Background:Early and precise identification of COVID-19 patients at high risk of mortality is vital for guiding treatment decisions. This study evaluated the predictive validity of the simplified Radiographic Assessment of Lung Edema (RALE) score, derived from chest X-rays (CXRs), for hospital mortality among critically ill patients with Delta-variant COVID-19. Methods:We conducted a retrospective observational study of 105 critically ill adults with confirmed Delta-variant COVID-19 at an intensive care center in Ho Chi Minh City, Vietnam, between 30 July and 15 October 2021. We calculated the simplified RALE score (range 0-8) from admission frontal CXRs. We evaluated predictive performance using the area under the receiver operating characteristic curve (AUROC). We used multivariable logistic regression to assess associations between the simplified RALE score and hospital mortality, adjusting for baseline confounders (inter-hospital transfers, demographics, comorbidities, clinical and laboratory parameters, and gas exchange data) and mediators (respiratory support, adjunctive therapies, and in-hospital complications). Results:The cohort averaged 60.5 years of age (40% male), and 79% died in the hospital. Bilateral lung opacities appeared in 99% of patients, and the median simplified RALE score reached 8.0 (IQR 6.0-8.0). The simplified RALE score discriminated mortality well (AUROC 0.747, 95% confidence interval [CI] 0.617-0.877), closely matching SOFA (0.747) and CURB-65 (0.776) scores. In baseline-adjusted models, both the simplified RALE (adjusted odds ratio [AOR] 2.170, 95% CI 1.353-3.482) and CURB-65 scores (AOR 4.316, 95% CI 1.684-11.059) independently predicted hospital mortality. Even after further adjusting for mediators, the simplified RALE score (AOR 1.934, 95% CI 1.220-3.066) remained an independent predictor. Conclusion:The simplified RALE score performed comparably to SOFA and CURB-65 scores in predicting hospital mortality and remained an independent predictor across all multivariable analyses. These findings support the use of the simplified RALE score as a practical tool for risk stratification in critically ill patients with Delta variant COVID-19, particularly in high-burden and resource-limited settings. Further studies in larger and more diverse populations are warranted to confirm these findings and facilitate broader clinical implementation. This study was previously presented in abstract form at: LIVES 2024, 37th Annual Congress of the European Society of Intensive Care Medicine; October 7-9, 2024; Barcelona, Spain. Do SN, Luong CQ, Nguyen MH, Pham DT, Khuat NH, Pham QT, et al. Predictive validity of the simplified Radiographic Assessment of Lung Edema score for mortality in critically ill COVID-19 patients with the B.1.617.2 (Delta) variant in Vietnam: a retrospective observational study. Intensive Care Med Exp. (2024) 12(Suppl 1):87. doi: 10.1186/s40635-024-00658-z.

OBJECTIVES:To evaluate guideline adherence using the EQUAL Candida Score and its prognostic value for mortality in patients with candidemia at a Vietnamese tertiary hospital. METHODS:Single-center retrospective cohort study of 196 consecutive patients with culture-confirmed candidemia at Bach Mai Hospital, Hanoi, Vietnam (June 2019-June 2022). The EQUAL Candida Score was calculated from medical records. All-cause mortality (including moribund discharge for end-of-life care) was modelled with logistic and Cox regression using pre-specified covariate adjustment, with treated-only, monomicrobial-only, and quartile-based sensitivity analyses. RESULTS:All-cause mortality was 51.5%. Mean EQUAL score was 7.2 ± 2.8 (33.7% of maximum). Blood culture volume and daily follow-up cultures had 0% adherence; echinocandin initial therapy was 27.6%. The EQUAL score independently predicted mortality (adjusted HR: 0.812 per point, 95% CI: 0.740-0.892, P < 0.001). Combined EQUAL+SOFA achieved AUC 0.806 (95% CI: 0.745-0.864). Landmark analysis confirmed robustness (HR: 0.873, P = 0.016). Of 83 untreated patients (42.4%), the early departure group had 80.0% mortality. CONCLUSION:Guideline adherence was low in this Vietnamese cohort, yet the EQUAL score retained independent prognostic value. Targeted antifungal stewardship focusing on echinocandin access and blood culture practices may improve outcomes.

