Introduction Racialised immigrant communities in Western nations face disproportionate risks for sexually transmitted and blood-borne infections (STBBIs) due to systemic barriers, including racism, stigma and limited access to culturally appropriate care. While the need is well-established, a comprehensive synthesis of effective, culturally responsive sexual health interventions is lacking. This scoping review aims to map the available evidence on sexual health intervention needs and protective factors of racialised immigrants, and to identify and describe existing culturally appropriate programmes in Western nations.Methods and analysis The review will follow the JBI methodology for scoping reviews and be reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search strategy, developed and peer-reviewed by a health sciences librarian, will be executed in MEDLINE, Embase, CINAHL and Scopus, alongside grey literature sources, with no date limit. Two independent reviewers will screen titles/abstracts and full texts against the inclusion criteria. Data will be extracted using a standardised tool, analysed via narrative synthesis and framed by a socio-ecological model to categorise interventions across individual, interpersonal, community and structural levels.Ethics and dissemination Ethical approval is not required for this review. Findings will be disseminated through a peer-reviewed publication, academic presentations and tailored summaries for community organisations and policy-makers to ensure practical application.Review registration Open Science Framework (https://osf.io/9qah6).

INTRODUCTION:Chlamydia trachomatis is the most commonly encountered sexually transmitted infection. Our objective was to describe the evolution of chlamydia incidence rates in Alberta, Saskatchewan, and Manitoba as compared to Canada overall, from 1991 to 2022. METHODS:We conducted an ecological study, collecting data on chlamydia infection from publicly available reports throughout Canada, laying special emphasis on Alberta, Saskatchewan, and Manitoba. As variables, we used: Chlamydia incidence rate per 100,000 inhabitants, stratified by sex, age group, ethnicity, province, and year. RESULTS:In 1991, chlamydia incidence in Alberta (265.0/100,000), Saskatchewan (328.2/100,000), and Manitoba (410.2/100,000) largely exceeded the nationwide rate (164.0/100,000). Incidence subsequently increased dramatically, peaking between 2013 and 2019 (Canada overall: 335.1/100,000; Alberta: 399.9/100,000; Saskatchewan: 534.6/100,000; Manitoba: 604.5/100,000). Females aged 20-29 years accounted for 61.6% of the cases, while incidence in individuals aged 30-39 pronouncedly increased. Coinfection rates with Neisseria gonorrhoeae increased in Alberta (1998-2006) from 2.1% to 5.2% and decreased in Manitoba (2004-2012) from 14.8% to 9.8%. One case of lymphogranuloma venereum was reported in Canada in 2004, 36 in 2005, and 96 between 2004 and 2011. Data on other equity indicators are limited or nonexistent. CONCLUSIONS:Between 1991 and 2022, the incidence of chlamydia infection increased across Canada and, more particularly, in three provinces (Alberta, Saskatchewan, and Manitoba), which consistently reported chlamydia infection incidence rates 1.5 to 2 times the national average. Young people and females were the most severely affected groups. More complete and consistent epidemiological data, which would include incidence disaggregated by equity indicators, are crucial to addressing the increasing burden of chlamydia in Canada and, more particularly, the Prairie provinces.

BACKGROUND:Canada aims to eliminate hepatitis C (HCV) by 2030. While national rates have dropped, regional disparities persist. In 2021, Manitoba had the highest new HCV rates, and Saskatchewan's rates were double the national average. This study aimed to describe the incidence and risk factors associated with HCV infections in Alberta, Saskatchewan, and Manitoba, compared to Canada,1980-2023. METHODS:This ecological study used publicly available government reports from Alberta, Saskatchewan, Manitoba, and Canada (1980-2023) on HCV cases and rates by year and disaggregated by sex (female/male), age, ethnicity, province, sexual orientation (gay/bisexual men who have sex with men, heterosexual), and risk factors (injection drug use, blood products, and history of incarceration). RESULTS:Since becoming nationally notifiable in 1991, HCV incidence in Canada has declined, but Saskatchewan has reported consistently rates above the national average since 2005. Manitoba's incidence rose, peaking in 2018, with the highest national rate in 2021 (42.8/100,000), while Alberta had the lowest rate (14.5/100,00 people). Males represented 61 % of HCV cases in Canada in 2022, but the sex gap is narrowing, particularly in the Prairies. Most cases in Canada occur among individuals aged 40-59, but younger groups (20-39) are increasingly affected in the Prairies, particularly females of childbearing age and males aged 30-39. Injection drug use was the leading risk factor in Saskatchewan and Manitoba. CONCLUSION:Canada is on a downward trend in rates of HCV; however, Manitoba and Saskatchewan have higher rates, possibly due to syndemics of substance use, which are leading to increased rates of HIV and STBBIs. A collaborative effort in surveillance, testing, treatment, and prevention of HCV across the three provinces is necessary.

