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Background: COVID-19 vaccination and shielding targeted hypertensive patients in low and middle income countries. We describe the COVID-19 experiences of hypertensive patients in Colombia and Jamaica and discuss factors associated with vaccine acceptance. Methods: A cross-sectional study was conducted between December 2021 and February 2022 in 4 randomly selected primary care clinics in Colombia and 10 primary care clinics in Jamaica. Participants in Colombia were randomly selected from an electronic medical record. In Jamaica consecutive participants were selected on clinic days for non-communicable diseases. Interviewer-administered questionnaires were conducted by telephone. Results: 576 participants were recruited (50% Jamaica; 68.5% female). Jamaica's participants were younger (36% vs 23% <60 years) and had a lower proportion of persons with "more than high school" education (17.2% vs 30.3%, p=0.011). Colombia's participants more commonly tested positive for COVID-19 (24.2% vs 6.3%, p<0.001), had a family member or close friend test positive for COVID-19 (54.5% vs, 21.6%; p<0.001), experienced loss of a family member or friend due to COVID-19 (21.5% vs 7.8%, p<0.001) and had vaccination against COVID-19 (90.6% vs 46.7%, p<0.001). Fear of COVID-19 (AOR 2.71, 95% CI 1.20-6.13) and residence in Colombia (AOR 5.88 (95% CI 2.38-14.56) were associated with COVID-19 vaccination. Disruption in health services affecting prescription of medication or access to doctors was low (<10%) for both countries. Conclusion: Health services disruption was low but COVID-19 experiences such as fear of COVID-19 and vaccine acceptance differed significantly between Colombia and Jamaica. Addressing reasons for these differences are important for future pandemic responses.

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The clinical spectrum of Coronavirus 2019 (COVID-19) includes acute COVID-19, long covid and multisystem inflammatory syndrome in children and adults (MISC/A). The rapid roll-out of COVID-19 vaccination has the potential to affect the clinical presentation of COVID-19 and case reports document rare occurrences of MIS-A after COVID-19 infection and recent vaccination with m-RNA vaccines. We describe 2 cases of MIS-A after COVID-19 infection and recent vaccination with ChAdOx1 nCoV-19.

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OBJECTIVES: To assess the status of the HIV epidemic and programmatic implementation in Jamaica while identifying strategies for achieving effective HIV control. METHODS: The assessment included a review of the core indicators of the UNAIDS Global Monitoring Framework, a desk review of program reports, and unstructured interviews of stakeholders. RESULTS: HIV prevalence among adults in Jamaica was 1.5% in 2018 with an estimated 32 617 persons living with HIV (PLHIV) and 27 324 persons (83.8%) diagnosed with HIV; 12 711 (39.0% of all PLHIV or 46.5% aware of their status) were on anti-retroviral therapy (ART) in the public health sector and 61.8% PLHIV on ART were virally suppressed. HIV prevalence among men who have sex with men remains high (31.4% in 2011, 29.6% in 2017) but has declined among female sex workers (12% in 1990, 2% in 2017). HIV prevalence among public sexually transmitted infection clinic attendees, prison inmates and the homeless has increased in recent years. During 2018 approximately 200 000 persons (14% of the population 15-49 years) were tested with 1 165 newly diagnosed PLHIV, indicating that many of the estimated 1 600 newly infected persons in 2018 were unaware of their status. CONCLUSIONS: Critical policy initiatives are needed to reduce barriers to HIV services, ensure young persons have access to condoms and contraceptives, affirm the rights of the marginalized, reduce stigma and discrimination, and introduce pre-exposure prophylaxis. While HIV spread in Jamaica has slowed, the UNAIDS Fast Track goals are lagging. The HIV program must be strengthened to effectively control the epidemic.