Viral load testing is recommended to monitor antiretroviral therapy effectiveness. This study examines changes overtime in the frequency of viral load and CD4 testing, as well as the relationship with AIDS diagnosis and mortality among an Asia-Pacific cohort of people with HIV. We included adults enrolled in the Treat Asia HIV Observational Database between 2003-2018 who were on ART for at least one year. VL and CD4 testing rates were analyzed using Poisson regression models. Association between testing frequency and AIDS diagnosis or survival were evaluated using Fine and Gray competing risk regression. The analysis included 8446 patients. VL testing rates remained steady at 1 per person-year (PYS) between 2013-2018. Increased VL testing was associated with more frequent CD4 testing ( > 2 tests in the previous year; IRR=1.57, 95%CI 1.53-1.60), later follow-up years (2008-2012: IRR=1.15, 95%CI 1.12-1.18; 2013-2015: IRR=1.07, 95%CI 1.04-1.10), older age (31-40 years: IRR=1.06, 95%CI 1.03-1.08; 41-50 years: IRR=1.08, 95%CI 1.05-1.11; > 50 years: IRR=1.07, 95%CI 1.03-1.11), higher current VL (401-1000 copies/mL: IRR=1.16, 95%CI 1.09-1.24; > 1000 copies/mL: IRR=1.07, 95%CI 1.04-1.11), initial ART regimen (NRTI+PI: IRR=1.07, 95%CI 1.04-1.10; other combinations: IRR=1.11, 95%CI 1.05-1.17), and higher country income levels (upper-middle: IRR=2.17, 95%CI 2.11-2.23; high: IRR=3.14, 95%CI 3.03-3.26). CD4 testing rates decreased from 2.04 to 1.06/PYS over the same period. Lower CD4 testing frequency was associated with HIV exposure mode (MSM: IRR=0.94, 95%CI 0.92-0.96; IDU: IRR=0.93, 95%CI 0.90-0.97; unknown: IRR=0.90, 95%CI 0.87-0.93), higher current CD4 (201-350 cells/µL: IRR=0.95, 95%CI 0.93-0.97; 351-500 cells/µL: IRR=0.89, 95%CI 0.87-0.91; > 500 cells/µL: IRR=0.85, 95%CI 0.83-0.87) and receiving an NRTI+PI first-line combination (IRR=0.96, 95% CI 0.94-0.98). VL and CD4 testing frequencies were not significantly associated with AIDS diagnosis. However, having > 2 CD4 tests in the previous year was associated with higher mortality risks. Recognizing demographic, clinical and socio-economic factors affecting the frequency of CD4 and VL testing is critical to optimizing monitoring strategies and improving outcomes for PWH in the region. All Authors: No reported disclosures

Introduction:Viral load (VL) testing is the recommended approach for monitoring antiretroviral therapy (ART) effectiveness, while guidelines recommend targeted CD4 testing after ART initiation. This study examined trends in VL and CD4 testing frequencies, as well as the relationship with AIDS diagnosis and mortality among people with HIV in the Asia-Pacific region. Methods:We included adults enrolled in the Treat Asia HIV Observational Database (TAHOD) between 2003-2018 who had been on ART for ≥1 year. VL and CD4 testing rates were analysed using Poisson regression models. Associations between testing frequency and AIDS diagnosis or mortality were evaluated using Fine and Gray competing risk regression. Results:Among 8,446 patients, VL testing rates remained steady at 1 per person-year (PYS) between 2003-2018. Increased VL testing was associated with more frequent CD4 testing (>2 tests in the previous year; IRR=1.57, 95%CI 1.53-1.60), later follow-up years (2008-2012: IRR=1.15, 95%CI 1.12-1.18; 2013-2015: IRR=1.07, 95%CI 1.04-1.10), older age (31-40 years: IRR=1.06, 95%CI 1.03-1.08; 41-50 years: IRR=1.08, 95%CI 1.05-1.11; >50 years: IRR=1.07, 95%CI 1.03-1.11), higher current VL (401-1000 copies/mL: IRR=1.16, 95%CI 1.09-1.24; >1000 copies/mL: IRR=1.07, 95%CI 1.04-1.11), initial ART regimen (NRTI+PI: IRR=1.07, 95%CI 1.04-1.10; other combinations: IRR=1.11, 95%CI 1.05-1.17), and higher country income levels (upper-middle: IRR=2.17, 95%CI 2.11-2.23; high: IRR=3.14, 95%CI 3.03-3.26). CD4 testing rates decreased from 2.04 to 1.06/PYS over the same period. Lower CD4 testing frequency was associated with HIV exposure mode (MSM: IRR=0.94, 95%CI 0.92-0.96; IDU: IRR=0.93, 95%CI 0.90-0.97; other/unknown: IRR=0.90, 95%CI 0.87-0.93), higher current CD4 (201-350 cells/μL: IRR=0.95, 95%CI 0.93-0.97; 351-500 cells/μL: IRR=0.89, 95%CI 0.87-0.91; >500 cells/μL: IRR=0.85, 95%CI 0.83-0.87) and receiving an NRTI+PI first-line combination (IRR=0.96, 95% CI 0.94-0.98). VL and CD4 testing frequencies were not significantly associated with AIDS diagnosis. However, having > 2 CD4 tests in the previous year was associated with higher mortality risk. Conclusion:The trends in the rates for CD4 and VL testing in the region between 2003-2018 were significantly affected by demographic, clinical and socio-economic factors. Recognizing these factors is critical to optimizing differentiated monitoring strategies and improving outcomes for PWH in the region.