OBJECTIVE:This review seeks to understand the global trends of contemporary witchcraft accusations and related harms against children and adolescents (0-18 years of age). INTRODUCTION:Witchcraft-related violence against children and adolescents (children) reflects an alarming and understudied phenomenon of socio-culturally legitimated harm around the globe, particularly in sub-Saharan Africa. 'Witchcraft' explains the unexplainable, such as strokes of luck and/or misfortune. Witchcraft accusations are linked to illness, sudden death, financial misfortune, miscarriages, financial windfall, disability, birth abnormalities, or rare conditions. Religious entities also levy witchcraft accusations, referring to black magic, evil, works or malicious spirits, to profit off families while harming the accused. These accusations result in marginalization, alienation, slandered reputation, communal expulsion, and violence, causing disfiguration, disability, and death. Children are especially vulnerable to witchcraft-related violence, including human trafficking, and ceremonial and cultural sacrifice. INCLUSION CRITERIA:This scoping review will examine witchcraft accusations and related harms against children and adolescents (0-18 years of age) globally from 1946 to 2024. EXCLUSION CRITERIA:This scoping review excludes articles that do not report specifics of the accusation, situation, result, age of the accused, or country of origin. METHODS:This scoping review will follow the Joanna Briggs Institute's Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Statement. Articles published from January 1, 1946 to December 31, 2024 will be collected across academic, grey literature and web-based databases. A systematic search strategy will be applied in each database, and all search results recorded. A bibliometric analysis will also be undertaken to systematically and rigorously review the extant literature. Findings of this review will identify areas of collaboration and gaps for further exploration. The literature analysis can raise awareness and inform resource development across health care, education, social work, government, and community sectors to better support victims of witchcraft-related harms.

[This corrects the article DOI: 10.1371/journal.pone.0338997.].

Background:Canada aims to end the HIV epidemic as a public health threat by 2030. However, the provinces Alberta, Saskatchewan, and Manitoba reported 564 new HIV diagnoses in 2021 and over 600 in 2022. This study describes changes in HIV epidemiology in these three provinces compared to the rest of Canada between 1985 and 2022. Methods:This was an ecological study that used data from publicly available HIV reports published by the Governments of Manitoba, Saskatchewan, Alberta, and Canada from the first reported HIV diagnoses to the latest available information. Variables of interest included number of HIV diagnoses per year (new, introduced), advanced HIV disease, proportion of diagnoses by sex (female/male), ethnicity, age, self-reported HIV mode of transmission, and mortality. We report the HIV incidence, advanced HIV disease, and mortality over time by province, and by sex, ethnicity, age, and mode of HIV transmission when data are available. Results:Canadian HIV incidence decreased over time, while new HIV diagnoses in Manitoba and Saskatchewan increased to the highest ever recorded. In Saskatchewan and Manitoba, the male-to-female ratio is 1:1, while in Alberta and Canada, it is 2:1. Indigenous people have been overrepresented in Saskatchewan and Manitoba diagnoses since 2006 and 2016, respectively. The most common modes of HIV transmission are injection drug use and heterosexual sex in Saskatchewan and Manitoba for several years, while "out-of-country" is the most common category in Alberta. The advanced HIV disease and mortality statistics have decreased over time in Canada and the three provinces. Conclusion:HIV incidence in Canada has slowly decreased; however, Manitoba and Saskatchewan have shown unprecedented increases in HIV incidence. The current epidemiology requires immediate public health action from local, provincial, and federal governments, considering that Alberta, Saskatchewan, and Manitoba contribute to about 40% of all new HIV diagnoses in Canada.

