptogenic liver abscess in Western countries. 1,2 Metastatic foci such as endophthalmitis and meningitis occur in about 10%-16% of cases. 1,2 Although our patient's K. pneumoniae isolate was susceptible to most β-lactam antibiotics, carbapenem-resistant strains of K. pneumoniae showing a hypermucoviscous phenotype have been recently reported and are a cause for global concern in an era of antimicrobial resistance. 3
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