INTRODUCTION:Since 2013, global HIV treatment guidelines have included recommendations for medication adherence support and monitoring for people on antiretroviral therapy (ART). We examined the implementation of recommended strategies for adherence support and monitoring for adults with HIV through serial cross-sectional structured surveys conducted by the International epidemiology Databases to Evaluate AIDS (IeDEA). METHODS:We used data from surveys completed by HIV clinics across 43 countries in 2017 (n = 206), 2020 (n = 200) and 2023 (n = 214); 131 clinics completed all three surveys. We used descriptive statistics to examine clinic resources and routine adherence support and monitoring at each time point, stratified by country income level (i.e. low/middle-income vs. high-income countries [LMICs/HICs]), and trends among clinics completing all three surveys. We created composite measures of the level or intensity of routine provision of adherence aids/reminders, adherence support and adherence monitoring, ranging from "none" to "enhanced" levels. Among clinics participating in the 2023 survey, we also examined adherence aids and support routinely provided to clients eligible for intensified support versus all clients. RESULTS:At each time point, surveyed clinics were predominantly in LMICs (68.4%-74.3%) and urban settings (65.0%-65.5%), situated within health centres (60.2%-64.0%) or regional/provincial or university hospitals (28.0%-33.5%). Among 131 clinics participating in all surveys, there was a decrease in the provision of multiple adherence readiness counselling sessions from 52.2% of clinics reporting ≥2 sessions before treatment initiation in 2017 to 26.0% in 2023, along with increased provision of 6-month ART refills (from 11.5% to 40.5%). The provision of "enhanced" levels of adherence support to all clients decreased from 2017 to 2023 in both LMICs (64.6% to 28.1%) and HICs (34.3% to 8.6%); in 2023, substantial proportions of clinics reported that such support was routinely provided only to clients eligible for intensive adherence support. At each time point, higher proportions of clinics in LMICs reported "enhanced" adherence monitoring than in HICs (63.5%-70.8% vs. 31.4%-54.3%). CONCLUSIONS:While streamlined provision of ART adherence support may reflect the implementation of guidelines recommending the targeting of support towards clients with known or suspected adherence challenges, further research should examine how evolving clinic adherence support practices are associated with care retention and virologic suppression outcomes.

Analysis of 13 imported malaria cases revealed 87.5% diagnostic failure rate at primary care facilities, with 38.5% progressing to severe malaria, emphasizing critical gaps in Vietnam's malaria elimination strategy.

Dengue virus(DENV)is a positive-sense single-stranded RNA virus belonging to the genus Flavivirus within the Flaviviridae family.Four serotypes,DENV 1-4,are distributed globally[1].Hanoi metropolitan city is an endemic hotspot for DENV transmission in Vietnam[2,3].The largest outbreak occurred in 2017,with more than 36 000 cases and 7 deaths reported,causing by all four serotypes with the predominance of DENV1,following by DENV2[4,5].During the following dengue season,we collected 390 blood and serum samples from 197 hospitalized patients in a national hospital in Hanoi city,Northern Vietnam to identify the circulating DENV serotypes responsible for the 2018-2019 outbreak.