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[ABSTRACT]. Objectives. To assess the status of the HIV epidemic and programmatic implementation in Jamaica while identifying strategies for achieving effective HIV control. Methods. The assessment included a review of the core indicators of the UNAIDS Global Monitoring Framework, a desk review of program reports, and unstructured interviews of stakeholders. Results. HIV prevalence among adults in Jamaica was 1.5% in 2018 with an estimated 32 617 persons living with HIV (PLHIV) and 27 324 persons (83.8%) diagnosed with HIV; 12 711 (39.0% of all PLHIV or 46.5% aware of their status) were on anti-retroviral therapy (ART) in the public health sector and 61.8% PLHIV on ART were virally suppressed. HIV prevalence among men who have sex with men remains high (31.4% in 2011, 29.6% in 2017) but has declined among female sex workers (12% in 1990, 2% in 2017). HIV prevalence among public sexually transmitted infection clinic attendees, prison inmates and the homeless has increased in recent years. During 2018 approximately 200 000 persons (14% of the population 15-49 years) were tested with 1 165 newly diagnosed PLHIV, indicating that many of the estimated 1 600 newly infected persons in 2018 were unaware of their status. Conclusions. Critical policy initiatives are needed to reduce barriers to HIV services, ensure young persons have access to condoms and contraceptives, affirm the rights of the marginalized, reduce stigma and discrimination, and introduce pre-exposure prophylaxis. While HIV spread in Jamaica has slowed, the UNAIDS Fast Track goals are lagging. The HIV program must be strengthened to effectively control the epidemic.

[RESUMEN]. Objetivos. Evaluar el estado de la epidemia de la infección por el VIH en Jamaica y de la ejecución programática, y determinar las estrategias para lograr un control eficaz de la infección por el VIH. Métodos. La evaluación incluyó una revisión de los indicadores básicos del Marco de Vigilancia Mundial del ONUSIDA, un estudio teórico de informes programáticos y entrevistas no estructuradas a los interesados directos. Resultados. La prevalencia de la infección por el VIH en adultos en Jamaica fue del 1,5% en el 2018, con unas 32 617 personas infectadas y unas 27 324 personas (83,8%) con diagnóstico de infección por el VIH; 12 711 personas (39,0% del total de personas con infección por el VIH, o el 46,5% de las que conocían su estado) estaban bajo tratamiento antirretroviral en el sector de salud pública, y el 61,8% de las personas con infección por el VIH que recibieron tratamiento antirretroviral alcanzó la supresión viral. La prevalencia de la infección por el VIH en hombres que tienen relaciones sexuales con hombres sigue siendo alta (31,4% en el 2011, 29,6% en el 2017), aunque ha descendido en las trabajadoras sexuales (12% en 1990, 2% en el 2017). En los últimos años, la prevalencia de la infección por el VIH en personas que acuden a centros públicos de atención de infecciones de transmisión sexual, presidiarios y personas sin hogar ha aumentado. En el 2018, aproximadamente 200 000 personas (14% de la población entre 15 y 49 años) se sometieron a la prueba de VIH, de las cuales 1 165 fueron diagnosticadas como personas recién infectadas por el HIV, lo cual indica que muchas de las 1 600 personas recién infectadas en el 2018 desconocían su estado. Conclusões. Se necesitan iniciativas políticas fundamentales para reducir los obstáculos que impiden el acceso a los servicios de atención de la infección por el VIH, asegurar que las personas jóvenes tengan acceso a preservativos y anticonceptivos, afirmar los derechos de las personas marginadas, reducir la estigmatización y la discriminación, e introducir la profilaxis previa a la exposición. Si bien la propagación de la infección por el VIH se ha desacelerado en Jamaica, el logro de los Objetivos de Respuesta Rápida del ONUSIDA está demorado. Debe fortalecerse el Programa contra el VIH para controlar eficazmente la epidemia.

