The company is one of the first in Ukraine to introduce a chain of home improvement stores and has successfully expanded across the country over the last decade.The company was the first in Ukraine to come up with wholesale stores in Ukraine. Currently Epicentr K is very similar to many stores in the United States such as Home Depot, Lowe's, or Menards. In 2008, the company became the title sponsor of the Ukrainian Premier League in football. As of 2018, the company had plans to bring the total number of stores to 53 nationwide. Despite the economic crisis of 2008–2009 the company continued to expand.
BACKGROUND:Lassa fever is an emerging zoonotic disease endemic to west Africa. Several vaccines aimed at preventing Lassa fever are currently under development, creating a need to assess how best to administer them once licensed for human use. We aimed to project the health-economic burden of Lassa fever from 2025 to 2037 across age and sex groups in subnational administrative divisions of west Africa with endemic Lassa mammarenavirus transmission and to estimate the cost-effectiveness of targeting Lassa vaccination to different risk groups. METHODS:In this vaccine-impact modelling study, we developed a mathematical model using a zoonosis risk map and epidemiological data from recent and ongoing cohort studies to predict the health-economic burden of Lassa fever across age and sex groups in endemic regions. We simulated vaccination campaigns targeting different risk groups to estimate the cost-effectiveness of various strategies for Lassa vaccine administration. Threshold vaccine costs (TVCs), which represent the break-even price per dose of vaccine administered, were estimated in international dollars (INT$ 2023), accounting for health-care costs, productivity losses, and monetised disability-adjusted life-years (DALYs) averted by vaccination. FINDINGS:Lassa fever was estimated to cause 6·23 (95% uncertainty interval (UI) 4·21-8·42) hospitalisations, 0·75 (0·48-1·10) deaths and 31·1 (17·7-52·2) DALYs per 100 000 person-years. Vaccine strategies targeting adolescents-adults aged 15-49, older adults aged 50 years and older, and women of childbearing age (WCBA) aged 15-49 years prevented, respectively, the most hospitalisations, deaths, and DALYs per 100 000 vaccine doses. Under base case assumptions, the most cost-effective strategy (greatest net monetary benefit) was untargeted vaccination for a vaccine costing INT$2 per dose, and targeting adolescents-adults at $5 per dose. At $10 per dose or more, none of the considered strategies were cost-effective. The highest TVC for a single-dose vaccine was estimated at $7·39 (95% UI 4·33-11·60) when targeting adolescents-adults, followed by $6·69 (4·17-9·85) when targeting older adults, $6·10 (3·56-9·74) when targeting WCBA, and $1·94 (1·10-3·10) when targeting children. INTERPRETATION:Targeting of adolescents-adults appears to generate the greatest health-economic value per vaccine dose. However, the most cost-effective vaccination strategy will depend on vaccine price. FUNDING:Coalition for Epidemic Preparedness Innovations.
BACKGROUND:In tuberculosis (TB) care, adherence is often assessed using a simple 80% threshold, which may overlook meaningful patterns. We analyzed adherence trajectories among individuals treated for rifampicin- or multidrug-resistant TB (RR/MDR-TB) in the endTB observational study to identify more informative patterns. METHODS:We applied a joint latent class mixed model to classify adherence trajectories and assess their relationship with treatment outcomes. Model performance was compared to common classification methods (eg 80% adherence threshold) using Kendall's τb and area under the receiver operating curve for predicting unsuccessful outcomes. RESULTS:Among 1787 individuals, we identified 4 adherence patterns: "consistently high" (72.5%), "high to low" (14.3%), "low to high" (7.3%), and "consistently low" (5.9%). Compared to the "consistently high" group, those in "high to low" (hazard ratio [HR] = 23.2; 95% confidence interval [CI]: 15.7-24.3) and "consistently low" (HR = 43.2; 95% CI: 26.2-71.5) groups had significantly higher risk of unsuccessful outcomes, while the "low to high" group did not (HR = 0.7; 95% CI: .1-3.8). Our trajectory model more accurately predicted outcomes than common classification methods (P < .01). CONCLUSIONS:Group-based trajectory modeling provides more nuanced insights into adherence patterns than conventional classification methods. Our findings demonstrate that patients with RR/MDR-TB who exhibited initial poor adherence followed by subsequent improvement achieved clinical outcomes comparable to those with consistently high adherence throughout treatment. This finding challenges the prevailing assumption that sustained high adherence is necessary for treatment success, suggesting that adherence patterns, rather than overall adherence rates, may be more predictive of clinical outcomes in the management of RR/MDR-TB.