A 46-year-old diabetic Vietnamese engineer presented with a 2-month fever and left foot swelling. Chest imaging showed bilateral nodules with right apical cavitation, prompting empirical anti-tuberculosis therapy. Despite positive Xpert MTB/RIF and 1 month of treatment, his condition worsened. Bronchoscopy culture isolated Burkholderia pseudomallei. Treatment with ceftazidime and trimethoprim-sulfamethoxazole led to complete recovery. Negative MGIT culture excluded tuberculosis co-infection. This case highlights the diagnostic challenge when melioidosis mimics tuberculosis in endemic regions, particularly in diabetic patients. Positive molecular tuberculosis tests may reflect the previous infection, emphasising the need for culture confirmation and clinical correlation.

Background Cryptococcal meningitis causes substantial HIV-related mortality globally. Aim This study aimed to identify determinants of mortality among HIV-infected adults with cryptococcal meningitis in Vietnam to inform targeted intervention strategies. Methods This retrospective cohort study analyzed medical records of 51 HIV-infected adults hospitalized for cryptococcal meningitis at two major hospitals in Hanoi, Vietnam from January 2018 to June 2023. Patients were eligible if aged ≥ 18 years, had confirmed HIV infection, and CSF testing positive for Cryptococcus neoformans. Demographic, clinical, treatment, and outcome data were extracted from paper and electronic records using a standardized collection form. Determinants of mortality using Kaplan-Meier survival and Cox proportional hazards regression analysis. Results Of 51 cryptococcal meningitis patients, 18 (35 %) died during hospitalization over 1319 days of follow-up. Non-survivors were older, had more comorbidities, lower CD4 counts, and higher illness severity compared to survivors. Labs showed non-survivors had more inflammation, organ injury, and severe neurological abnormalities. Despite similar initial antifungal therapy, non-survivors received shorter amphotericin B courses and had more antibiotic use, reduced fluconazole susceptibility, and complications. Using multivariate Cox regression, we found lower CD4 counts, neurological abnormalities, and delayed amphotericin B initiation were associated with higher mortality. Conclusion Out findings identify low CD4 cell counts due to late presentation and inadequate antifungal therapy duration as independent predictors of mortality. These findings support implementation of early HIV diagnosis, cryptococcal screening, and optimized antifungal protocols in comparable resource-limited settings.

INTRODUCTION:The World Health Organization Bacterial Pathogen Priority List 2024 highlights carbapenem-resistant Gram-negative bacteria (CRGNB), including Enterobacterales (CRE), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA), as top priorities due to their virulence, resistance, transmission and limited treatment options. OBJECTIVE:This national hospital survey aimed to assess the burden of CRGNB infections and evaluate microbiological laboratory capacity across Vietnam. METHODS:An online survey was distributed to central hospitals and provincial departments of health in the 63 provinces of Vietnam, which then forwarded it to district and private hospitals. RESULTS:In total, 324 hospitals participated in this study: 20 central hospitals, 190 provincial hospitals, 106 district hospitals and eight private hospitals. Half reported microbiological capacity for bacterial culture and susceptibility testing. Among 57,667 reported Gram-negative isolates, 17,417 (30.2%) were CRGNB, including Klebsiella pneumoniae (CRE 37%), Escherichia coli (CRE 11%), A. baumannii (CRAB 64%) and P. aeruginosa (CRPA 39%). CRE sepsis treatment included cephalosporins, aminoglycosides, carbapenems, fluoroquinolones and colistin. CRE infections were associated with higher crude mortality rates (31.7% vs 20.2%; P<0.001), longer hospital stays (10.4 vs 8.9 days; P<0.001), and higher costs (1025 vs 773; P<0.001) compared with carbapenem-susceptible Enterobacterales. Reported infection prevention and control (IPC) interventions included CRE surveillance (41%), isolation (36%), point prevalence surveys (15%), and cohort care (7%). IPC funding sources included general health insurance (40%) and hospital funds (32%). CONCLUSION:CRGNB pose a significant burden in terms of morbidity, mortality and financial impact. There is an urgent need to strengthen the microbiological infrastructure, improve CRGNB screening, and enhance IPC measures.

