John M. Kaldor

Background: Bacterial vaginosis affects one third of reproductive-aged women, and recurrence is common. Evidence of sexual exchange of bacterial vaginosis-associated organisms between partners suggests that male-partner treatment may increase the likelihood of cure. Methods: This open-label, randomized, controlled trial involved couples in which a woman had bacterial vaginosis and was in a monogamous relationship with a male partner. In the partner-treatment group, the woman received first-line recommended antimicrobial agents and the male partner received oral and topical antimicrobial treatment (metronidazole 400-mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days). In the control group, the woman received first-line treatment and the male partner received no treatment (standard care). The primary outcome was recurrence of bacterial vaginosis within 12 weeks. Results: A total of 81 couples were assigned to the partner-treatment group, and 83 couples were assigned to the control group. The trial was stopped by the data and safety monitoring board after 150 couples had completed the 12-week follow-up period because treatment of the woman only was inferior to treatment of both the woman and her male partner. In the modified intention-to-treat population, recurrence occurred in 24 of 69 women (35%) in the partner-treatment group (recurrence rate, 1.6 per person-year; 95% confidence interval [CI], 1.1 to 2.4) and in 43 of 68 women (63%) in the control group (recurrence rate, 4.2 per person-year; 95% CI, 3.2 to 5.7), which corresponded to an absolute risk difference of -2.6 recurrences per person-year (95% CI, -4.0 to -1.2; P<0.001). Adverse events in treated men included nausea, headache, and metallic taste. Conclusions: The addition of combined oral and topical antimicrobial therapy for male partners to treatment of women for bacterial vaginosis resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks than standard care. (Funded by the National Health and Medical Research Council of Australia; StepUp Australian New Zealand Clinical Trials Registry number, ACTRN12619000196145.).

This document provides a summary of guidance developed for national programmes on conducting serosurveys to assess yaws transmission status, with the objective of confirming yaws seroprevalence below 1% at each of three serosurveys over a period of 3-10 years after reporting the last case of active yaws in a region. It proposes active testing of children aged 1-5 years through population-based surveys and includes recommendations on survey design, sample size determination, sampling of primary sampling units (PSUs) within an evaluation unit, sampling of households within PSUs, integration with existing public health surveys, and follow-up protocols for positive results. Geospatial analysis and sustained surveillance are recommended for accurate assessment of whether transmission interruption has been achieved.

Australia is the only high-income country where trachoma has been endemic, defined as an overall trachoma prevalence in Aboriginal and Torres Strait Islander children aged 5-9 years of 5% or more. The Australian Government funds the National Trachoma Surveillance and Reporting Unit to collate and analyse trachoma prevalence data and control strategies annually. This report presents data submitted from 2014 to 2022. In 2022, there were 87 remote communities considered at-risk of endemic trachoma, a decline of 51% since 2014 when 177 communities were considered at-risk. World Health Organization grading criteria are used to diagnose trachoma in at-risk populations. Overall prevalence, which includes estimates from all communities ever considered at-risk, fell below 5% endemicity thresholds for the first time in 2022 in Western Australia (2.9%), the Northern Territory (2.1%), New South Wales (0.5%), and in Queensland and South Australia (0.0% each). New cases of trachomatous trichiasis-a severe consequence of trachoma that causes blindness-were detected in eight out of 10,806 persons, aged 15 years and over, screened in 2022. Jurisdictional trichiasis prevalence was 0.2% in Western and South Australia and 0.0% in the Northern Territory. Australia must maintain overall trachoma and trichiasis prevalence below endemicity levels for a further two years before applying for World Health Organization validation of elimination of trachoma as a public health problem.

Objective: Globally, there is a lack of evidence regarding access to and utilisation of antigen rapid diagnostic tests (Ag-RDTs). This might hinder public health interventions to increase testing. We conducted a survey to understand access to and utilisation of COVID-19 Ag-RDT among residents in Phnom Penh, Cambodia. Methods: This is a representative household survey using linear regression models with random effects to account for clustering and a logistic model with random effects to assess factors associated with Ag-RDT access. Methods: We conducted the study in 10 villages in Phnom Penh between August and mid-September 2022. Methods: We enrolled one member per household (n=280), aged between 18 and 65 years. Methods: Both access and utilisation were defined at the individual level (self-reports). We defined access as having undergone COVID-19 rapid testing within 6 months and utilisation as having administered this test (to themselves or others) within 12 months, prior to the study interview. Results: In a clustering-adjusted linear model, access to Ag-RDTs among the general population from the 10 villages was 34% (n=95) and utilisation was 28% (n=77). Price and advice from the pharmacist were commonly reported to be the main selection criteria for Ag-RDTs, with 41% (n=111) and 62% (n=175), respectively. In the logistic model, those with higher educational attainment were more likely to have access to the Ag-RDT compared with those with lower education levels (adjusted OR4.42, 95% CI 1.82 to 10.74). Conclusions: Unfamiliarity with Ag-RDT tests and low education levels negatively affect access and utilisation of Ag-RDTs among the general population in Phnom Penh.

Objective: This study aimed to describe the prevalence of lymphatic filariasis (LF), soil-transmitted helminthiasis (STH) and schistosomiasis (SC) in Indonesia before and after PC implementation through a systematic review and meta-analysis. Methods: Embase, MEDLINE, PubMed, Scopus, Web of Science and Google Scholar were searched for articles published between 1 January 1992 and 31 December 2022, reporting LF, STH and SC in Indonesia. Using the Ministry of Health lists of districts receiving PC programs, we identified whether data collection was conducted before or after PC implementation in that particular district. A meta-analysis was performed with a random-effects model applied to pool pre- and post-PC prevalence of LF, STH and SC. Results: Overall, 195 studies were included. The pooled prevalence of LF was 9.72% (95% CI, 5.56%-13.87%). The pre-PC pooled prevalence of LF was 11.48% (95% CI, 5.52%-17.45%). The prevalence decreased after PC implementation, and the pooled prevalence was 7.12% (95% CI, 1.79%-12.44%). The overall prevalence of STH was 35.16% (95% CI, 30.36%-39.96%). The pre-PC prevalence of STH was 36.29% (95% CI, 30.37%-42.20%). The post-PC prevalence of STH decreased at 31.93% (95% CI, 24.25%-39.62%), although the difference between before and after PC was not significant (p = 0.379). Only nine studies investigated the prevalence of SC; based on the random-effects model, the pooled prevalence was 21.90% (95% CI, 4.88%-38.92%). Owing to the scarcity of studies, we could not perform the funnel tests for publication bias and moderating variables of the pooled prevalence for SC. Conclusions: The prevalence of LF and STH decreased after PC implementation, although it was not significant. The difference for SC could not be assessed because of limited post-PC data. The uneven distribution of research and the lack of standardised sampling methods may not fully capture the situation.