Abstract Background Studies suggest poor oral health increases the risk of infective endocarditis (IE) as 20-53% of cases stem from organisms linked with oral flora. Despite intravenous drug use being a known risk factor for IE, our local data reveals nearly 33% of IE pathogens in individuals who inject drugs (PWID) come from oral microflora. Shockingly, only 9.1% of IE patients received dental consultation during admission.Table 1.Classification of isolated infective endocarditis pathogens by site of origin and injection drug use status.77 participants underwent retrospective chart review with 36.4% identifying as people who inject drugs (PWID). A heat map was used with blue indicating 0 and red indicating higher number of pathogens up to 12. This demonstrates that the majority of pathogens identified from positive blood cultures were from skin, oral cavity, and GI sources. However, among the PWID group, environmental pathogens were more prevalent. Methods This is a pre-and-post intervention cohort study. Through retrospective chart review, we established baseline PWID status, pathogen identified in positive blood cultures, dentistry details, and determined origin site of the microorganism. We reviewed all adult IE admissions to our tertiary care hospital in Saskatoon, SK from January 1, 2022 to May 31, 2023 who met the Modified Duke Criteria. Using this data, we designed a Multi-Disciplinary Endocarditis (MENDO) Clinical Pathway to address gaps in dentistry review and intervention at our hospital. This intervention, which began September 25, 2023, has enrolled 35 patients so far. Results Among the 77 retrospective participants meeting inclusion criteria, 36.4% were PWID and 31.2% of all IE pathogens were from oral sources. Commonly isolated oral pathogens included Viridans Group Streptococci and Streptococcus anginosis. Notably, 32.1% of IE organisms in PWID were oral pathogens which was similar to non-PWID (p = 1.0). In the retrospective cohort, the baseline rates of dentistry consultation and dental intervention were 9.1% and 7.8% respectively. Since September 2023, 35 patients have been enrolled in the MENDO pathway, 72.1% of which are PWID. Through care standardization and case worker support, our dentistry consultation rate and intervention rates are now 35.5% (p = 0.0115) and 9.7% (p = 0.714) respectively. Conclusion In our study, approximately 1 in 3 PWID had IE due to oral pathogens. This was comparable to non-PWID, suggesting equal prevalence of IE due to dental sources in both populations. Our intervention enhanced dentistry access for PWID, and we hypothesize that our longitudinal data will show reduced infection relapse. Integrating oral health assessments and interventions into the care of individuals at risk for IE, including those with PWID, could potentially reduce the burden of this serious condition. Disclosures Satchan Takaya, MD FRCPC, Moderna: Advisor/Consultant

Background:The rates of HIV and syphilis in Saskatchewan (SK) have been rising rapidly in recent years. The syndemic has raised concern for neurosyphilis, a complication that can occur at any stage of syphilis and is more common in people living with HIV (PLWH). Criteria published by the Public Health Agency of Canada recommends considering a lumbar puncture (LP) in patients with concomitant HIV and syphilis infection whose rapid plasma reagin (RPR) titre is ≥1:32 or whose CD4+ count is ≤350. We assessed whether this recommendation was met at 2 comparable clinical sites. Methods:In this retrospective analysis, we compare rates of LP and corresponding syphilis treatment success at two clinics in Saskatoon, SK: a community-based primary care clinic and a tertiary care hospital-based infectious disease clinic. Results:Of 193 syphilis cases across both sites, 128 cases met laboratory criteria for lumbar puncture. Rates of LP (9% primary care clinic and 19% infectious disease clinic) and syphilis treatment success (87% primary care clinic and 89% infectious disease clinic) were comparable between groups. When RPR titre was controlled for, clinic type did not statistically significantly affect the rates of lumbar puncture (p = 0.104) or syphilis treatment success (p = 0.068). A RPR titre ≥1:32 was positively associated with both treatment success (OR 2.596) and lumbar puncture (OR 4.495). Conclusion:Results suggest that there is no difference in either the community or hospital-based clinic type for syphilis treatment success and that rates of lumbar puncture of patients meeting serologic criteria are low across diverse HIV patient groups and clinical settings.