Background: Viral suppression following anti-retroviral therapy (ART) is one of the most effective factors determining human immunodeficiency virus (HIV) treatment success. However, certain numbers of HIV-infected patients do not experience viral suppression despite ART initiation, which ultimately might lead to treatment failure. Method: A cross-sectional study was conducted including 194 male patients enrolled at the out-patient clinic, centre for tropical diseases, Bach Mai hospital, Vietnam. Data was analyzed using Stata 12.0.20 for Man-Whitney, Chi-square test/ Fisher’s exact test, and multivariable logistic regression with statistically significant p<0.05. Results: The results show that being men who have sex with men (aOR=12.14, 95% CI: 1.48-99.49), having low CD4 T cell counts (aOR=269.58, 95% CI: 4.94-14721.27), living in rural areas (aOR=4.63, 95% CI: 1.04-20.57), and not having preventive tuberculosis treatment (aOR=9.92, 95% CI: 1.17-84.10), have increased odds of having detectable viral loads (VL). On the contrary, opportunistic infection was negatively associated with a lack of viral suppression (aOR=0.21, 95% CI: 0.05-0.96). Conclusions: The results suggest that intervention programs should focus on patients living in rural areas, having low CD4 T cell counts, acquiring opportunistic infection, and MSM patients.

Background This study aims to evaluate the cost-effectiveness of tenofovir alafenamide fumarate (TAF) versus tenofovir disoproxil fumarate (TDF) for chronic hepatitis B treatment from a payer’s perspective in a limited-income context like Vietnam. Methods A Markov model was developed to estimate the lifetime cost and effectiveness (measured in quality-adjusted life year, QALY) of TAF compared to TDF in the HbeAg+ patient population. Efficacy data came from clinical trials, and costs were based on 2023 data from an exit survey of 94 inpatients and 464 outpatients in Bach Mai hospital. Other clinical data were also sourced from CHB patients at Bach Mai hospital. Along with deterministic analysis, two-way sensitivity analysis, probabilistic sensitivity analysis, threshold, and budget impact analysis were performed. Results Compared to TDF, TAF yielded an additional cost of USD 3,983 and an additional QALY gained of 0.14, resulting in the incremental cost-effectiveness ratio (ICER) of USD 32,090 per QALY gained. The ICER exceeds the cost-effective threshold of three-time gross domestic product (GDP) per capita, that is, USD 11,348, by 2.8 times. According to one-way sensitivity analysis, ICERs were driven mainly by transition probabilities and TDF/ TAF prices. TAF would be cost-effective compared to TDF at the three-time GDP per capital threshold if TAF price were reduced by 33.4%. Conclusions TAF is not cost-effective compared to TDF for treating chronic hepatitis B in HBeAg+ patients. The study offers relevant evidence for policymakers to consider including TAF in the social health insurance package, with a focus on price negotiation. Future updates are needed as new evidence on the effectiveness and costs of treating chronic hepatitis B emerges.

This study investigated kidney dysfunction among people with HIV (PWH), comparing those with and without hepatitis B virus (HBV) co-infection. We further identified predictors of kidney dysfunction in PWH with HBV. Adult PWH in the TREAT Asia Observational Database—Low Intensity TransfEr cohort, who were on antiretroviral therapy, with follow-up after 2010 were included. HBV co-infection was defined by positive hepatitis B surface antigen. Kidney dysfunction was determined as a single estimated glomerular filtration rate < 60mL/min/1.73m2. Kaplan-Meier curves were used to evaluate cumulative incidence of kidney dysfunction, and we used Cox proportional hazards model to analyze factors associated with kidney dysfunction in PWH with HBV. Among 23,415 participants (median age = 37 years; interquartile range [IQR]: 31–43), most were male (62.2

Objectives: to investigate the association of IL-18 and CXCL10 levels with disease severity in Vietnamese patients infected with Dengue virus. Methods: A total of 295 serum samples were collected from patients with clinical presentation of Dengue virus infection during the 2022-2023 outbreaks in Hanoi, Vietnam. Clinical and laboratory parameters were recorded at the time of admission. IL-18 and CXCL-10 were measured by standard ELISA assays. The clinical outcome of Dengue infection was classified into three groups according to the WHO 2009 criteria. Results: Among the 295 patients, 140 were diagnosed with Dengue without warning signs, 134 with Dengue with warning signs, and 21 with severe Dengue according to the WHO 2009 criteria. Patients with SD had a greater proportion of warning signs than those with DwoWS and DwWS (bleeding: 57.1% versus 47.8% and 1.4%, p < 0.001) and (hepatomegaly: 23.8% versus 9.7% and 1.4%, p < 0.001). Higher levels of liver enzymes were observed in the SD group than in the DwoWS and DwWS groups (p < 0.001). Of note, elevated levels of IL-18 and CXCL-10 levels were found in the SD group compared to the DwoWS and DwWS groups (p < 0.01 and p = 0.037). Further ROC analysis revealed that the cut-off values for distinguishing severe Dengue from non-severe Dengue for IL-18 and CXCL-10 were both 669.65 pg/mL, whereas that of CXCL-10 was 3739.5 pg/mL. Conclusions: The present study showed that IL-18 and CXCL-10 are associated with Dengue severity. This finding suggests that IL-18 and CXCL-10 may be biomarkers for disease progression and disease severity in Dengue infection.

