Objectives Sexually transmitted infections (STIs) are a major cause of morbidity. Understanding drivers of transmission can inform effective prevention programs. We describe STI prevalence and identify factors associated with STIs in four African countries. Methods The African Cohort Study is an ongoing, prospective cohort in Kenya, Nigeria, Tanzania and Uganda. At enrollment, a physical exam was conducted and STI diagnosis made by a clinician using a syndromic management approach. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for factors associated with an STI diagnosis. Results As of June 2020, 3544 participants were enrolled. STI prevalence was 7.7% and did not differ by HIV status (p = 0.30). Prevalence differed by syndrome (3.5% vaginal discharge, 1.5% genital ulcer, 2.1% lower abdominal pain, 0.2% inguinal bubo). The odds of having an STI were higher at all sites compared to Kisumu West, Kenya, and among those with a primary level education or below compared to those with secondary or higher (aOR: 1.77; 95% CI: 1.32–2.38). The odds of an STI diagnosis was higher among participants 18–29 years (aOR: 2.29; 95% CI: 1.35–3.87), females (aOR: 2.64; 95% CI: 1.94–3.59), and those with depression (aOR: 1.78; 95% CI: 1.32–2.38). Among PLWH, similar factors were independently associated with an STI diagnosis. Viral suppression was protective against STIs (aOR: 2.05; 95% CI: 1.32–3.20). Conclusions Prevalence of STIs varied by site with young people and females most at risk for STIs. Mental health is a potential target area for intervention.

Background Kenya has a high burden of HIV, viral hepatitis, and tuberculosis. Screening is necessary for early diagnosis and treatment, which reduces morbidity and mortality across all three illnesses. We evaluated testing uptake for HIV, viral hepatitis, and tuberculosis in Kisumu, Kenya. Methods Cross-sectional data from adults aged 18–35 years who enrolled in a prospective HIV incidence cohort study from February 2017 to May 2018 were analyzed. A questionnaire was administered to each participant at screening for study eligibility to collect behavioral characteristics and to assess prior testing practices. Among participants without a history of previously-diagnosed HIV, multivariable robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV testing in the 12 months prior to enrollment. A hierarchical model was used to test for differential access to testing due to spatial location. Results Of 671 participants, 52 (7.7%) were living with HIV, 308 (45.9%) were female, and the median age was 24 (interquartile range 21–28) years. Among 651 (97.0%) who had ever been tested for HIV, 400 (61.2%) reported HIV testing in the past 6 months, 129 (19.7%) in the past 6–12 months, and 125 (19.1%) more than one year prior to enrollment. Any prior testing for viral hepatitis was reported by 8 (1.2%) participants and for tuberculosis by 51 (7.6%). In unadjusted models, HIV testing in the past year was more common among females (PR 1.08 [95% CI 1.01, 1.17]) and participants with secondary education or higher (PR 1.10 [95% CI 1.02, 1.19]). In the multivariable model, only secondary education or higher was associated with recent HIV testing (adjusted PR 1.10 [95% CI 1.02, 1.20]). Hierarchical models showed no geographic differences in HIV testing across Kisumu subcounties. Conclusions Prior HIV testing was common among study participants and most had been tested within the past year but testing for tuberculosis and viral hepatitis was far less common. HIV testing gaps exist for males and those with lower levels of education. HIV testing infrastructure could be leveraged to increase access to testing for other endemic infectious diseases.

The American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care have recommended that rapid responses and cardiac arrests be debriefed. A "hot" structured debrief immediately after the event is one strategy which maximizes participation from the resuscitation team. METHODS:Using the MIDASþ occurrence reporting software an electronic tool was developed to facilitate and standardize a hot debrief of emergency event management. Led by a critical care fellow, a series of pre-populated question prompts guides the discussion and aims to collect quality measures such as adherence to ACLS protocols, recognition and understanding of assigned roles, and disagreements amongst the team. Additionally, the tool characterizes the emergency event and can be used to report equipment malfunction, personnel delays, medication delays, or any additional concerns.RESULTS: From January 2019 to March 2021 there were 1,430 documented emergency events throughout our three campus, academic medical center: 907 rapid responses (63.4%), 364 cardiac arrest codes (25.5%), and 159 rapid responses that progressed to cardiac arrest codes (11.1%). The leading indications for calling a rapid response were as follows: respiratory 41.3%, cardiovascular 27.5%, neurologic 26.4% and medical/other 4.8%. The primary rhythm for the cardiac arrest codes were: pulseless electrical activity 50.3%, asystole 43.1%, ventricular fibrillation 4.0%, and ventricular tachycardia 2.5%. Our analysis demonstrated that in most events the team leader was clearly identified (97.5%), a clear delegation of roles was assigned (96.7%) along with a clear understanding of those roles (95.9%). Disagreements amongst the teams were rare (12.5%) and so were deviations from the ACLS algorithm (9.4%). Following nearly every event the family (93.7%) and primary service was immediately notified (94.5%). A hot debrief was performed at the end of 95.2% of the documented events.CONCLUSIONS: Our analysis demonstrates that a standardized electronic questionnaire can be used to effectively guide and document a hot debrief for rapid responses and cardiac arrests.CLINICAL IMPLICATIONS: Our data shows that the implementation of an electronic debriefing questionnaire is feasible in the immediate post arrest setting. This work can be used to advance post cardiac arrest and rapid response quality improvement and investigation initiatives.

This is a case report of a 42-year-old woman who presented to a clinic with a history of progressive left foot and ankle swelling. She had a suspected history of myectoma, but had never been officially diagnosed despite repeated cultures and debridements over the course of decades. The inciting event occurred approximately 30 years prior in her home country of Belize. Her wound culture revealed Scedosporium apiospermum as the causative agent. Treatment included surgical debridement and oral antifungal therapy. This case represents an interesting adjunct to the differential diagnosis for military physicians, as mycetomas are prevalent in many of the areas where our forces are deployed and may only present after the service member has left active service because of its naturally indolent course.