Background: We aimed to describe trends in M. genitalium prevalence and associated resistance in Canada between 1980 and 2022. Methods: Ecological study and a scoping review. We collected publicly available data published by the governments of all Canadian provinces and territories. We also systematically searched PubMed, Medline, Embase, and grey literature using the keywords ‘M. genitalium’, ‘Canada’, and all provinces and territories. We reported M. genitalium prevalence, age, sex, gender, symptoms, coinfections, sample types used for diagnosis, and macrolide and fluoroquinolone resistance rates. Results: National or provincial surveillance systems for M. genitalium are absent. Eight studies reported the epidemiology of M. genitalium. The prevalence ranged between 3% in Quebec and 30.3% in Ontario. Half of the patients reported symptoms. The most collected sample for M. genitalium diagnosis was urine, followed by cervical and urethral swabs. Co-infection with Chlamydia trachomatis was reported in 3.3% to 16.4% of cases and with Neisseria gonorrhoeae in 0.0% to 24.0%. Macrolide resistance ranged between 25% and 82.1%, and fluoroquinolone resistance between 0.0% and 29.1%. Conclusions: M. genitalium prevalence and resistance rates varied by sex, gender, province, and specimen type. In the absence of routine surveillance, incomplete data hinders understanding the bacterium’s natural history, its impact on some key groups, and the tracking of antibiotic resistance.

Background: Canada aims to end the HIV epidemic as a public health threat by 2030. However, the provinces Alberta, Saskatchewan, and Manitoba reported 564 new HIV diagnoses in 2021 and over 600 in 2022. This study describes changes in HIV epidemiology in these three provinces compared to the rest of Canada between 1985 and 2022. Methods: Ecological study. Data: publicly available HIV reports published by the Governments of Manitoba, Saskatchewan, Alberta, and Canada from the first reported HIV diagnoses to the latest available information. Variables: Number of HIV diagnoses per year (new, introduced), advanced HIV disease, proportion of diagnoses by sex (female/male), ethnicity, age, self-reported HIV mode of transmission, and mortality. We report the HIV incidence, advanced HIV disease, and mortality over time by province, and by sex, ethnicity, age, and mode of HIV transmission when data are available. Results: Canadian HIV incidence decreased over time, while new HIV diagnoses in Manitoba and Saskatchewan increased to the highest ever recorded. In Saskatchewan and Manitoba, the male-to-female ratio is 1:1, while in Alberta and Canada, it is 2:1. Indigenous people have been overrepresented in Saskatchewan and Manitoba diagnoses since 2006 and 2016, respectively. The most common modes of HIV transmission are injection drug use and heterosexual sex in Saskatchewan and Manitoba for several years, while “out-of-country” is the most common category in Alberta. The advanced HIV disease and mortality have decreased over time in Canada and the three provinces. Conclusion: HIV incidence in Canada has slowly decreased; however, Manitoba and Saskatchewan have shown unprecedented increase in HIV incidence. The current epidemiology requires immediate public health action from local, provincial, and federal governments, considering that Alberta, Saskatchewan, and Manitoba contribute to ∼40% of all new HIV diagnoses in Canada.