BACKGROUND:Tuberculosis (TB) remains the leading cause of illness and death among people living with HIV (PLHIV), particularly in high-burden areas. This study examined associations between TB and routine clinical markers: serum cholesterol, platelet count, and CD4 cell count. SETTING:The analysis included data from the TREAT Asia HIV Observational Database (TAHOD), a multicenter cohort of adult PLHIV receiving care across the Asia-Pacific region. METHODS:We conducted a cross-sectional matched case-control study of prospective and retrospective TB cases, comparing clinical and laboratory data within ±3 months of TB diagnosis. Conditional logistic regression assessed associations between TB and covariates. RESULTS:The analysis included 4,244 PLHIV from 20 sites: 1,427 TB cases and 2,817 matched controls. TB cases were predominantly male (75.3%) and 45.7% aged 31-40. Multivariable analysis showed greater odds of TB diagnosis among males, those with low BMI, prior AIDS diagnosis, high HIV viral load, low CD4+ counts, or low total cholesterol. CD4+ counts <200 cells/μL had higher TB odds (adjusted OR [aOR] 12.90, 95% CI 8.84-18.82) compared to CD4+ >500 cells/μL. Cholesterol <3.9 mmol/L had higher TB odds (aOR 3.11, 95% CI 1.94-4.98) compared to cholesterol >5.5 mmol/L. CONCLUSION:In this Asia-Pacific cohort of adults living with HIV, low CD4+ cell count and low total serum cholesterol were associated with increased TB odds. Cholesterol may represent a low-cost adjunct marker to support TB risk stratification in PLHIV in endemic settings, but requires validation and evaluation of feasibility and cost-effectiveness.

Đặt vấn đề: Hỗ trợ xã hội là yếu tố vô cùng cần thiết đối với người nhiễm HIV nhưng vẫn chưa có nhiều các nghiên cứu về vấn đề này tại Việt Nam. Nghiên cứu này nhằm mục tiêu mô tả thực trạng hỗ trợ xã hội đối với người nhiễm HIV đang điều trị ARV tại Bệnh viện Bạch Mai. Đối tượng và phương pháp nghiên cứu: Nghiên cứu sử dụng thiết kế mô tả cắt ngang. Công cụ thu thập số liệu là thang đo MSPSS dùng để đánh giá mức độ hỗ trợ xã hội từ 3 phía: gia đình, bạn bè và những người quan trọng trong cuộc sống. Đối tượng khảo sát gồm 286 người nhiễm HIV điều trị ARV tại Trung tâm Bệnh Nhiệt đới, Bệnh viện Bạch Mai. Kết quả nghiên cứu: Kết quả cho thấy nhóm tuổi 31-50 chiếm tỷ lệ cao nhất, đa số là nam giới, đã có gia đình và có trình độ học vấn phổ thông trở lên. Tổng điểm hỗ trợ xã hội theo MSPSS đạt 65,7 điểm với hỗ trợ cao nhất từ gia đình, thấp nhất từ bạn bè. Tổng tỉ lệ người có mức độ hỗ trợ xã hội ở mức cao là 52,8%, mức trung bình là 31,1%. Kết luận: Kết quả nghiên cứu cho thấy hỗ trợ xã hội đối với người nhiễm HIV ở Việt Nam còn ở mức hạn chế. Vì vậy cần đẩy mạnh các chiến lược và can thiệp nhằm nâng cao mức độ hỗ trợ xã hội cho đối tượng này, thông qua việc thúc đẩy hoạt động của các tổ chức xã hội dân sự cũng như kết nối cộng đồng người nhiễm để tự hỗ trợ, chia sẻ lẫn nhau

