This week PLOS Medicine publishes the following new articles:
Using observational data collected in cohort studies in Southern Africa, Michael Schomaker and colleagues estimate the mortality associated with starting Antiretroviral Therapy (ART) at different CD4 thresholds among children aged 2–5 years. Recent changes to World Health Organization guidelines for starting anti-AIDS drugs in young children are unlikely to improve death rates but may increase the numbers of children receiving ART by simplifying access to treatment. The findings suggest that, among southern African children aged 2–5 years at HIV diagnosis, there was no difference in three year death rates between children in whom ART was started immediately and those in whom starting ART was deferred until their CD4 count and percentage (markers of progression of HIV infection) fell below 750 cells/mm3 and 25% respectively.
Cécile Viboud and colleagues describe epidemiological patterns of influenza incidence across China to support the design of a national vaccination program. Since an immune response produced during one year provides only partial protection against influenza the next year, many countries run seasonal influenza vaccination programs. Before a national program can be established in such a large, climatologically diverse country as China, public-health experts need a clear picture of influenza seasonality across the country. These findings suggest that it will be necessary to stagger the timing of vaccination over three broad geographical regions to optimize routine influenza vaccination in China. More generally, given that there is growing interest in rolling out national influenza immunization programs in low- and middle-income countries, these findings highlight the importance of ensuring that vaccination strategies are optimized by taking into account local disease patterns. In a related Perspective, Steven Riley describes how understanding complex influenza dynamics can aid the design of influenza programs in China.
Using a modified Delphi exercise, Aziz Sheikh and colleagues identify research priorities for patient safety research in primary care contexts. The authors found that family practice and pharmacy were considered the main contexts on which to focus attention in order to advance patient safety in primary care across all income categories. Other clinical contexts that were prioritized included community midwifery and nursing in low-income countries and care homes in high-income countries. Sources of patient safety incidents that were identified as priorities for future research were communication between health care professionals and with patients, teamwork within the health care team, laboratory and diagnostic imaging investigations, issues relating to data management, transitions between different care settings, and chart/patient record completeness.
Xonghong Xiao and colleagues present findings from a recent government strategy to promote rational use of antimicrobials in health care and offer insights to shape future initiatives. In China, antimicrobial resistance is caused by the irrational use of antimicrobial drugs, in healthcare, veterinary settings, and also by the general public. A government strategy to promote rational use of antimicrobials in health care reduced antibiotic sales and percentage of prescriptions for antimicrobials for both hospitalized patients and outpatients and offers insights to shape future initiatives. However, according to the authors, a number of challenges, such as the unregulated use of antibiotics in animal husbandry and over-the-counter purchases of antibiotics, still need to be addressed to ensure further improvements. Eliminating economic incentives for drug sales is also of utmost importance.