The management of drug-use associated endocarditis (DUA-IE) has historically been piece-meal with variable involvement of multiple specialties - cardiology, addictions medicine, infectious disease, surgery and others. The literature was reviewed and combined with the writing group's insights from years of clinical experience to come up with recommendations for care. In this review, the potential benefits of providing holistic, person-centered, multidisciplinary care to these patients are discussed. The diagnosis of a patient with DUA-IE provides an opportunity to not only treat their presenting condition, but to screen for co-infections, address socioeconomic barriers, and connect with longitudinal care. Moreover, there is an ongoing paradigm shift towards the use of partial-oral antibiotic regimens which may reduce barriers to access and adherence for this population. Variability in whether surgery is offered for persons who inject drugs exists, especially in relation to first expecting abstinence, however this is a non-evidence-based criterion to determine operative candidacy. Decisions around timing and type of surgical intervention should be made systematically with the support of a multi-disciplinary team to avoid bias and achieve the best possible clinical outcome. Regarding management of substance use, data exists to support harm reduction strategies including provision of sterile substance use equipment, opioid agonist therapy, overdose prevention, take-home naloxone programs, drug checking services, and supportive housing programs. The mobilization of a multi-disciplinary endocarditis team is fundamental for providing the best possible care, which should be individualized.

Importance In the US and Canada, women comprise approximately one-third of people who inject drugs (PWID); however, clinical characteristics and outcomes of injection drug use complications in women are poorly described. Objective To identify clinical characteristics and outcomes of infective endocarditis (IE) among women who inject drugs (WWID). Design, Setting, and Participants This is a retrospective cohort study of PWID with definite IE (per 2023 Duke-International Society for Cardiovascular Infectious Diseases criteria) admitted from April 5, 2007, to March 15, 2018, at 5 tertiary-care hospitals in London, Ontario, and Regina, Saskatchewan, Canada. Data were analyzed from June 1, 2023, to August 2, 2024. Descriptive analyses were conducted for baseline characteristics at index hospitalization and stratified by sex. Main Outcomes and Measures The primary outcome was the difference in 5-year survival between female and male PWID with IE. The secondary outcome was 1-year survival. Multivariable time-dependent Cox proportional hazards regression analyses were conducted for variables of clinical importance to evaluate 5-year mortality. Results Of 430 PWID with IE, 220 (51.2%) were women; of 332 non-PWID with IE, 101 (30.4%) were women. WWID with IE were younger than men (median [IQR] age, 31.5 [27.0-38.5] vs 38.5 [31.0-49.0] years), and 11 of 220 (5.0%) were pregnant at index hospitalization, although only 12 of 220 (5.5%) had contraceptive use documented. Women had a larger proportion of right-sided IE than men (158 of 220 women [71.8%] vs 113 of 210 men [53.8%]). WWID living in urban areas had higher mortality than WWID in rural areas (adjusted hazard ratio [aHR], 2.70; 95% CI, 1.15-6.34; P = .02). Overall mortality was lower among PWID referred for substance use disorder counseling in centers with inpatient services compared with centers with only outpatient referrals (aHR, 0.29; 95% CI, 0.17-0.51; P < .001). Overall mortality was lower with right-sided heart disease for both women (aHR, 0.44; 95% CI, 0.27-0.71; P < .001) and men (aHR, 0.22; 95% CI, 0.10-0.50; P < .001) and was higher with congestive heart failure for both women (aHR, 2.32; 95% CI, 1.29-4.18; P = .005) and men (aHR, 1.73; 95% CI, 1.07-2.79; P = .02). Conclusions and Relevance In this cohort of PWID with IE, women were overrepresented. Reasons for women's disproportionately high IE incidence need further study. Inpatient substance use disorder services, contraception counseling, and enhanced social support for WWID living in urban areas need to be prioritized.

Head porters working in markets in sub-Saharan Africa (SSA) are one of the world's most vulnerable and socioeconomically disadvantaged groups. They consist predominantly of uneducated women and girls seeking to escape poverty, early marriage, and other issues of domestic violence. Most female head porters are in their reproductive years and often lack access to sexual reproductive health services (SRHS) despite being at high risk for sexually transmitted infections (STIs), unplanned pregnancies, and gender-based violence. The low priority for women and girls' SRH in many SSA countries highlights the need to explore the factors influencing the accessibility of services for failure to do so restrains human development. An initial search of the literature was conducted and revealed no current scoping or systematic reviews on the accessibility to SRHS for female head porters in SSA. We outline a scoping review protocol, using the Joanna Briggs Institute methodology, to determine the interventions that influence the accessibility of SRHS for female head porters in SSA. The protocol is registered with Open Science Framework (https://osf.io/hjfkd). Findings will not only be valuable for female head porters but for all vulnerable female groups in SSA who experience high SRH risks and social disparities.