Background Evaluating the prognosis of COVID-19 patients who may be at risk of mortality using the simple chest X-ray (CXR) severity scoring systems provides valuable insights for treatment decisions. This study aimed to assess how well the simplified Radiographic Assessment of Lung Edema (RALE) score could predict the death of critically ill COVID-19 patients in Vietnam.Methods From July 30 to October 15, 2021, we conducted a cross-sectional study on critically ill COVID-19 adult patients at an intensive care centre in Vietnam. We calculated the areas under the receiver operator characteristic (ROC) curve (AUROC) to determine how well the simplified RALE score could predict hospital mortality. In a frontal CXR, the simplified RALE score assigns a score to each lung, ranging from 0 to 4. The overall severity score is the sum of points from both lungs, with a maximum possible score of 8. We also utilized ROC curve analysis to find the best cut-off value for this score. Finally, we utilized logistic regression to identify the association of simplified RALE score with hospital mortality.Results Of 105 patients, 40.0% were men, the median age was 61.0 years (Q1-Q3: 52.0-71.0), and 79.0% of patients died in the hospital. Most patients exhibited bilateral lung opacities on their admission CXRs (99.0%; 100/102), with the highest occurrence of opacity distribution spanning three (18.3%; 19/104) to four quadrants of the lungs (74.0%; 77/104) and a high median simplified RALE score of 8.0 (Q1-Q3: 6.0-8.0). The simplified RALE score (AUROC: 0.747 [95% CI: 0.617-0.877]; cut-off value ≥5.5; sensitivity: 93.9%; specificity: 45.5%; PAUROC <0.001) demonstrated a good discriminatory ability in predicting hospital mortality. After adjusting for confounding factors such as age, gender, Charlson Comorbidity Index, serum interleukin-6 level upon admission, and admission severity scoring systems, the simplified RALE score of ≥5.5 (adjusted OR: 18.437; 95% CI: 3.215-105.741; p =0.001) was independently associated with an increased risk of hospital mortality.Conclusions This study focused on a highly selected cohort of critically ill COVID-19 patients with a high simplified RALE score and a high mortality rate. Beyond its good discriminatory ability in predicting hospital mortality, the simplified RALE score also emerged as an independent predictor of hospital mortality.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThe author(s) received no specific funding for this work.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.Not ApplicableThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:This study was approved by the Scientific and Ethics Committees of Bach Mai Hospital (Approval number: 3412/Đ-BM) and conducted according to the principles of the Declaration of Helsinki. The Bach Mai Hospital Scientific and Ethics Committees waived the written informed consent for this non-interventional study. Public notification of this study was made by published posting, according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration - the STROBE Statement - Checklist of items that should be included in reports of cross-sectional studies. The authors who performed the data analysis kept the data set in password-protected systems and only presented anonymized data.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.Not ApplicableI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Not ApplicableI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.Not ApplicableAll relevant data are within the manuscript and its Supporting Information files.

ABSTRACTHCV RNA test determines current active infection and is a requirement prior to initiating HCV treatment. We investigated trends and factors associated with post‐diagnosis HCV RNA testing rates prior to HCV treatment, and risk factors for first positive HCV RNA among people living with HIV (PLHIV) with HCV in the Asia‐Pacific region. PLHIV with positive HCV antibody and in follow‐up after 2010 were included. Patients were considered HCV‐antibody positive if they ever tested positive for HCV antibody (HCVAb). Repeated measures Poisson regression model was used to analyse factors associated with post‐diagnosis HCV RNA testing rates from positive HCVAb test. Factors associated with time to first positive HCV RNA from positive HCVAb test were analysed using Cox regression model. There were 767 HCVAb positive participants included (87% from LMICs) of whom 11% had HCV RNA tests. With 163 HCV RNA tests post positive HCVAb test, the overall testing rate was 5.05 per 100 person‐years. Factors associated with increased testing rates included later calendar years of follow‐up, HIV viral load ≥1000 copies/mL and higher income countries. Later calendar years of follow‐up, ALT >5 times its upper limit of normal, and higher income countries were associated with shorter time to first positive HCV RNA test. Testing patterns indicated that uptake was predominantly in high income countries possibly due to different strategies used to determine testing in LMICs. Expanding access to HCV RNA, such as through lower‐cost point of care assays, will be required to achieve elimination of HCV as a public health issue.