New Human immunodeficiency virus (HIV) infections among adults have decreased in the last ten years in high HIV prevalent countries. However, unsuppressed individuals with high-risk sexual practices can play a key role in transmitting HIV and maintaining the HIV epidemic. We assessed the association between sexual behavior, HIV awareness, antiretroviral therapy (ART) intake and viral suppression, and the age-gender groups most at risk of maintaining HIV transmission in KwaZulu-Natal, South Africa.We conducted a population-based cross-sectional survey including adolescents and adults aged 15 years and above from August to December 2018 in KwaZulu-Natal, South Africa. In this analysis we included only data from HIV-positive participants aged 15-59 years.In total, 862 HIV-positive individuals aged 15-59 years were included, 76.2% (657) were women, and the median age was 36 [IQR 29-46] years, 10.1% (95%CI 8.2-12.3) were unaware of their HIV status, 15.8% (95%CI 13.4-18.2) not on ART, and 16.3% (95%CI 13.9-18.9) virally unsuppressed. Among the 671 participants who had sexual intercourse in the preceding year, 46.9% (315) consistently used condoms. Among those who provided information on the number of sexual partners, 7.5% (64/856) reported more than one. Overall, 10.6% (88/831) (95%CI 8.7-12.9) of HIV-positive participants were either at high or very high risk of sexually transmitting HIV. Of these, 42.0% (37/88) (95%CI 32.1-52.7) were women aged 20-34 years, 39.8% (35/88) (95%CI 30.0-50.4) were men aged 20-59 years, 50.0% (44/88) (95%CI 39.6-60.4) were unaware of their HIV-positive status and 76.1% (67/88) (95%CI 66.0-84.0) were not on ART. Within the 2.3% (95%CI 1.5-3.6) individuals at very high risk of HIV transmission (19 individuals virally unsuppressed with more than one partner and inconsistent condom use), 68.4% (13/19) (95%CI 43.4-85.9) were men aged 20 to 59 years, 52.6% (10/19) (95%CI 29.7-74.5) were unaware of their HIV- positive status, and 78.9% (15/19) (95%CI 53.5-92.4) were untreated.Efforts and age-gender targeted interventions to increase HIV diagnosis and HIV-positivity awareness, detect early ART treatment failure, provide enhanced adherence support and second- or third-line ART, as well as promote behavioral-risk reduction interventions, are needed to reduce the pool of individuals at high-risk of transmitting HIV.
BACKGROUND:WHO recommends fractional dose vaccination to address yellow fever vaccine shortages during outbreaks. In adults, a 500 IU dose has recently been shown to be non-inferior to the full standard dose, but the minimum effective dose for children is unknown. METHODS:We conducted a randomised, double-blind, non-inferiority trial at two centres in Kenya and Uganda, including infants aged 9-12 months with no previous yellow fever vaccination or infection. Participants were randomly assigned 1:1 in blocks of variable sizes of four, six, or eight to receive either the standard dose (>13 000 IU) or 500 IU of the Institut Pasteur de Dakar (Dakar, Senegal) 17D-204 yellow fever vaccine, co-administered with the measles-rubella vaccine. The primary outcome was seroconversion 28 days post-vaccination, defined as a four-fold or greater increase in antibody titre at day 28 from baseline (day 0), as measured by the 50% plaque reduction neutralisation test. Non-inferiority was shown if the lower bound of the 95% CI for the difference in seroconversion rates between doses exceeded -10 percentage points. Safety was assessed in the safety population, which included all participants who received a study vaccine dose. This study is registered with ClinicalTrials.gov (NCT04059471) and is complete. FINDINGS:Between Oct 7, 2021, and June 14, 2023, 420 infants were enrolled and randomly assigned (210 participants in each group). The seroconversion rate at day 28 was 99% (95% CI 96-100; 177 of 179 infants) for the standard dose and 93% (88-96; 166 of 179 infants) for the 500 IU dose in the per-protocol population. The difference in seroconversion rate was -6·15 percentage points (95% CI -10·27 to -2·02); therefore, non-inferiority was not met for the 500 IU dose. 12 serious adverse events were reported in the study (eight in the 500 IU dose group and four in the standard dose group), but all were considered unrelated to vaccination. INTERPRETATION:Compared with the standard yellow fever vaccine dose, a dose of 500 IU did not meet the non-inferiority criterion, suggesting that minimum dose requirements in adults are not generalisable to infants. Therefore, standard yellow fever doses should be used for infants in the routine WHO Expanded Programme on Immunization. FUNDING:European and Developing Countries Clinical Trials Partnership and the Wellcome Trust.
BACKGROUND:Diagnostics are essential for understanding hepatitis E epidemiology, but the field performance of available tests remains unclear. We evaluated the performance of polymerase chain reactions (PCR), IgM ELISA, and the Assure hepatitis E virus (HEV) IgM rapid diagnostic test (RDT) during a HEV genotype 1 outbreak and assessed the duration of viremia and antibodies responses. METHODS:We used data from enhanced surveillance at a health facility in Bentiu internally displaced persons camp, South Sudan (March-December 2022). As part of a vaccine effectiveness study, suspected hepatitis E cases underwent testing with all 3 diagnostics at enrollment with a follow-up sample. We used a latent class model to estimate test performance and accelerated failure time models to estimate time from jaundice onset to a negative test for PCR and ELISA. RESULTS AND CONCLUSIONS:Among 893 suspected cases, test sensitivity declined with time from jaundice onset. Within 30 days of jaundice onset, PCR sensitivity was 73% (95% Credible Interval [CrI] 27, 90), compared to 86% for RDT (95% CrI: 74, 93), and 95% for ELISA (95% CrI: 91, 98). Specificity was high across tests: PCR at 98% (95% CrI: 98, 99), RDT at 95% (95% CrI: 93, 96), and ELISA at 95% (95% CrI: 93, 96). Median time from jaundice onset to negative test was 19 days (95% CI: 17, 21) for PCR and 113 days (95% CI: 87, 163) for ELISA. The Assure IgM RDT showed higher sensitivity for identifying hepatitis E than PCR and similar specificity to IgM ELISA, supporting its use in surveillance. Care seeking delays can greatly influence the interpretation of diagnostic tests.
