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T. vaginalis patients were more likely to have documented histories of chlamydia (p less then 0.0001) and gonorrhea (p=0.0191), with 18% having concurrent triple infections (T. vaginalis, chlamydia, and gonorrhea). All 26 pregnant girls with T. vaginalis delivered full-term, healthy infants. Conclusions We identified a disproportionally high burden of T. vaginalis infection, with an alarmingly high rate of triple infections, among a population of suspected high-risk adolescents. Our results indicate the need to clarify infection prevalence, develop pediatrician-focused education campaigns, and elucidate potentially modifiable risk factors for these high-risk patients.Background Four partner notification approaches were introduced in health facilities in Côte d'Ivoire to increase HIV testing uptake amongst the type of contacts (sex partners and biological children under 15). The study assessed the four approaches client referral (index cases refer the contacts for HIV testing), provider referral (healthcare providers refer the contacts), contract referral (index case-provider hybrid approach), and dual referral (both the index and their partner are tested simultaneously). Methods Program data were collected at four facilities from October 2018 to March 2019 from index case files and HIV-testing register. We compared uptake of the approaches, uptake of HIV testing, and HIV positivity percentages, stratified by contact type and gender. Results There were 1,089 sex partners and 469 children from 1,089 newly diagnosed index cases. About 90% of children were contacted through client referral 85.2% of those were tested and 1.4% was positive. DNA Repair inhibitor 90% of children came from female index cases. The provider referral brought in 56.3% of sex partners, of whom 97.2% were HIV-tested. The client referral brought in 30% of sex partners, of whom only 81.5% were HIV-tested. HIV positivity percentages were 75.5% and 72.7% respectively for the two approaches. Male index cases helped to reach twice as many HIV positive sexual contacts outside the household (115) than female index cases (53). The contract and dual referrals were not preferred by index cases. Conclusion Provider referral is a successful and acceptable strategy for bringing in sex partners for testing. Client referral is preferred for children.Both thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. There also is concern about the effect of overt maternal thyroid disease on fetal development. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. This document reviews the thyroid-related pathophysiologic changes that occur during pregnancy and the effects of overt and subclinical maternal thyroid disease on maternal and fetal outcomes. This Practice Bulletin has been updated with information on the diagnosis and the management of thyroid disease in pregnant women and includes a new clinical algorithm on management of thyroid disease in pregnancy.Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide. It has been estimated that preeclampsia complicates 2-8% of pregnancies globally (). In Latin America and the Caribbean, hypertensive disorders are responsible for almost 26% of maternal deaths, whereas in Africa and Asia they contribute to 9% of deaths. Although maternal mortality is much lower in high-income countries than in developing countries, 16% of maternal deaths can be attributed to hypertensive disorders (). In the United States, the rate of preeclampsia increased by 25% between 1987 and 2004 (). Moreover, in comparison with women giving birth in 1980, those giving birth in 2003 were at 6.7-fold increased risk of severe preeclampsia (). This complication is costly one study reported that in 2012 in the United States, the estimated cost of preeclampsia within the first 12 months of delivery was $2.18 billion ($1.03 billion for women and $1.15 billion for infants), which was disproportionately borne by premature births (). This Practice Bulletin will provide guidelines for the diagnosis and management of gestational hypertension and preeclampsia.Both thyrotoxicosis and hypothyroidism are associated with adverse pregnancy outcomes. There also is concern about the effect of overt maternal thyroid disease on fetal development. In addition, medications that affect the maternal thyroid gland can cross the placenta and affect the fetal thyroid gland. This document reviews the thyroid-related pathophysiologic changes that occur during pregnancy and the effects of overt and subclinical maternal thyroid disease on maternal and fetal outcomes. This Practice Bulletin has been updated with information on the diagnosis and the management of thyroid disease in pregnant women and includes a new clinical algorithm on management of thyroid disease in pregnancy.Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide. It has been estimated that preeclampsia complicates 2-8% of pregnancies globally (). In Latin America and the Caribbean, hypertensive disorders are responsible for almost 26% of maternal deaths, whereas in Africa and Asia they contribute to 9% of deaths. Although maternal mortality is much lower in high-income countries than in developing countries, 16% of maternal deaths can be attributed to hypertensive disorders (). In the United States, the rate of preeclampsia increased by 25% between 1987 and 2004 (). Moreover, in comparison with women giving birth in 1980, those giving birth in 2003 were at 6.7-fold increased risk of severe preeclampsia (). This complication is costly one study reported that in 2012 in the United States, the estimated cost of preeclampsia within the first 12 months of delivery was $2.18 billion ($1.03 billion for women and $1.15 billion for infants), which was disproportionately borne by premature births (). This Practice Bulletin will provide guidelines for the diagnosis and management of gestational hypertension and preeclampsia.Objective To implement a standardized cause of death (CoDe) reporting and review process in order to systematically disaggregate causes of HIV-related deaths in a cohort of Asian children and adolescents. Design Death-related data were retrospectively and prospectively assessed in a longitudinal regional cohort study. Methods Children under routine HIV care at sites in Cambodia, India, Indonesia, Malaysia, Thailand, and Vietnam between 2008-2017 were followed. Causes of death were reported and then independently and centrally reviewed. Predictors were compared using competing risks survival regression analyses. Results Among 5918 children, 5523 (93%; 52% male) had ever been on combination antiretroviral therapy (cART). Of 371 (6.3%) deaths, 312 (84%) occurred in those with a history of cART (crude all-cause mortality 9.6 per 1000 person-years; total follow-up time 32,361 person-years). In this group, median age at death was 7.0 (2.9-13) years; median CD4 count was 73 (16-325) cells/mm3. The most common underlying causes of death were pneumonia due to unspecified pathogens (17%), tuberculosis (16%), sepsis (8.
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