[RESUMO]. Objetivos. Avaliar a situação da epidemia de HIV e a implementação do Programa Nacional de HIV na Jamaica, identificando estratégias eficazes para controlar o HIV. Métodos. A avaliação incluiu uma revisão dos indicadores-chave da Estrutura de Monitoramento Global do UNAIDS, uma revisão documental dos relatórios do programa e entrevistas não estruturadas com participantes. Resultados. A prevalência de infecção pelo HIV em adultos na Jamaica foi de 1,5% em 2018. Estima-se que haja 32.617 pessoas vivendo com o HIV (PVHIV), das quais 27.324 (83,8%) foram diagnosticadas; 12.711 (39,0% de todas as PVHIV, e 46,5% das que conhecem seu diagnóstico) estavam em terapia antirretroviral (TAR) no setor da saúde pública, e 61,8% das PVHIV em ART alcançaram a supressão viral. A prevalência de HIV entre homens que fazem sexo com homens continua alta (31,4% em 2011, 29,6% em 2017), mas diminuiu entre mulheres profissionais do sexo (12% em 1990, 2% em 2017). A prevalência de HIV entre os pacientes que frequentam clínicas públicas de atenção a infecções sexualmente transmissíveis, presidiários e desabrigados tem aumentado nos últimos anos. No ano de 2018, aproximadamente 200.000 pessoas (14% da população de 15 a 49 anos) foram testadas, sendo feitos 1.165 novos diagnósticos de infecção pelo HIV, o que indica que muitas das 1.600 pessoas recém-infectadas estimadas em 2018 não estavam cientes de sua infecção. Conclusões. São necessárias iniciativas políticas essenciais para reduzir as barreiras no acesso aos serviços de HIV, assegurar que os jovens tenham acesso a preservativos e métodos contraceptivos, afirmar os direitos dos marginalizados, reduzir o estigma e a discriminação e introduzir a profilaxia pré-exposição. Embora a propagação do HIV na Jamaica tenha perdido velocidade, o progresso para alcançar as metas da estratégia Fast Track do UNAIDS tem sido lento. Para controlar a epidemia de forma eficaz, é preciso fortalecer o Programa Nacional de HIV.

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This study evaluates a simple clinical audit tool for assessing quality of care and blood pressure control among persons with hypertension in primary care clinics. A systematic random sampling of persons with diabetes mellitus (DM) and hypertension (HTN) attending five health centers in Kingston, Jamaica, was conducted. A modified Ministry of Health paper-based audit tool captured quality of care and outcome indicators (blood pressure and glycemic control). Additional chart audits were conducted by a physician and nurse to assess reliability. One hundred and forty-nine charts were audited between January and September 2017. One hundred and thirty-eight persons (92.6%) had hypertension (27 men and 111 women); 77 persons (51.7%) had DM (14 men and 63 women). The median age was 64 years old. Approximately two-thirds of persons with HTN and DM had electrolytes, lipid profile, and ECG done within the last year. One-fifth of persons with hypertension (18.5% men and 19.8% women, P = 1.000) had adequate blood pressure control with greater control among persons with HTN only compared to persons with both DM and HTN. Poor glycemic control was recorded for 69% of persons with DM (57% men and 71% women, P = .297). Moderate to substantial inter-rater agreement was observed for quality of care indicators. Our findings confirmed that hypertension and glycemic control are inadequate among persons attending primary care clinics in Jamaica's capital city. Simplified clinical audits can provide important quality of care and outcome indicators without losing the meaningfulness of the data collected.

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To estimate the association between a simple measure of sexual partner concurrency and sexually transmitted infection (STI) we conducted a cross-sectional population-based household survey (n = 1795) and targeted surveys of people at venues where people meet sexual partners (n = 1580) to ask about sexual behaviour. Persons interviewed at venues were tested for HIV, gonorrhoea, chlamydia, and trichomoniasis. We compared the association between STI and reporting a partner had other partners. More women than men reported their main partner had other partners. Thirteen percent of all women in the population-based survey and 14.4% in the targeted survey reported having one partner in the past 12 months and that partner had additional partners. STI prevalence was significantly associated with reporting a partner had other partners (36.8% vs. 30.2%; prevalence ratio [PR] 1.2; 95% confidence interval [CI] 1.1, 1.4). Construction of complete sexual networks is costly and not routinely feasible. We recommend adding a question to cross-sectional surveys used to monitor sexual behaviour about whether the respondent believes his or her partner has other sexual partners. Although subject to bias, the question was useful in Jamaica to identify a group of women with only one sexual partner at increased risk of infection.

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