Background Hypertension is dramatically increasing in Africa with evidence of increased severity and resistance to treatment. Although angiotensin converting enzyme gene polymorphism is associated with higher prevalence of hypertension, the evidence is inconclusive on its influence on the emerging pattern in Africa. This meta-analysis is conducted to pool the available evidence to inform future research and interventions. Methods Articles published through May 2018 were systematically searched in PubMed, Scopus and EMBASE databases. Studies were assessed for inclusion by two independent researchers. Six models were used to assess the effect of angiotensin converting enzyme deletion-insertion gene polymorphism. Heterogeneity and publication bias were tested and sensitivity analysis was carried out. Odds ratio and 95% confidence intervals were measured for pooled effect. Both random effect and fixed effect models were used, whilst the frequency of DD, II and DI genotypes were computed and compared. Result Patients with D allele were 1.49 times more likely to develop essential hypertension compared with patients who carry the I allele (OR:1.49; CI:1.07, 2.07). Similarly, patients who had homozygous co-dominance genotype DD (i.e., DD vs II) were at a 2.17 times higher risk of essential hypertension compared to the co-dominant genotype II (OR:2.17, CI:1.79, 3.18), dominant model (I.e., DD+ID vs II) (OR:1.48; CI:1.03, 2.12), and recessive model (OR:1.64; CI:1.03, 2.61). On subgroup analysis, participants from Sub-Saharan Africa were more genetically susceptible to hypertension compared to their North Africa counterparts. There was no publication bias found, but there was high to moderate heterogeneity. Conclusion ACE I/D polymorphism is associated with essential hypertension in Africa in the allele contrast model, as well as the dominant, recessive and homozygous codominance model. On subgroup analysis, ACE I/D was associated with essential hypertension in patients from Sub-Saharan Africa but not in North Africa. A future large scale study, which includes different ethnic groups, is recommended.

Background With the approaching sunset on the Millennium Development Goals (MDGs), Tanzania continues with its final national push towards achievement of MDG #4 and MDG #5. The Mama Kwanza Socio-economic Health Initiative (MKSHI) was introduced in the hope of contributing to improving maternal, newborn, and child health in Arusha and Ngorongoro. The MKSHI project is a holistic, inter-sectoral approach to maternal, newborn, and child health which aligns with the Government of Tanzania’s Vision 2025 . At the project onset, a baseline assessment was conducted to launch ongoing benchmarking, monitoring, and evaluation of the project’s impacts and implications. The aim of this baseline assessment was twofold. First it was to determine the state of maternal, newborn, and child health in the two project sites. Second it was to ensure that a baseline of key indicators was established as well as identification of unique indicators relevant to the populations of interest. Results The baseline study was a mixed methods approach to identify maternal, newborn, and child risk factors and indicators in the two target sites. This paper focuses on the qualitative methods and findings. The qualitative component included a series of five community dialogue meetings and thirty-seven individual/dyad interviews with women, providers, and stakeholders. Initially, community meetings were held as open dialogues on maternal, newborn, and child health issues, opportunities, and preferred futures. Individual/dyad interviews were held with women, providers, and stakeholders who held unique information or experiences. Both community dialogue and interview data was analysed for themes and guiding or critical comments. Three over-arching findings emerged: What took you so long to come? How do we know what you know? and How will it change for our daughters? Conclusions Participant voices are vital in ensuring the achievement of local and global efforts and preferred futures for maternal, newborn, and child health services. This study contributes to the inclusion of women in all aspects of the planning, implementation, and delivery of maternal, newborn, and child health services in the target areas and beyond.